An unsensitized Rh-negative woman presents at 10 weeks gestation with a small amount of vaginal bleeding. Ultrasound shows a single live intrauterine fetus matching dates, with a closed cervix. Bleeding settles over two days. What is the correct advice regarding anti-D immunoglobulin?

• A Anti-D is required because any antepartum bleeding is a sensitizing event
• B Anti-D is not indicated for threatened abortion with a continuing viable pregnancy ✓
• C Anti-D is required only if the bleeding recurs after 20 weeks
• D Anti-D is indicated now and repeated every 6 weeks until delivery

Explanation

Threatened abortion with an ongoing viable pregnancy is not listed as a sensitizing event because significant fetomaternal haemorrhage is uncommon when the pregnancy continues intact. Anti-D is indicated for spontaneous or induced abortion, ectopic pregnancy, molar pregnancy, chorionic villus sampling, amniocentesis, antepartum haemorrhage, external cephalic version and abdominal trauma. Recurrent bleeding does not change this advice while the fetus remains alive, so option C is wrong.

Reference: Ian Donald's Practical Obstetric Problems, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.