Thanks for your responses re this matter. I ended up investigating this myself, and spoke to the doctor directly. He politely and willingly stated his reasons for not administering the Anti-D, as per the Royal College of Obs & Gyn guidelines as of 2002/03 ..(see below - 5.3)
I also went on to research these guidelines (copied below). The lack of administration of Anti-D was due to the fact that it was a 'compete spontaneous abortion that required no instrumentation, and it occured before 12 weeks' (and fetus didnt develop much after 7-9 weeks) . The doctor also stated he was from Holland and they never administered the anti-D in these cases.
Needless to say, the woman felt very relieved it was not a fault on the practitioners part that could have set her and her future babes up for risk. She is getting the antibodies tested just to be sure, and fingers crossed it all works out OK!
"5. Prophylaxis following abortion
Some RhD negative women require anti-D Ig following abortion; 250iu before 20 weeks' gestation and 500iu thereafter. A test for the size of FMH should be performed when anti-D Ig is given after 20 weeks.
5.1 Therapeutic termination of pregnancy: Anti-D Ig should be given to all non-sensitised RhD negative women having a therapeutic termination of pregnancy, whether by surgical or medical methods, regardless of gestational age (Grade B recommendation).
5.2 Ectopic pregnancy: Anti-D Ig should be given to all non-sensitised RhD negative women who have an ectopic pregnancy (Grade B recommendation).
5.3 Spontaneous miscarriage: Anti-D Ig should be given to all non-sensitised RhD negative women who have a spontaneous complete or incomplete abortion after 12 weeks of pregnancy (Grade B recommendation). Published data on which to base recommendations in earlier miscarriages are scant. There is evidence that significant FMH only occurs after curettage to remove products of conception but does not occur after complete spontaneous miscarriages.12,13 Anti-D Ig should therefore be given when there has been an intervention to evacuate the uterus. On the other hand, the risk of immunisation by spontaneous miscarriage before 12 weeks' gestation is negligible when there has been no instrumentation to evacuate the products of conception and anti-D Ig is not required in these circumstances (Grade C recommendation).
5.4 Threatened miscarriage: Anti-D Ig should be given to all non-sensitised RhD negative women with a threatened miscarriage after 12 weeks of pregnancy. Where bleeding continues intermittently after 12 weeks' gestation, anti-D Ig should be given at 6-weekly intervals (Grade C recommendation). Evidence that women are sensitised after uterine bleeding in the first 12 weeks of pregnancy where the fetus is viable and the pregnancy continues is scant14 though there are very rare examples.15 Against this background, routine administration of anti-D Ig cannot be recommended. However it may be prudent to administer anti-D Ig where bleeding is heavy or repeated or where there is associated abdominal pain particularly if these events occur as gestation approaches 12 weeks (Grade C recommendation). The period of gestation should be confirmed by ultrasound.
>From: "Marilyn Kleidon" <[EMAIL PROTECTED]>
>Reply-To: [EMAIL PROTECTED]
>To: <[EMAIL PROTECTED]>
>Subject: Re: [ozmidwifery] rhesus neg mother
>Date: Wed, 28 Jan 2004 22:50:43 -0800
>
>Exactly what i learned too. The reason for the prophylactic anti-D is to prevent those 10% which is quite a significant number. My mother was also neg, dad pos, I am pos (also much prior to antiD)and mum had had several miscarriages, and since I was not compromised I am part of the lucky 90%. I did have childhood friends whose parents were the same except that all except the first born had to be transfused at birth as they were born "blue". Prophylactic medicine always runs the risk of being thought unnecessary especially when most of the time it wont be needed. So long as those who choose not to use it fully understand the risks (in both directions) it's fine with me. In this case since the antiD was perhaps overlooked/mistakenly not given then perhaps at least the odds are in the mums favour.
>
>marilyn
> ----- Original Message -----
> From: mh
> To: [EMAIL PROTECTED]
> Sent: Wednesday, January 28, 2004 3:25 AM
> Subject: Re: [ozmidwifery] rhesus neg mother
>
>
> Hi all,
> When I learned about rh isoimmunisation etc many years ago I asked about this because my mother is neg, father is pos and all 6 of us are pos, born prior to anti-D (my mother had it after the last child!) with no difficulty, not even physiological jaundice.
>
> IIRC the incidence of isoimmunisation was only 10% of neg mothers with pos infants but the consequences are so horrific as anyone who's seen a hydropic baby will know, when anti-D was available it was welcomed with open arms.
> I have no references for this, only mu possibly faulty memory.
>
> Monica
> ----- Original Message -----
> From: Mary Murphy
> To: [EMAIL PROTECTED]
> Sent: Wednesday, January 28, 2004 9:59 PM
> Subject: Re: [ozmidwifery] rhesus neg mother
>
>
> Hi Terry, That is amazing, but I do know that some Jehova Witness members who have had a similar experience with no harm to their subsequent positive babies. Puzzling eh? Cheers, MM
>
> Hi Kristen,
> Some hope, I have had an Rh neg women have 4 pregnancies her babies were positive, she declined Anti D for her own reasons, and went on to have normal healthy pregnancies and births without problems.
> Terry Stockdale
> ----- Original Message -----
> From: Kristin Beckedahl
> To: [EMAIL PROTECTED]
> Sent: Tuesday, January 27, 2004 3:09 PM
> Subject: [ozmidwifery] rhesus neg mother
>
>
> Dear List,
>
> I have a 33year woman, with a repro history - 4 x TOP, and recently (3-4 weeks) a miscarrige at 12 weeks ( fetus didnt develop much past 7-9 weeks?)
> She is O -ve blood group and all TOP were followed with Anti-D. However following the recently complete miscarriage, she was not given Anti-D. It seems the doctor 'forgot', 'didnt realise' or was incompetent..?!? No D & C was performed.
>
> She is concerned now her future pregnancy will be affected. Her partner is + ve grp.
> What does she need to do to confirm whether her subsequent preg are at risk? How risky is this for her and babe?
> During TOP or miscarriages does much of the fetus blood pass into the mothers circulation?
>
> Thanks for your help!,
> Kristin
>
>
>------------------------------------------------------------------------
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