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Rh negative in pregnancy: what the anti-D injection does | CION Cancer Clinics
If you are Rh negative and your baby may be Rh positive, an anti-D injection stops your body making antibodies against the baby's red cells. It is usually offered at around 28 weeks, after any bleeding or injury in pregnancy, and within 72 hours of birth if the baby is Rh positive. It protects future babies most. It does not help once your body has already made its own antibodies. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why does an Rh negative mother need an anti-D injection?
- When will you be offered anti-D?
- What happens from your first visit to after the birth?
- What do the words on your blood report mean?
- What do families believe about Rh negative pregnancy, and what is true?
- Who does anti-D not help, and what can this page not tell you?
- Common questions about Rh negative pregnancy and anti-D
The short answer
Why does an Rh negative mother need an anti-D injection?
If your blood group is Rh negative and your baby's is Rh positive, your body can learn to make antibodies against the baby's red cells. An anti-D injection stops your body from learning this. It protects this baby and, even more, any baby you carry after this one.
What "Rh negative" means
Your blood group has two parts. The letter (A, B, AB or O) is one part. The plus or minus sign is the other. Rh negative, also written RhD negative or "O negative", "B negative" and so on, means your red cells do not carry a protein called RhD. Most people in India are Rh positive. Being Rh negative is not an illness, and it does not affect your own health.
Why it only matters in pregnancy
During pregnancy and birth, a small amount of the baby's blood can cross into yours. If the baby is Rh positive, your immune system may see that blood as foreign and make antibodies called anti-D. The first baby is rarely harmed. In a later pregnancy, those antibodies can cross back and break down the next Rh positive baby's red cells. Doctors call this rhesus disease, or haemolytic disease of the newborn.
Anti-D works only before your body has made its own antibodies. That is why the timing of each injection matters.When it is offered
When will you be offered anti-D?
There are three kinds of moment. Your obstetric team decides which apply to you, and they set the dose.
A routine injection in pregnancy
Many hospitals offer anti-D to every Rh negative mother early in the third trimester, even when nothing has gone wrong. Small bleeds from the baby can happen without you noticing. Some units give one injection, others give it in two parts a few weeks apart.
After the birth
A blood sample is taken from the cord once the baby is born. If the baby turns out to be Rh positive, you are offered another injection within three days of delivery.
If the baby is Rh negative too, this injection is not needed.After an event that can mix blood
Some events can let the baby's blood reach yours at any stage. Each one is a reason to be checked and offered anti-D.
Examples
- Bleeding from the vagina
- A fall or a blow to the tummy
- Miscarriage, ectopic pregnancy or termination
- A needle test such as amniocentesis
- Turning a breech baby by hand
Not sure whether this applies to you?
Ask an oncologistThrough the pregnancy
What happens from your first visit to after the birth?
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Blood group and antibody screen
At your first antenatal visit, your blood group is checked. A second test, the antibody screen, looks for antibodies you may already have. If you already have anti-D antibodies, the plan changes completely.
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The father's blood group, sometimes
If the baby's father is known to be Rh negative too, the baby will also be Rh negative. Some teams use this to decide whether anti-D is needed. Others give it anyway, because the information is not always certain.
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A repeat antibody check
A blood sample is usually taken before the routine injection. This makes sure you had not already made antibodies before it was given.
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The routine injection
An injection into a muscle, usually the upper arm or thigh. It feels like any other injection and takes a moment.
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Cord blood test and the after-birth injection
The cord blood shows the baby's group. A small blood test from you can also show how much of the baby's blood crossed over. If a lot crossed, you may be offered more anti-D.
On your report
What do the words on your blood report mean?
- RhD negative
- Your red cells do not carry the RhD protein. Also written as "Rh -ve" or a minus sign after your group.
- Antibody screen
- A test that looks for antibodies in your blood that could affect the baby. "Negative" here is the result you want.
- Indirect Coombs test (ICT)
- Another name for an antibody screen, often used on Indian lab reports.
- Sensitised
- Your body has already made anti-D antibodies. Anti-D injections cannot reverse this.
- Anti-D immunoglobulin
- The injection itself. It is made from donated blood plasma, the liquid part of blood.
- Kleihauer test
- A blood test after a bleed or birth that estimates how much of the baby's blood entered yours.
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Do not wait for your next check-up
If you are Rh negative and you have any bleeding from the vagina, a fall, a blow to the tummy, or you feel the baby moving less, contact your maternity unit the same day. Tell them you are Rh negative. The anti-D injection after such an event works best when given within three days. Heavy bleeding or severe pain means going to the nearest emergency department or calling 108.
