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Erum Anwar Khan: NICE NG126 2026 Update on Anti-D in Early Pregnancy
Erum Anwar Khan/LinkedIn
Jun 26, 2026, 14:52

Erum Anwar Khan: NICE NG126 2026 Update on Anti-D in Early Pregnancy

Erum Anwar Khan, National Maternity Improvement Advisor at NHS England, shared a post on LinkedIn:

“NICE NG126 Update (2026): Ectopic pregnancy and miscarriage: diagnosis and initial management.

One of the most significant updates in the latest NICE NG126 guideline is the change to Anti-D immunoglobulin use in RhD-negative patients.

Anti-D is no longer recommended before 12 weeks’ gestation (up to 11+6 weeks) for:

  • Ectopic pregnancy
  • Miscarriage
  • Threatened miscarriage

At 12+0 to 12+6 weeks, Anti-D (minimum 250 IU) should be offered for medical or surgical management of miscarriage or ectopic pregnancy, and considered for threatened miscarriage with heavy or recurrent bleeding.

Where there is discrepancy between length of gestation as measured from ultrasound and that calculated from last menstrual period, the findings from ultrasound should be used to guide management.

Kleihauer testing is not recommended for quantifying feto-maternal haemorrhage in this setting. This is not a new update.

This represents a notable shift away from historical practice, where Anti-D was frequently administered following early pregnancy loss regardless of gestation.

The update reflects the growing evidence that the risk of RhD sensitisation before 12 weeks is extremely low and that routine prophylaxis in this group offers limited benefit.

For EPAUs, emergency gynaecology services and primary care, this change will likely reduce unnecessary administration of a blood-derived product, simplify care pathways and support more evidence-based use of Anti-D.”

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Anti-D immunoglobulin early pregnancy loss ectopic pregnancy emergency gynaecology Erum Anwar Khan Fertility Fertility News feto-maternal haemorrhage gestation Heavy bleeding Kleihauer testing miscarriage NICE NG126 Update prophylaxis recurrent bleeding reproductive health Reproductive Medicine RhD-negative patients threatened miscarriage
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