A Rh-negative woman at 28 weeks has a routine antenatal visit. Her indirect Coombs test (ICT) is negative. She had a term delivery 2 years ago (baby was Rh positive) and received anti-D at that time. What is the correct management now?

• A No anti-D required as she is already sensitised
• B Check baby's blood group before any anti-D administration
• C Anti-D is not needed until delivery
• D Administer 300 µg anti-D immunoglobulin at 28 weeks ✓

Explanation

A Rh-negative woman with a negative ICT (unsensitised) should receive antenatal anti-D prophylaxis at 28 weeks (300 µg IM or 1500 IU), regardless of previous anti-D doses administered at prior deliveries, as passive anti-D from prior prophylaxis has waned. The ICT is negative, confirming she has not been sensitised. Fetal blood grouping (non-invasive prenatal testing for fetal RhD) can avoid unnecessary anti-D but where not available, anti-D is given empirically at 28 weeks and postpartum.

Reference: Williams Obstetrics, 26th ed.

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