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Rh alloimmunisation prevention — MCCQE Part 1 MCQ

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EasyPregnancyRh alloimmunisation preventionMCCQE Part 1

28-year-old rh-negative woman at 28 weeks' gestation presents with routine antenatal care. Antibody screen is negative and partner blood type is unknown. Which of the following is the most appropriate next step?

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Correct answer: B — Give Rh immune globulin according to Canadian antenatal prophylaxis schedule

Give Rh immune globulin according to Canadian antenatal prophylaxis schedule is best because unsensitised Rh-negative pregnant patients require prophylaxis. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Additional doses may be required after sensitising events.

Reference: SOGC Rh alloimmunisation guidance