The introduction of anti-D immunoglobulin (Ig) has been one of the great achievements in medicine over the past 50 years.1 Its use has reduced the incidence of alloimmunisation by 85% where formerly about 10% of pregnancies were affected.2 3 Whereas previously 38% of affected neonates would have died, now haemolytic disease of the newborn is a very rare cause of death in developed countries.1 Although the value of anti-D prophylaxis in routine antenatal care in women who are rhesus (RhD)-negative is evidence-based,4 its role in first-trimester abortion and miscarriage management is not. National guidelines are inconsistent and have been based on observational studies from over 40 years ago when practices were quite different5 (table 1). When the scope for the National Institute for Health and Care Excellence (NICE) abortion care guideline was being developed,6 stakeholders rated the role of anti-D prophylaxis as one of the most important topics to be included. View this table: Table 1 Examples of national guidelines for recommended use of anti-D in the first trimester The systematic review and rationale for the NICE guideline is published in this edition of the journal.7 With no evidence of either benefit from use of anti-D in abortion care, or harm if it is not given in the first trimester, NICE has challenged the traditional stance of many national guidelines that recommend using anti-D because of historic practice. The recommendation from NICE not to give anti-D to women having a medical abortion up to 10 weeks’ gestation reversed previous practice and was swiftly implemented by abortion providers across the UK. The main reason to continue …

中文翻译：

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是时候重新评估流产护理中的恒河猴检测和抗 D 预防了

抗 D 免疫球蛋白 (Ig) 的引入是过去 50 年来医学上的一项伟大成就。1 它的使用使同种免疫的发生率降低了 85%，而以前约有 10% 的怀孕受到影响。2 3 而以前 38% 的受影响新生儿会死亡，现在新生儿溶血病在发达国家是一种非常罕见的死因。 1 尽管抗 D 预防在恒河猴 (RhD) 阴性妇女的常规产前保健中具有价值是基于证据的，4 它在孕早期流产和流产管理中的作用不是。国家指南不一致，并且是基于 40 多年前实践完全不同的观察性研究5（表 1）。在制定国家健康与护理卓越研究所 (NICE) 堕胎护理指南的范围时，6 利益相关者将抗 D 预防的作用列为最重要的主题之一。查看此表： 表 1 建议在孕早期使用抗 D 的国家指南示例 NICE 指南的系统评价和基本原理发表在本期杂志上。7 没有证据表明使用抗 D 有益-D 在堕胎护理中，或者如果在头三个月不给予伤害，NICE 已经挑战了许多国家指南的传统立场，这些指南由于历史惯例而建议使用抗 D。NICE 建议不要给妊娠 10 周以内药物流产的妇女服用抗 D 药物，这一建议扭转了以前的做法，并迅速被英国各地的堕胎提供者实施。继续下去的主要原因……