Rh Immunoglobulin Uptake With Opt-In Versus Opt-Out Clinic Policy [ID 978]

INTRODUCTION: Based on growing evidence against Rh immunoglobulin (RhIg) administration in the first trimester, Planned Parenthood Keystone (PPK) updated their policy from “opt-out” to “opt-in.” We aim to quantify RhIg uptake by Rh-negative patients before and after the policy change. METHODS: In this retrospective chart review, we compared RhIg administration in all Rh-negative patients accessing abortion care at less than 12 weeks of gestation at PPK from August 15, 2021, to August 14, 2022 (pre), and August 15, 2022, to August 15, 2023 (post). We compared pregnancy characteristics and demographics to determine differences in those receiving versus declining RhIg. RESULTS: A total of 1,497 Rh-negative patients underwent an abortion at PPK at less than 12 weeks of gestation, 691 (46.2%) in the pre-period and 806 (53.8%) in the post-period. Rate of RhIg uptake was 76.1% pre versus 10.4% post ( P <.0001). In the first 6 months, 88.2% received RhIg with decreasing monthly uptake as the official policy change approached. In the post period, 203 (25.2%) patients had a preceding abortion at PPK. Of these, 13 (6.4%) received RhIg in all encounters, 37 (18.2%) never received RhIg , and 151 (74.4%) had received RhIg in the past, but not in the most recent encounter. No patients opted to receive RhIg after declining in the past. Factors associated with receiving RhIg in the post period were higher gestational age and being Hispanic or Latino. CONCLUSIONS/IMPLICATIONS: The rate of RhIg uptake significantly decreased post-policy change, with evidence of an anticipatory effect before the official change. Further studies on patient risk tolerance and decision making surrounding RhIg are warranted.