A 37 year old primi Rh negative patient is very concerned above her pregnancy at this age. Her pregnancy is 16 weeks and she is HIV negative, hepatitis B surface Ag neg, Rubella non immune and has no complain.Her triple test report is normal but still due to her age she insists on getting an amniocentesis done.Which of the following is the next best step in management:

Points worth noting are: Primi patient with Rh negative blood group She is 37 years old-elderly primi (>30 years) and has risk of Down syndrome (>35 years) She is concerned about the risk of having a down syndrome baby at this age and so insists on having amniocentesis done. Option a: Advise against amniocentesis as it will increase the risk of isoimmunisation –although the risk of isoimmunisation will definitely be increased but still I will not advise her against amniocentesis seeing her age and her concern. Option b: Follow Rh titres carefully and give Anti D if evidence of isoimmunisation is present. Come on in the theory I have explained that Anti d should be given only if evidence of isoimmunisationt is absent. If isoimmunisation is present it means antibodies are already formed, hence no need for giving Anti D. Thus this statement is absolutely wrong. Option c: Give Anti D at 28 weeks of pregnancy and after delivery if baby is Rh negative. If baby is Rh negative, no need to give Anti D. Option d: Give Anti D prior to her amniocentesis: This is the most logical step which should be done in this case. Option e: Give rubella vaccine as she is Rubella non immune: Now I don’t need to explain that Rubella vaccine is contraindicated during pregnancy.