From the Guidelines
Rh-negative pregnant women who are carrying or have delivered an Rh-positive baby, as well as those who have experienced miscarriage, abortion, ectopic pregnancy, or any procedure that might cause fetal-maternal hemorrhage, should receive Rhogam (Rh immune globulin) to prevent the development of antibodies against the Rh factor in the baby's blood. This is based on the most recent evidence from the American Journal of Obstetrics and Gynecology, which recommends the administration of RhIg after spontaneous or induced abortion at less than 12 weeks of gestation 1. The recommended dose is 50 mg within 72 hours of the spontaneous or induced abortion, although a 300 mg dose may be used if the lower dose is unavailable 1. Key considerations for RhIg administration include:
- The risk of alloimmunization and its adverse perinatal outcomes 1
- The limited data on the risks of feto-maternal hemorrhage and sensitization in early pregnancy 1
- The potential benefits and drawbacks of RhIg administration, including the low risk of administration to maternal health and the potential financial and logistical burdens on patients and independent clinical sites 1 It is essential to prioritize the administration of RhIg to postpartum patients and antenatal patients at later gestational ages when the supply of RhIg is limited 1. Overall, the administration of Rhogam to Rh-negative pregnant women who are at risk of developing antibodies against the Rh factor in the baby's blood is a crucial step in preventing hemolytic disease in subsequent pregnancies.
From the FDA Drug Label
If there is any doubt about the mother’s Rh type, she should be given Rho(D) Immune Globulin (Human).
- Rhogram (Rho(D) Immune Globulin) will be administered to:
- Mothers with uncertain Rh type
- Mothers who have experienced a large fetomaternal hemorrhage late in pregnancy or following delivery 2
From the Research
Eligibility for Rh Immune Globulin
The following individuals will receive Rh immune globulin:
- Pregnant women who are Rh-negative (D antigen-negative) 3
- Individuals who are undergoing abortion or experiencing pregnancy loss at less than 12 weeks of gestation, and are Rh-negative 4
Special Considerations
- Women with variant D antigens, which may be reported as Rh-positive or Rh-negative depending on the laboratory method, may still be eligible for Rh immune globulin 3
- Revisions in laboratory procedures for Rh typing may affect a woman's eligibility for Rh immune globulin 3
Administration Guidelines
- The administration of Rh D immune globulin is guided by clinical practice updates, such as those provided by the American College of Obstetricians and Gynecologists (ACOG) 4