Antenatally
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At 28 and 34 weeks Home Birth women will be booked into the Antenatal Pre Admission (OPD midwife) for discussion and administration of Anti D.
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This should be documented in the Medical Record (patient history) under the Antenatal Section. It should be also documented in a new or existing medication sheet.
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- include product name and dose
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- write batch or lot number on the chart next to the order
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- sign and date drug chart once administered
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- medication chart should be filed into the Antenatal section of the Medical Record
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ANTENATAL PROPHYLAXIS (Rh(D) Negative Women)
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| Rh(D) Ig 625IU (ARCBS/CSL brand product)
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| | Universal antenatal prophylaxis for all Rh(D) negative women
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| | Rh(D) Ig 625IU (ARCBS/CSL brand product)
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| - All Rh(D) negative women delivering an Rh(D) positive infant within 72 hours of birth.
|  | - All Rh(D) negative women with an Rh(D) positive infant should have an estimate of feto-maternal haemorrhage (FMH test. Previously known as Kleihaur test) to determine the need for additional doses of anti-D.
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Postpartum
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On request from "Home Birth Midwife" a 9mL EDTA tube (red tube) should be given to the woman at the 34 week Antenatal Pre-Admission (prophylactic Anti-D) or sent to either:
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This tube is to enable the midwife to collect cord blood at the time of delivery.
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This blood should be labelled appropriately with the following details:
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- maternal surname and first name
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- infant's gender and date of birth
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- date and time of collection
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The Home Birth Midwife and her patient should present to Urgent Care (emergency) at the Royal Women's Hospital, within 72 hours of the infant's birth.
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The Urgent Care (emergency) midwives will collect 4mls of maternal bood (Post Birth) in an EDTA tube; this will be labelled with the maternal details for the FMH. Both the maternal blood and the cord blood will be sent to Pathology.
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- The woman can elect to have a dose of Rh D Ig administered at that time, however it is recommended the Rh D Ig only be administered once the cord blood group is known to be Rh D positive (to avoid unnecessary administration of Rh D Ig). If the woman elects to wait for the result, please indicate to the laboratory that the cord blood result is 'urgent'.
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- The results of the FMH testing will be available the next day. The woman will be contacted to return for additional doses of Rh D Ig if the test shows a significant FMH. (The likelihood of this occurring is low, < 1:100).
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Please refer to the Women's CPG: Rh D Immunoglobulin in Obstetrics for further information.
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Advice regarding result interpretation can be obtained from the Royal Women's Hospital on-call via switchboard Tel: (03) 8345 2000.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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