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Background High-throughput non-invasive prenatal testing (NIPT) for fetal Rhesus D (RhD) status could avoid unnecessary treatment with anti-D immunoglobulin for RhD-negative women found to be carrying an RhD-negative fetus. We aimed to assess the diagnostic accuracy of high-throughput NIPT for fetal RhD status in RhD-negative women not known to be sensitized to the RhD antigen, by performing a systematic review and meta-analysis. Methods Prospective cohort studies of high-throughput NIPT used to determine fetal RhD status were included. The eligible population were pregnant women who were RhD negative and not known to be sensitized to RhD antigen. The index test was high-throughput, NIPT cell-free fetal DNA tests of maternal plasma used to determine fetal RhD status. The reference standard considered was serologic cord blood testing at birth. Databases including MEDLINE, EMBASE, and Science Citation Index were searched up to February 2016. Two reviewers independently screened titles and abstracts and assessed full texts identified as potentially relevant. Risk of bias was assessed using QUADAS-2. The bivariate and hierarchical summary receiver-operating characteristic (HSROC) models were fitted to calculate summary estimates of sensitivity, specificity, false positive and false negative rates, and the associated 95% confidence intervals (CIs). Results A total of 3921 references records were identified through electronic searches. Eight studies were included in the systematic review. Six studies were judged to be at low risk of bias. The HSROC models demonstrated high diagnostic performance of high-throughput NIPT testing for women tested at or after 11 weeks gestation. In the primary analysis for diagnostic accuracy, women with an inconclusive test result were treated as having tested positive. The false negative rate (incorrectly classed as RhD negative) was 0.34% (95% CI 0.15 to 0.76) and the false positive rate (incorrectly classed as RhD positive) was 3.86% (95% CI 2.54 to 5.82). There was limited evidence for non-white women and multiple pregnancies. Conclusions High-throughput NIPT is sufficiently accurate to detect fetal RhD status in RhD-negative women and would considerably reduce unnecessary treatment with routine anti-D immunoglobulin. The applicability of these findings to non-white women and women with multiple pregnancies is uncertain. Electronic supplementary material The online version of this article (10.1186/s12916-019-1254-4) contains supplementary material, which is available to authorized users.

The introduction of anti‐Rh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. The International Federation of Gynecology and Obstetrics, International Confederation of Midwives, and Worldwide Initiative for Rhesus Disease Eradication have reviewed current evidence regarding the utility of anti‐Rh(D) immunoglobulin. Taking into account the effectiveness anti‐Rh(D), the new guidelines propose adjusting the dose for different indications and prioritizing its administration by indication., These FIGO/ICM guidelines review the evidence regarding the usefulness of anti‐Rh(D) immunoglobulin, prioritizing its administration by indication.

Background The determination of foetal Rhesus D (RHD) status allows appropriate use of IgRh prophylaxis by restricting its use to cases of RHD feto-maternal incompatibilities. There is a degree of uncertainty about the cost-effectiveness of foetal RHD determination, yet screening programs are being introduced into clinical practice in many countries. This paper evaluates the impact of non-invasive foetal Rhesus D (RHD) status determination on the costs of managing RHD-negative pregnant women and on the appropriate use of anti-D prophylaxis in a large sample of RHD-negative pregnant women using individual prospectively collected clinical and economic data. Methods A prospective two-armed trial of RHD negative pregnant women was performed in 11 French Obstetric Departments. Non-invasive foetal RHD genotyping was performed before 26 weeks' gestation in the experimental arm whereas the control arm participants received usual care. The costs associated with patient management in relation to their RHD negative status (biological tests, anti-D prophylaxis and visits) were calculated from inclusion to the end of the postpartum period. The costs of hospital admissions during pregnancy and delivery were also determined. Results A total of 949 patients were included by 11 centres between 2009 and 2012, and 850 completed follow-up, including medical and biological monitoring. Patients were separated into two groups: the genotyping group (n=515) and the control group (n=335). The cost of the genotyping was estimated at 140 euros per test. The total mean cost per patient was estimated at €3,259 (SD ± 1,120) and €3,004 (SD ± 1,004) in the genotyping and control groups respectively. The cost of delivery represented three quarters of the total cost in both groups. The performance of managing appropriately RHD negative anti-D prophylaxis was 88% in the genotyping group, versus 65% in the control group. Using the costs related to RHD status (biological tests, anti-D immunoglobulin injections and visits) the incremental cost-effectiveness ratio (ICER) was calculated to be €578 for each percentage gain in women receiving appropriate management. Conclusion Early knowledge of the RHD status of the foetus using non-invasive foetal RHD genotyping significantly improved the management of RHD negative pregnancies with a small increase in cost. Trial registration Clinical trials registry-NCT00832962–13 January 2009 - retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12884-018-2114-5) contains supplementary material, which is available to authorized users.

