SMFM Statement: RhD immune globulin after spontaneous or induced abortion less than 12 weeks of gestation

Abstract: Guidelines for management of first-trimester spontaneous and induced  abortion vary regarding RhD testing and Rho(D) immune globulin administration. These existing guidelines are based on limited data that do not convincingly demonstrate the safety of withholding Rho(D) immune globulin for first-trimester abortions or pregnancy losses. Given the adverse fetal and neonatal outcomes associated with RhD alloimmunization, prevention of maternal sensitization is essential in RhD negative patients who may experience subsequent pregnancies. In care settings where RhD testing and Rho(D) immune globulin administration are logistically and financially feasible and do not hinder access to abortion care, we recommend offering both RhD testing and RhIg administration for spontaneous and induced abortion at <12 weeks of gestation in unsensitized, RhD-negative individuals. Guidelines for RhD testing and Rho(D) immune globulin in the first trimester must balance the prevention of alloimmunization with the individual- and population-level harms of restricted access to abortion.