EMQ — Extended Matching Question · Review
Question 218
Delivery suite → Haemorrhage
Classification
Question
EEMQQuestion Header
Select the single most appropriate approach to rhesus prophylaxis.
Question Stem
Withhold anti-D if fetal assessment is reassuring
Answer Bank
A
Withhold anti-D if fetal assessment is reassuring
B
Give anti-D immunoglobulin to a non-sensitised RhD-negative woman following APH, with assessment of fetomaternal haemorrhage where indicated
C
Give anti-D only if ultrasound demonstrates placental abruption
D
Give anti-D only after delivery
E
Anti-D is unnecessary after recurrent APH
F
Use maternal haemoglobin to determine anti-D dose
G
Give anti-D only when bleeding exceeds 500 mL
H
Anti-D is indicated only for placenta praevia
Correct Answer
B. Give anti-D immunoglobulin to a non-sensitised RhD-negative woman following APH, with assessment of fetomaternal haemorrhage where indicated
Explanation
APH is a potentially sensitising event. A non-sensitised RhD-negative woman should receive appropriate anti-D prophylaxis, and testing for fetomaternal haemorrhage is used where required to determine whether additional anti-D is necessary. The indication is not dependent on demonstrating abruption, fetal compromise or a particular visible blood-loss threshold.
Option Validity
A) Reassuring fetal assessment does not remove the sensitisation risk.
C) Anti-D prophylaxis does not depend on ultrasound confirmation of abruption.
D) Prophylaxis is required following the sensitising event rather than being deferred routinely until delivery.
E) Recurrent bleeding does not make prophylaxis unnecessary.
F) Maternal haemoglobin does not determine the magnitude of fetomaternal haemorrhage.
G) Sensitisation can occur without a 500 mL maternal blood-loss threshold.
H) APH from causes other than placenta praevia can also constitute a sensitising event.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.