Single dose v two-dose antenatal anti-D prophylaxis: a randomised controlled trial

被引:10
作者
White, Scott W. [1 ,2 ]
Cheng, Janice C. [3 ]
Penova-Veselinovic, Blagica [1 ]
Wang, Carol [4 ]
White, Melanie [4 ]
Ingleby, Bernie [2 ]
Arnold, Christine [2 ]
Pennell, Craig E. [4 ,5 ]
机构
[1] Univ Western Australia, Perth, WA, Australia
[2] King Edward Mem Hosp Women, Perth, WA, Australia
[3] Royal Perth Hosp, Perth, WA, Australia
[4] Univ Newcastle, Newcastle, NSW, Australia
[5] Hunter Med Res Inst, Newcastle, NSW, Australia
关键词
Preventive medicine; Transfusion medicine; Prenatal care; Perinatology; Neonatology; Fetal medicine; D IMMUNOGLOBULIN; RH ISOIMMUNIZATION; IMMUNIZATION; PREVENTION; PREGNANCY;
D O I
10.5694/mja2.50266
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To compare rates of detectability of circulating Rh(D)-immunoglobulin (anti-D) at delivery with single and two-dose antenatal anti-D prophylaxis (RAADP) regimens; to compare compliance with the two regimens. Design Open label, randomised controlled trial between May 2013 and November 2015. Setting, participants 277 women who attended a tertiary obstetric referral hospital in Perth for antenatal care and were at least 18 years of age, less than 30 weeks pregnant and yet to receive RAADP, Rh(D)-negative (negative antibody screen), and who intended to deliver their baby at the hospital. Exclusion criteria were prior anti-D sensitisation, any contraindication of anti-D administration, and a history of isolated IgA deficiency. Interventions One 1500 IU anti-D dose at 28 weeks of pregnancy (single dose regimen); two doses of 625 IU each at 28 and 34 weeks of pregnancy (two-dose regimen). Main outcome measures The primary outcome was the proportion of women with detectable anti-D levels at delivery; the secondary outcome was compliance with the allocated RAADP regimen. Results Circulating anti-D was detectable at delivery in a greater proportion of women in the two-dose group (111 of 129, 86%) than in the single dose group (70 of 125, 56%; P < 0.001). Compliance was not significantly different between the single dose (86 of 138, 61%) and two-dose groups (70 of 139, 50%; P = 0.06). Conclusions The two-dose RAADP schedule currently recommended in Australia provides better protection against Rh(D) sensitisation than a one-dose regimen. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12613000661774).
引用
收藏
页码:261 / 265
页数:5
相关论文
共 20 条
[1]  
Bowman J M, 1987, Transfus Med Rev, V1, P101, DOI 10.1016/S0887-7963(87)70010-8
[2]  
BOWMAN JM, 1978, CAN MED ASSOC J, V118, P627
[3]  
BOWMAN JM, 1978, CAN MED ASSOC J, V118, P623
[4]  
Crowther C, 2000, Cochrane Database Syst Rev, DOI DOI 10.1002/14651858.CD000021
[5]   Routine antenatal anti-D prophylaxis - is the protection adequate? [J].
Davies, J. ;
Chant, R. ;
Simpson, S. ;
Powell, R. .
TRANSFUSION MEDICINE, 2011, 21 (06) :421-426
[6]   Targeted antenatal anti-D prophylaxis program for RhD-negative pregnant women - outcome of the first two years of a national program in Finland [J].
Haimila, Katri ;
Sulin, Kati ;
Kuosmanen, Malla ;
Sareneva, Inna ;
Korhonen, Anu ;
Natunen, Suvi ;
Tuimala, Jarno ;
Sainio, Susanna .
ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, 2017, 96 (10) :1228-1233
[7]   Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis [J].
Koelewijn, J. M. ;
de Haas, M. ;
Vrijkotte, T. G. M. ;
van der Schoot, C. E. ;
Bonsel, G. J. .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2009, 116 (10) :1307-1314
[8]   MULTICENTER TRIAL OF ANTEPARTUM LOW-DOSE ANTI-D IMMUNOGLOBULIN [J].
LEE, D ;
RAWLINSON, VI .
TRANSFUSION MEDICINE, 1995, 5 (01) :15-19
[9]   Evidence to support the single-dose over the two-dose protocol for routine antenatal anti-D Rhesus prophylaxis: a prospective observational study [J].
MacKenzie, I. Z. ;
Dutton, Susan ;
Roseman, Fenella .
EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2011, 158 (01) :42-46
[10]   Efficacy and safety of a new, chromatographically purified rhesus (D) immunoglobulin [J].
MacKenzie, IZ ;
Bichler, J ;
Mason, GC ;
Lunan, CB ;
Stewart, P ;
Al-Azzawi, F ;
De Bono, M ;
Watson, N ;
Andresen, I .
EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 2004, 117 (02) :154-161