Background In order to develop the 2019 National Institute for Health and Care Excellence (NICE) national guideline on abortion care for the National Health Service1 we undertook a systematic review comparing anti-D prophylaxis to no prophylaxis in rhesus D (RhD)-negative women undergoing medical or surgical abortion of pregnancy at ≤13+6 weeks’ gestation Methods We searched Embase, Medline and the Cochrane Library on 19 October 2018. We also consulted experts and checked reference lists for any missed trials. Eligible studies were randomised controlled trials and non-randomised comparative studies, published in English from 1985 onwards, comparing anti-D prophylaxis to no anti-D prophylaxis in RhD-negative women undergoing medical or surgical abortion at ≤13+6 weeks’ gestation, and reporting subsequent anti-D isoimmunisation/sensitisation or subsequent affected pregnancy. These outcomes were to be analysed as risk ratios in Review Manager 5.3 using the Mantel-Haenszel statistical method and a fixed or random effect model. The overall quality of the evidence was planned to be assessed using GRADE. Results The search identified 426 potentially relevant studies of which none met the inclusion criteria. Recommendations for practice were therefore based on the clinical expertise of the guideline committee. Conclusions (1) Offer anti-D prophylaxis to women who are Rhesus D negative who are having an abortion after 10+0 weeks’ gestation. (2) Do not offer anti-D prophylaxis to women who are having a medical abortion up to and including 10+0 weeks’ gestation. (3) Consider anti-D prophylaxis for women who are rhesus D negative and are having a surgical abortion up to and including 10+0 weeks’ gestation.

中文翻译：

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妊娠流产至妊娠13 ⁺⁶周的恒河猴D（RhD）阴性妇女的抗D预防：系统评价和新的NICE共识指南

背景为了制定2019年美国国家卫生与健康研究院（NICE）关于国家卫生服务1的堕胎护理国家指南，我们进行了系统的回顾，比较了接受恒河猴D（RhD）阴性的女性在接受抗D预防与无预防方面的比较。妊娠≤13+ 6周的药物流产或手术流产方法我们于2018年10月19日在Embase，Medline和Cochrane图书馆进行了搜索。我们还咨询了专家并检查了参考文献以查找任何遗漏的试验。符合条件的研究是随机对照试验和非随机比较研究，从1985年开始以英语发表，比较了在≤13 + 6周的妊娠中接受药物或手术流产的RhD阴性女性的抗D预防与无D预防，并报告随后的抗D同种免疫/致敏作用或随后发生的妊娠。将使用Mantel-Haenszel统计方法和固定或随机效应模型在Review Manager 5.3中将这些结果作为风险比进行分析。计划使用GRADE评估证据的整体质量。结果搜索确定了426项潜在相关研究，其中没有一项符合纳入标准。因此，对实践的建议是基于指导委员会的临床专业知识。结论（1）为妊娠10 + 0周后流产的恒河猴D阴性的妇女提供抗D预防。（2）请勿为妊娠至10 + 0周且包括堕胎在内的药物流产的妇女提供抗D预防。