Anti-D prophylaxis in 1997: The Edinburgh Consensus Statement
- Department of Obstetrics
- School of Human Development
- Queen’s Medical Centre
- Nottingham NG7 2UH
Over 200 delegates from hospitals and blood transfusion units around the world attended a consensus conference on anti-D prophylaxis in Edinburgh on 7 and 8 April 1997. The conference was convened jointly by the Royal College of Physicians of Edinburgh and the Royal College of Obstetricians and Gynaecologists. The aims were to reach a consensus on: the current management of rhesus D (RhD) negative women in pregnancy and the future management of such women
The consensus process was fairly rigorous. It was mediated through a panel of independent healthcare and lay professionals. The available evidence in the form of written, oral, and poster presentations were reviewed and opposing views were presented by an advocate and an adversary, each with a seconder. A draft consensus statement, prepared by the panel, was debated by the delegates and the resulting second draft statement with amendments was adopted by the conference. The final consensus statement is now in the public domain.1
Current status of rhesus disease and anti-D prophylaxis in the UK
Perinatal deaths in the UK due to RhD alloimmunisation have fallen a 100-fold since the introduction in 1969 of a policy to administer anti-D immunoglobulin (Ig) to RhD negative women after sensitising events in pregnancy and the birth of RhD positive infants.2 There is no dispute that this represents a dramatic success in preventive medicine. However, rhesus disease has not been eradicated. In the 1990s pregnancy, loss, and death in the first week after delivery due to RhD alloimmunisation is about 50 a year in the UK (position papers presented at the conference).
Opinion was divided at the conference over the acceptability of this level of loss. On the one hand should further efforts be directed to reduce a mortality that is already less than 10 in 100000 pregnancies? Yet the contrary view was also presented—namely, that no loss is acceptable …