Background and aim Rh isoimmunization still contributes to the neonatal morbidity and mortality due to non-immunization, under-immunization, and in rare cases, false Rh typing. The main objective of this study was to determine the prevalence of Rh incompatibility, mothers' knowledge about Rh incompatibility, mothers' knowledge about anti-D immunoglobulin and to show the pregnancy outcome of Rh negative mothers. Methods A cross-sectional study was carried out at the Maternity and Children Hospital in Arar city from November 2016 to May 2017. All pregnant mothers attending the Maternity and Children Hospital for pregnancy follow up or delivery, during the study period were studied. Data were collected by means of personal interview with the sampled population using a researcher-made questionnaire covering the needed data. Data were analyzed by SPSS version 16, using descriptive statistics and Chi-Square test. Results Of the studied mothers, 23% were Rh negative. Only 38% of the studied mothers had knowledge about Rh incompatibility, 68.5% had knowledge about anti-D and 51% had knowledge about time of administration of anti D. Considering pregnancy outcome; 55% of the delivered babies needed incubation after delivery, 23.3% of those babies were born to Rh negative mothers. However, 6.7% of the incubated children died after incubation (47.8% of them belong to Rh negative mothers). Conclusion About a quarter of the mothers in the studied population were Rh negative. Mothers had a low level of knowledge about Rh incompatibility and anti-D immunoglobulin and its administration. Health education sittings are needed to increase public awareness about this important issue.

Rhesus-conflict is a pathological condition that manifests itself in the formation of antibodies against fetal erythrocytes in the body of pregnant woman due to the incompatibility of maternal and fetal Rh-factors. The main causes of morbidityand mortality in rhesus conflict are intrauterine hemolytic anemia, fetal hydrops, hemolytic neonatal disease. In addition, an important factor contributing to the increase in perinatal losses in this pathology is the high birth rate of extremely immature children. The reason for this is a preterm labor induction in case of a threat to the life of the fetus, as well as premature births associated with a variety of fetal manipulations. The number of cases of this pathology has declined dramatically throughout the world over the last decades, due to the widespread coverage of women at risk of immunization (anti-D - immunoglobulin). Unfortunately, in Ukraine this situation is not uncommon to this day.The article covers the main modern views on the causes, pathogenesis, course and prevention of immunological conflict associated with incompatibility of the Rh factor in terms of evidence-based medicine. The article describes the experience gained during recent years and attempts to unify the prognostic and preventive approaches in this area.Conclusions:1. Rhesus-conflict remains a serious problem of domestic medicine with a significant contribution to perinatal loss.2. Proper and timely anti-Rh immune prophylaxis among all non-immunized women can significantly reduce the incidence of severe disease in fetuses and newborns.3. There are no remedies for Rhesus conflict. Treatment is subjected to severe hemolytic disease only that occurs before the fetal maturity. Intrauterine hemotransfusion allows prolonging such pregnancy and preventing antenatal fetal death., Резус-конфликт – это патологическое состояние, которое проявляется образованием в организме беременной антител против эритроцитов плода в связи с несовместимостью материнского и плодового резус-факторов. Основными причинами заболеваемости и смертности при резус-конфликте является внутриутробная гемолитическая анемия, водянка плода, гемолитическая болезнь новорожденных. Кроме того, важным фактором, способствующим росту перинатальных потерь при данной патологии, является высокий уровень рождения крайне незрелых детей. Причина этого – родоразрешение на ранних сроках в случае угрозы для жизни плода, а также преждевременные роды, связанные с различными фетальными манипуляциями. Количество случаев данной патологии резко уменьшилось во всем мире в течение последних десятилетий благодаря широкому охвату женщин группы риска иммунопрофилактикой (антирезусный иммуноглобулин). К сожалению, в Украине это состояние не является редкостью и по сей день.В статье освещены основные современные взгляды на причины возникновения, патогенез, течение и профилактику иммунологического конфликта, связанного с несовместимостью по резус-фактору, с точки зрения доказательной медицины. В материале изложен опыт, приобретенный в течение последних лет и предпринята попытка унификации прогностических и профилактических подходов по данной проблематике.Выводы:1. Резус-конфликт остается серьезной проблемой отечественной медицины со значительным вкладом в перинатальные потери.2. Правильное и своевременное проведение анти-резус иммунопрофилактики всех неиммунизированных женщин способно существенно уменьшить частоту случаев тяжелых проявлений гемолитической болезни плодов и новорожденных.3. Не существует способов лечения резус-конфликта. Лечению подлежит только тяжелая гемолитическая болезнь, возникающая до момента зрелости плода. Внутриутробные гемотрансфузии позволяют пролонгировать такую беременность и профилактировать антенатальную гибель плода., Резус-конфлікт є патологічним станом, що проявляється утворенням в організмі вагітної антитіл проти еритроцитів плода в зв’язку з несумісністю материнського та плодового резус-факторів. Основними причинами захворюваності та смертності при резус-конфлікті є внутрішньоутробна гемолітична анемія, водянка плода, гемолітична хвороба новонароджених. Окрім того, важливим фактором, який сприяє зростанню перинатальних втрат за даної патології, є високий рівень народження вкрай незрілих дітей. Причина цього – розродження на ранніх термінах у випадку загрози для життя плода, а також передчасні пологи, пов’язані з різноманітними фетальними маніпуляціями. Кількість випадків даної патології різко зменшилася в усьому світі протягом останніх десятиліть завдяки широкому охопленню жінок групи ризику імунопрофілактикою (антирезусний імуноглобулін). На жаль, в Україні цей стан не є рідкістю й донині.У статті висвітлено основні сучасні погляди на причини виникнення, патогенез, перебіг і профілактику імунологічного конфлікту, пов’язаного з несумісністю за резус-фактором, з точки зору доказової медицини. У матеріалі викладено досвід, набутий протягом останніх років і здійснено спробу уніфікації прогностичних та профілактичних підходів за даною проблематикою.Висновки:1. Резус-конфлікт залишається серйозною проблемою вітчизняної медицини зі значним внеском у перинатальні втрати.2. Правильне та вчасне проведення анти-резус імунопрофілактики серед усіх неімунізованих жінок здатне суттєво зменшити частоту випадків важких проявів гемолітичної хвороби плодів і новонароджених.3. Не існує засобів лікування резус-конфлікту. Лікуванню підлягає лише важка гемолітична хвороба, що виникає до моменту зрілості плода. Внутрішньоутробні гемотрансфузії дозволяють пролонгувати таку вагітність і профілактувати антенатальну загибель плода.

