Is a third-trimester antibody screen in Rh+ women necessary?

Jeffrey M. Rothenberg, Beata Weirermiller, Kelly Dirig, William W. Hurd, Jeanne Schilder, Alan Golichowski

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To determine the need for routine third-trimester antibody screening in Rh+ women. Study Design: An analytic case-control study. Methods: We identified Rh+ pregnant women who had received prenatal care and retrospectively analyzed their laboratory data. Patients were grouped into those with a positive third-trimester antibody screen (cases) and those with a negative third-trimester screen (controls). Because entry into a group was decided by the investigators, it could not be randomized. We reviewed the maternal medical records for antibody identification and final pregnancy outcome. We also reviewed the neonatal medical records for evidence of direct Coombs-positive cord blood, anemia, need for transfusion or phototherapy, other medical complications, and death. Results: Using a computerized laboratory database from 2 teaching hospitals, we identified 10,581 obstetric patients who underwent routine first- and third-trimester antibody screening between 1988 and 1997. Of these, 1233 patients were Rh- and 9348 were Rh+. Among the Rh+ patients, 178 (1.9%) had 1 or more atypical antibodies at the first-trimester screen, and 53 (0.6%) had a positive third-trimester antibody screen despite a negative first-trimester screen. Although 6 of these 53 patients (0.06% of the study population) had clinically relevant antibodies for hemolytic disease of the newborn, no significant neonatal sequelae occurred among these 6 patients. Conclusion: Based on the patient and hospital records studied, a repeat third-trimester antibody screen for Rh+ patients is clinically and economically unjustified. Eliminating this laboratory test from clinical practice will not adversely affect pregnancy outcomes and will decrease the costs of prenatal care.

Original languageEnglish
Pages (from-to)1145-1150
Number of pages6
JournalAmerican Journal of Managed Care
Volume5
Issue number9
StatePublished - 1999

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Third Pregnancy Trimester
Antibodies
pregnancy
First Pregnancy Trimester
obstetrics
Prenatal Care
Pregnancy Outcome
Disease
Medical Records
death
Teaching
costs
Fetal Erythroblastosis
Phototherapy
evidence
Hospital Records
Group
Fetal Blood
Teaching Hospitals
Obstetrics

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Rothenberg, J. M., Weirermiller, B., Dirig, K., Hurd, W. W., Schilder, J., & Golichowski, A. (1999). Is a third-trimester antibody screen in Rh+ women necessary? American Journal of Managed Care, 5(9), 1145-1150.

Is a third-trimester antibody screen in Rh+ women necessary? / Rothenberg, Jeffrey M.; Weirermiller, Beata; Dirig, Kelly; Hurd, William W.; Schilder, Jeanne; Golichowski, Alan.

In: American Journal of Managed Care, Vol. 5, No. 9, 1999, p. 1145-1150.

Research output: Contribution to journalArticle

Rothenberg, JM, Weirermiller, B, Dirig, K, Hurd, WW, Schilder, J & Golichowski, A 1999, 'Is a third-trimester antibody screen in Rh+ women necessary?', American Journal of Managed Care, vol. 5, no. 9, pp. 1145-1150.
Rothenberg JM, Weirermiller B, Dirig K, Hurd WW, Schilder J, Golichowski A. Is a third-trimester antibody screen in Rh+ women necessary? American Journal of Managed Care. 1999;5(9):1145-1150.
Rothenberg, Jeffrey M. ; Weirermiller, Beata ; Dirig, Kelly ; Hurd, William W. ; Schilder, Jeanne ; Golichowski, Alan. / Is a third-trimester antibody screen in Rh+ women necessary?. In: American Journal of Managed Care. 1999 ; Vol. 5, No. 9. pp. 1145-1150.
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