Written by Jessica Beaman, MD MPH

The National Abortion Federation (NAF) recently updated its guidelines, removing Rh testing and Rhogam treatment for people seeking medication and surgical abortion care with gestation under 12 weeks.¹ This update aligns with the current World Health Organization guidelines and has the potential to reduce barriers to care.² Previous NAF guidelines recommended routine Rh testing for patients with unknown Rh status over 56 days or 8 weeks gestation followed by anti-D immune globulin (e.g., RhoGAM) treatment if found to be Rh negative. Recent evidence and systematic review have found that fetal red blood cell exposure before 12 weeks is below the threshold needed for Rh sensitization to occur and the evidence supporting anti-D immune globulin is limited.^3-5

Furthermore, routine Rh testing can be burdensome for patients. By removing the Rh testing requirements for patients less than 12 weeks, we have the potential to reduce barriers for individual patients, clinics, and larger organizations. Some clinicians, clinics, and organizations are eager to expand the scope of abortion services they provide through virtual or telehealth means. Changing Rh testing guidelines will undoubtedly have a positive impact on our ability to care for patients in a timely manner as well as reinforces the safety and evidence for patients seeking care in a variety of in-person, virtual, or self-managed contexts.

Patients seeking care after 12 weeks should still be offered Rh testing and anti-D immune globulin (e.g., RhoGAM).¹ If anti-D immune globulin is not available for treatment, then patients need to be referred for administration of the treatment. As with any medication or medical procedure, patients must have the right to decline testing and/or treatment and a signed waiver should document this informed consent process. This practice change has the potential to improve patient access, limit time and cost associated with abortion care, and streamline care by eliminating unnecessary testing and treatment.

RHAP Resources:

Protocol for Medication Abortion Using Mifepristone and Misoprostol

Telehealth Care for Medication Abortion Protocol

Sources:

1. Prager S, Carlisle S, Chaiten L, et al. 2022 Clinical Policy Guidelines for Abortion Care. 2022

2. World Health Organization. (2022). Abortion care guideline. World Health Organization. https://apps.who.int/iris/handle/10665/349316. License: CC BY-NC-SA 3.0 IGO

3. Chan MC, Gill RK, Kim CR. Rhesus isoimmunization in unsensitized RhD-negative individuals seeking abortion care at less than 12 weeks’ gestation: a systematic review. BMJ Sex Reprod Health; 2022;48(3):163-8.

4. Horvath S, Tsao P, Huang Z, Zhao L, Du Y, Sammel MD, et al. The concentration of fetal red blood cells in first-trimester pregnant women undergoing uterine aspiration is below the calculated threshold for Rh sensitization. Contraception; 2020;102(1):1-6.

5. Mark A, Foster AM, Grossman D, Prager SW, Reeves M, Velásquez CV, Winikoff B. Foregoing Rh testing and anti-D immunoglobulin for women presenting for early abortion: a recommendation from the National Abortion Federation’s Clinical Policies Committee. Contraception; 2019:99(5):265-266.

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.