The G antigen of Rh blood group system is present in almost all D-positive or C-positive red cells but absent from red cells lacking D and C antigens. The differentiation of anti-D and anti-C from anti-G is not necessary for routine transfusion; however, during pregnancy, it is important because anti-G can masquerade as anti-D and anti-C with initial antibody testing. The false presence of anti-D will exclude the patient from receiving anti-D immunoglobulin (RhIG) when the patient actually is a candidate for RhIG prophylaxis. Moreover, patients with positive anti-D or anti-G are at risk of developing hemolytic disease of the fetus and newborn and need close monitoring. Thus, proper identification allows the clinicians to manage patients properly. This case report highlights a rare case of anti-G together with anti-D and anti-C in a pregnant woman. This report disseminates knowledge on identification of anti-G and its importance in pregnant women.

Background The purpose of this scoping review was to review the literature on healthcare provider provision of anti-D prophylaxis to RhD negative pregnant women in appropriate clinical situations in various healthcare settings. Methods A scoping review framework was used to structure the process. The following databases were searched: CINAHL (EBSCO), EBM Reviews (OvidSP), Embase (OvidSP), Medline (OvidSP), and Web of Science (ISI). In addition, hand searching of article references was conducted. The search yielded 301 articles. Thirty-five articles remained for review after screening. Two team members reviewed each article using a detailed data collection sheet. A third reviewer was utilized if discrepancies occurred amongst reviewers. Results The review process yielded 18 included articles. The majority of the studies were conducted in the United Kingdom. Of the 18 studies, 15 were retrospective studies. The articles were largely conducted in one institution. The articles with a focus on routine antenatal provision of anti-D immunoglobulin found that it was given 80 to 90% of the time. Postpartum provision of anti-D immunoglobulin had significantly higher results of 95-100%. The review found that the delivery of anti-D immunoglobulin to RhD negative pregnant women during situations of potential sensitizing events was suboptimal. Conclusions The included articles examine the management of RhD negative pregnancies in various countries with existing national guidelines. The existing evidence indicates an opportunity for quality improvement in situations where potential sensitizing events are not at routine times in pregnancy, such as miscarriage or fetal demise early in pregnancy. Routine care for the prevention of RhD alloimmunization in pregnancy and postpartum appears to be fairly consistent. The paucity of recent literature in this area leads to a recommendation for further research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-014-0411-1) contains supplementary material, which is available to authorized users.