{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:48:15Z","timestamp":1790419695849,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012023","name":"Stichting Sanquin Bloedvoorziening","doi-asserted-by":"publisher","award":["PPOD 14\u201015"],"award-info":[{"award-number":["PPOD 14\u201015"]}],"id":[{"id":"10.13039\/501100012023","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000\u00a0IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Two\u2010year nationwide cohort of alloimmunised RhD\u2010negative women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>RhD\u2010negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non\u2010immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 2\u2010year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD\u2010positive child (<jats:italic>n<\/jats:italic>\u00a0=\u00a0113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1\u20132.6), perinatal death (OR 3.5, 95% CI 1.1\u201310.9), gestational age &gt;42\u00a0weeks (OR 6.1, 95% CI 2.2\u201316.6), postnatal bleeding (&gt;1000\u00a0ml) (OR 2.0, 95% CI 1.1\u20133.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0\u20139.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.\u20105%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Complicated delivery (caesarean section, manual removal placenta, major bleeding) is the most valid risk factor for RhD immunization despite antenatal and postnatal RhIg.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17118","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T12:33:47Z","timestamp":1644323627000},"page":"1721-1730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Risk factors for <scp>RhD<\/scp> immunisation in a high coverage prevention programme of antenatal and postnatal <scp>RhIg<\/scp>: a nationwide cohort study"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-7237","authenticated-orcid":false,"given":"Y. M.","family":"Slootweg","sequence":"first","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"},{"name":"Centre for Clinical Transfusion Research, Sanquin Research  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5844-6142","authenticated-orcid":false,"given":"C.","family":"Zwiers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"},{"name":"Centre for Clinical Transfusion Research, Sanquin Research  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0532-0022","authenticated-orcid":false,"given":"J. M.","family":"Koelewijn","sequence":"additional","affiliation":[{"name":"Centre for Clinical Transfusion Research, Sanquin Research  Amsterdam the Netherlands"},{"name":"Department of Immunohaematology Diagnostics Sanquin Diagnostic Services  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8065-3540","authenticated-orcid":false,"given":"E.","family":"van der Schoot","sequence":"additional","affiliation":[{"name":"Centre for Clinical Transfusion Research, Sanquin Research  Amsterdam the Netherlands"},{"name":"Department of Immunohaematology Diagnostics Sanquin Diagnostic Services  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-1532","authenticated-orcid":false,"given":"D.","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-3397","authenticated-orcid":false,"given":"I. 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