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Rhesus isoimmunisation — DRCOG MCQ

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HardAntenatal CareRhesus isoimmunisationDRCOG

A 30-year-old rhesus D-negative woman is 19 weeks pregnant and has a small vaginal bleed after a minor fall. She is haemodynamically stable and the bleeding has stopped. The local early pregnancy unit confirms a viable intrauterine pregnancy. What is the most appropriate management?

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Correct answer: B — Arrange anti-D immunoglobulin after the sensitising event

The best answer is “Arrange anti-D immunoglobulin after the sensitising event”. Antenatal bleeding after 12 weeks is a potentially sensitising event in a rhesus D-negative woman, so anti-D should be arranged according to local maternity protocols. Waiting until the routine 28-week dose would not cover this event. Fetal rhesus status may guide some pathways, but in primary care the safe action is urgent maternity advice. Oral iron does not address isoimmunisation risk. Antenatal decisions combine gestation, maternal stability, fetal risk and whether care can safely remain in the community. Screening, diagnostic testing and urgent assessment are not interchangeable. The UK pathway should be followed with clear safety-netting whenever symptoms may evolve before the next routine appointment.

Reference: NICE NG126: Anti-D immunoglobulin prophylaxis: https://www.nice.org.uk/guidance/ng126/chapter/anti-d-immunoglobulin-prophylaxis