W W Wee1, D Kanagalingam. 1. Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore. wcube@hotmail.com
Abstract
INTRODUCTION: The development of anti-D antibodies results from foetomaternal sensitisation occurring in rhesus (Rh) negative blood group women who carry an Rh-positive foetus. Despite guidelines on Rh immunoprophylaxis, isoimmunisation continues to occur, suggesting that the guidelines are not being fully applied by obstetricians. This study aims to establish the adequacy of knowledge on Rh immunoprophylaxis among obstetricians and trainees in obstetrics and gynaecology in Singapore, and their usual practice in the care of an Rh-negative mother; and hence to audit their practice in accordance with evidence-based guidelines. METHODS: An anonymous questionnaire survey auditing obstetricians' knowledge of guidelines on anti-D prophylaxis and their usual practice in the clinical setting. RESULTS: The mean score achieved on the questionnaire was 75.9 percent. Many obstetricians did not know that anti-D immunoglobulins (Ig) should be given within 72 hours of a sensitising event for successful immunoprophylaxis. In clinical practice, all the obstetricians who participated in the questionnaire would offer anti-D Ig prophylaxis to Rh-negative women both antenatally and postnatally. However, only 12.7 percent of them would routinely perform a Kleihauer test in Rh-negative women following delivery. CONCLUSION: The knowledge on anti-D prophylaxis among obstetricians can be improved. A continual system of education to raise awareness of evidence-based practices as well as clinical audit has been implemented to address this.
INTRODUCTION: The development of anti-D antibodies results from foetomaternal sensitisation occurring in rhesus (Rh) negative blood group women who carry an Rh-positive foetus. Despite guidelines on Rh immunoprophylaxis, isoimmunisation continues to occur, suggesting that the guidelines are not being fully applied by obstetricians. This study aims to establish the adequacy of knowledge on Rh immunoprophylaxis among obstetricians and trainees in obstetrics and gynaecology in Singapore, and their usual practice in the care of an Rh-negative mother; and hence to audit their practice in accordance with evidence-based guidelines. METHODS: An anonymous questionnaire survey auditing obstetricians' knowledge of guidelines on anti-D prophylaxis and their usual practice in the clinical setting. RESULTS: The mean score achieved on the questionnaire was 75.9 percent. Many obstetricians did not know that anti-D immunoglobulins (Ig) should be given within 72 hours of a sensitising event for successful immunoprophylaxis. In clinical practice, all the obstetricians who participated in the questionnaire would offer anti-D Ig prophylaxis to Rh-negative women both antenatally and postnatally. However, only 12.7 percent of them would routinely perform a Kleihauer test in Rh-negative women following delivery. CONCLUSION: The knowledge on anti-D prophylaxis among obstetricians can be improved. A continual system of education to raise awareness of evidence-based practices as well as clinical audit has been implemented to address this.