New ACOG Recommendations for Rh Testing & RhIg Prophylaxis
The American College of Obstetricians and Gynecologists (ACOG) released a clinical update on September 10, 2024, regarding Rh testing and prophylaxis in pregnancy loss before 12 weeks gestation. The update is a significant shift in practice recommendations. It is especially pertinent in light of the ongoing shortage of RH immunoglobulin in the U.S.:
For patients less than 12 weeks 0 days gestation undergoing abortion or experiencing pregnancy loss (managed medically or surgically), ACOG now suggests forgoing routine Rh testing and RhIg prophylaxis.
Rationale Behind the Change
The new guidance is based on 3 recent studies. These studies suggest a very low likelihood of Rh alloimmunization associated with abortion or pregnancy loss at less than 12 weeks gestation. This update aligns ACOG with several other international organizations that have already moved away from routine Rh testing and RhIg prophylaxis in early pregnancy loss, including:
- World Health Organization
- Royal College of Obstetricians and Gynaecologists
- Society of Obstetricians and Gynaecologists of Canada
- Society of Family Planning
- National Abortion Federation
Implications for Practice
This update emphasizes the importance of individualized care and shared decision-making. Healthcare providers should discuss the potential benefits and risks with patients, considering their unique circumstances and preferences. ACOG’s patient education resource on Rh incompatibility may serve as a helpful tool in these discussions.
It’s important to note that while this represents a significant change in practice, the evidence supporting this shift is still evolving. The clinical update does note that Rh testing and RhIg administration can still be considered on an individual basis through shared decision-making discussions about potential benefits and risks.
For More: First Trimester Pregnancy Emergencies: Recognition and Management
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
