## Standard Anti-D Prophylaxis Dosing in India **Key Point:** The standard dose of anti-D immunoglobulin for **routine antenatal prophylaxis** in Rh-negative unsensitised women in India is **2000 IU (400 μg) intramuscularly**, as recommended by FOGSI and aligned with international guidelines (RCOG, ACOG). ### Dosing Schedule | Scenario | Dose | Timing | Route | | --- | --- | --- | --- | | Routine antenatal prophylaxis (India/FOGSI) | **2000 IU (400 μg)** | 28 weeks (± 34 weeks) | IM | | Post-delivery (if baby Rh+) | 300 μg (1500 IU) or 500 IU (100 μg) | Within 72 hours | IM | | Sensitising event (1st trimester) | 250 IU (50 μg) | As needed | IM | | Sensitising event (2nd/3rd trimester) | 500 IU (100 μg) | As needed | IM | ### Rationale **High-Yield:** The 2000 IU (400 μg) dose: - Is the standard antenatal prophylaxis dose recommended by FOGSI for Indian practice - Provides adequate passive immunisation to prevent sensitisation from occult fetomaternal haemorrhage during the third trimester - Is given at 28 weeks of gestation (and sometimes repeated at 34 weeks in some protocols) - Must be administered intramuscularly for optimal bioavailability **Clinical Pearl (per FOGSI/RCOG):** The RCOG Green-top Guideline No. 22 recommends 500 IU (100 μg) for post-sensitising events in the first trimester and 1500 IU (300 μg) post-delivery. For routine antenatal prophylaxis, the standard dose used in India is **2000 IU (400 μg)** IM at 28 weeks. The 1000 IU dose cited in some older texts is not the current standard for antenatal prophylaxis. **Warning:** Do NOT confuse antenatal prophylaxis dose (2000 IU / 400 μg) with post-delivery dose or first-trimester sensitising event dose. Each scenario requires a different dose calculation. *Reference: FOGSI Good Clinical Practice Recommendations on Rh Isoimmunisation; RCOG Green-top Guideline No. 22 (2011).*
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