Commonly believed
What do families believe about Rh negative pregnancy, and what is true?
"Rh negative mothers cannot have healthy babies."
This is not true. Most Rh negative mothers have healthy babies. The problem is preventable in most cases, provided anti-D is given at the right times and the antibody screens are done.
"The first baby was fine, so we do not need the injection."
The first baby is usually fine. The risk is to the next one. Missing anti-D now is how antibodies form that affect a later pregnancy.
"After a miscarriage there is no baby, so anti-D does not matter."
It can matter. Blood can mix during a miscarriage or a termination. Ask whether anti-D is advised in your situation, especially if you were further along.
"The injection harms the baby."
Anti-D has been used in pregnancy for decades. Like any blood product it carries a very small risk, which your team will explain before asking for your consent.
Being straight with you
Who does anti-D not help, and what can this page not tell you?
Anti-D does not help a mother who has already made anti-D antibodies. At that point it cannot undo anything. What she needs instead is closer watching of the baby by a fetal medicine specialist, a doctor who looks after unborn babies, with repeat antibody levels and special scans.
When it may not be needed
It is not needed if you are Rh positive. It may not be needed if the baby is confirmed to be Rh negative. Anti-D also does not protect against other, rarer antibodies that an antibody screen can pick up. Those need a separate plan.
What a haematologist adds
Most Rh negative pregnancies are handled well by an obstetrician alone. A haematologist, a blood specialist, becomes useful when antibodies are already present, when a report is unclear, or when there are other blood problems in the pregnancy. At CION, the haematology team reviews the reports, explains what they mean and coordinates with qualified maternity and fetal medicine centres. We do not deliver babies, and anti-D is given by your obstetric team.
What you should take away
This page cannot tell you whether your baby is at risk. Only your own antibody screen results, your history and your team can.
Keep a copy of every blood group and antibody report. Carry it to every hospital visit, including for a later pregnancy.Questions we are asked
Common questions about Rh negative pregnancy and anti-D
I am O negative and my husband is B positive. Is my baby in danger?
Not in this pregnancy, in most cases. Your baby may be Rh positive or Rh negative. The risk is that your body makes antibodies that affect a later baby. Anti-D at the right times, with antibody screens in between, prevents this for most mothers. Your obstetric team will plan it with you.
Is the anti-D injection safe for me and the baby?
It has been used widely for many years. It is made from donated plasma, which is screened and treated to lower the risk of infection. You may have soreness at the injection site. Allergic reactions are rare. Your team will explain the risks and ask for your consent first.
I missed the routine injection. What should I do?
Tell your obstetrician at your next visit, or sooner if you can. Do not try to arrange an injection on your own. Your team may check your antibody screen first and then decide what to offer. Missing it does not mean harm has happened, but it does need a conversation.
Do I need anti-D in every pregnancy?
Usually yes, for each pregnancy, as long as you have not made your own anti-D antibodies. The protection from one injection does not last into the next pregnancy. Your antibody screen is checked again each time, so take your old reports with you.
My antibody screen came back positive. What does that mean?
It means an antibody was found. It could be anti-D, a different antibody, or sometimes anti-D from a recent injection. Your team will find out which one and how much. If it is your own anti-D, you will be referred for closer watching of the baby. Ask for a haematology opinion if the report is unclear.
Will my baby need treatment after birth?
Most babies of Rh negative mothers need nothing at all. If antibodies were present in pregnancy, the baby's blood is checked after birth for jaundice, the yellowing of the skin, and for a low haemoglobin. Some babies need light therapy. A few need more care in a newborn unit.
Can I refuse anti-D?
Yes. It is your choice. Some families decline it for religious reasons, because it comes from blood, or because the baby's father is confirmed Rh negative. Talk it through with your team first, so you understand what declining could mean for a future pregnancy.
Is anti-D available and covered in Telangana and Andhra Pradesh?
Anti-D is given in government and private maternity hospitals. Whether a scheme such as Aarogyasri, CGHS, ECHS, EHS or PM-JAY, or your insurer, pays for it depends on current rules and your policy. These change, so check with the hospital billing desk and your insurer before the injection is due.
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Sources
- NHS — Rhesus disease: prevention
- NHS — Rhesus disease
- NICE — Routine antenatal anti-D for women who are rhesus D negative (TA156)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
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