In this episode of The Good GP, host Dr Krystyna de Lange is joined by Dr Tegan Allin, rural generalist and GP obstetrician from Thursday Island live from the GP25 Conference, to discuss the topic of foetal rhesus screening and recent changes in Australian guidelines.

They began with an overview of anti-D prophylaxis and its importance for women who are rhesus negative. Dr Tegan Allin explains the pathophysiology of rhesus disease, risks associated with sensitisation during pregnancy, and the traditional approach of universal prophylaxis with anti-D immunoglobulin.

They then shift to the new availability of non-invasive prenatal screening (NIPS) for foetal rhesus status. Dr Tegan Allin describes how this serum-based test examines cell-free foetal DNA in maternal blood from 11 weeks gestation. With sensitivity and specificity over 99%, it allows for more targeted administration of anti-D only to those carrying a rhesus positive fetus.

Covering key practicalities of ordering foetal rhesus screening, including the appropriate gestational window (after 11 weeks and before 29 weeks), the importance of lab-specific request forms, and consideration of slight lab-to-lab differences in recommended timing.

Highlighting the ongoing changes in first trimester antenatal management and the need for GPs to remain up to date with evolving testing protocols. Reinforcing the necessity of confirming neonatal rhesus status at birth via cord blood testing, even when negative results are obtained antenatally.

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