Abortion Care — DFSRH MCQ

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EasyAbortion CareDFSRH

A 32-year-old woman requests vacuum aspiration for an undesired intrauterine pregnancy. Ultrasound confirms a gestational age of 11+6 weeks. She is O RhD negative, with no detectable immune anti-D antibodies. She has previously received anti-D following delivery and asks whether surgical instrumentation makes prophylaxis necessary on this occasion. Which anti-D management is most appropriate?

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Correct answer: A — Do not administer anti-D prophylaxis

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

Current NICE abortion-care guidance recommends against anti-D prophylaxis for RhD-negative people having either medical or surgical abortion up to and including 11+6 weeks. The gestational threshold and the route of abortion are both decisive: vacuum aspiration does not create an exception to the recommendation for abortions before 12 weeks. Her previous receipt of anti-D does not itself create an indication during this pregnancy. B and C reflect older practice in which surgical abortion was treated as a potentially sensitising event requiring peri-procedural anti-D; the current recommendation does not distinguish medical from surgical abortion below 12 weeks. D incorrectly imports bleeding-based considerations from other early-pregnancy contexts. Heavy bleeding after aspiration requires clinical assessment for complications, but it does not create a routine anti-D indication at 11+6 weeks. E is mechanistically attractive because sensitisation requires exposure to RhD-positive fetal erythrocytes, but fetal RhD testing is not required to determine prophylaxis in this setting. From 12+0 weeks, an unsensitised RhD-negative person should have access to anti-D at the time of abortion, without rhesus testing or product availability delaying the procedure.

Reference: Abortion care (NG140): Recommendations, section 1.3 Anti-D prophylaxis (Updated 27 May 2025) — https://www.nice.org.uk/guidance/NG140/chapter/recommendations Abortion care: Resource impact statement (Updated 27 May 2025) — https://www.nice.org.uk/guidance/ng140/resources/resource-impact-statement-15362152813