The Rhesus Negative Woman
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults, Updated for the 2023 Edition
O36.0 + (Z29.1)
GENERAL MEASURES
Maternal serum antibodies absent
Prevention
Test for maternal serum antibodies at ‘booking’, 28 and 34 weeks’ gestation.
During pregnancy, give prophylactic anti-D immunoglobulin to the mother within 72 hours of a potentially sensitising event.
MEDICINE TREATMENT
After a termination of pregnancy (TOP), miscarriage, ectopic pregnancy or amniocentesis 13-22 weeks:
- Anti-D immunoglobulin, IM, 50 mcg.
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After external cephalic version or potentially sensitizing event ≥22 weeks:
- Anti-D immunoglobulin, IM, 100 mcg.
At birth, determine the Rh status of the cord blood and request a Coomb’s test:
Cord blood Rh negative - no treatment.
Cord blood Rh positive, Coomb’s negative:
- Anti-D immunoglobulin, IM, 100 mcg.
If a large foeto-maternal haemorrhage is suspected:
- Anti-D immunoglobulin, IM, 300 mcg for every 30 mL haemorrhage.
- Maximum dose: 1 200 mcg.
AND
Do a maternal blood Kleihauer test (consult a specialist).
Rh positive, Coomb’s positive:
In these cases, the mother will also have antibodies.
Do not administer anti-D immunoglobulin.
Maternal serum antibodies present.
Consult a specialist.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026
Chapter 6 Obstetrics_6.18 The Rhesus Negative Woman