A 26-year-old Rh-negative woman with anti-D absent from her serum receives single-dose methotrexate for an unruptured tubal ectopic pregnancy. What additional measure is required regarding rhesus immunisation?
- A No prophylaxis is needed for medical management of ectopic pregnancy
- B Anti-D immunoglobulin 300 micrograms (or equivalent) is indicated ✓
- C Anti-D is needed only if surgical evacuation becomes necessary later
- D Kleihauer-Betke test first, and give anti-D only if fetomaternal haemorrhage exceeds 4 mL
Correct answer: B. Anti-D immunoglobulin 300 micrograms (or equivalent) is indicated
Explanation
Anti-D prophylaxis is indicated for all Rh-negative women with an ectopic pregnancy, whether treated surgically or medically, because trophoblast can enter the maternal circulation and sensitise her. Indian exam convention follows this blanket recommendation for ectopic gestation regardless of route of treatment. Waiting for surgery or performing Kleihauer testing before giving anti-D risks missing sensitisation, and once antibodies appear they persist for life and complicate future pregnancies with haemolytic disease of the fetus and newborn.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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