Preventing rhesus isoimmunization. Antepartum Rh immune globulin prophylaxis versus a sensitive test for risk identification.

The controversial proposal to use Rho (D) immune globulin (human) prophylactically in pregnancy should not detract from the most expedient approach to further reduction of Rh disease; that is, to ensure that every eligible woman is given Rho (D) immune globulin (human) after delivery, abortion, or ectopic pregnancy. Family planning by Rh-negative women at risk and limiting the number of pregnancies in women already immunized will be additional effective ways to reduce the current incidence of hemolytic disease in most communities. Present evidence shows that blanket antepartum Rho (D) immune globulin (human) prophylactic treatment will be very costly and will place many subjects at potential risk while offering benefit to only a few. Sensitive and practical laboratory testing for fetomaternal hemorrhage is presently only a research tool but will soon be clinically available to provide new data on fetomaternal hemorrhage. In the near future, pregnant women truly at risk for Rh isoimmunization may be identified by analysis of their blood, and this will be a rational basis for antepartum Rho (D) immune globulin (human) treatment. There are compelling advantages in cost, risks, and benefits for an approach of selective antepartum Rho (D) immune globulin (human) therapy as opposed to routine prophylaxis for all Rh-negative gravid women.