skip to main content

Early miscarriage requiring medical management in an RhD-negative patient — DFSRH MCQ

Instant feedback + full explanation. One question, done properly.

EasyMiscarriageEarly miscarriage requiring medical management in an RhD-negative patientDFSRH

A 34-year-old woman is diagnosed with a missed miscarriage after a confirmatory transvaginal ultrasound scan. She is 11+5 weeks by a certain last menstrual period, but fetal crown–rump length corresponds to 12+1 weeks. Her blood group is O RhD negative and her antibody screen is negative. She has no vaginal bleeding and chooses medical management of the miscarriage. What is the most appropriate approach to anti-D immunoglobulin prophylaxis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Offer at least 250 IU anti-D immunoglobulin as part of medical management

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · C = shown as D · A = shown as E

NICE recommends offering at least 250 IU anti-D immunoglobulin to an unsensitised RhD-negative patient at 12+0 to 12+6 weeks who undergoes either medical management or a surgical procedure for miscarriage. Where gestational age calculated from the last menstrual period differs from ultrasound dating, the ultrasound assessment should guide management. This patient is therefore managed as 12+1 weeks and should receive prophylaxis. B reflects previous UK guidance, under which anti-D in early miscarriage depended partly on whether management was surgical. Current guidance includes medical management at 12+0 to 12+6 weeks. C incorrectly prioritises menstrual dating over the ultrasound measurement. D confuses management of confirmed miscarriage with threatened miscarriage: at 12+0 to 12+6 weeks, anti-D may be considered for threatened miscarriage with heavy or recurrent bleeding, but bleeding is not required when a confirmed miscarriage is being medically managed. E is incorrect because a Kleihauer test should not be used to quantify fetomaternal haemorrhage in this setting or to determine whether prophylaxis is indicated.

Reference: Ectopic pregnancy and miscarriage: diagnosis and initial management — Anti-D immunoglobulin prophylaxis (17 June 2026) — https://www.nice.org.uk/guidance/ng126/chapter/anti-d-immunoglobulin-prophylaxis