PURPOSE:
To implement targeted, non-invasive antenatal screening using cell-free fetal DNA (cffDNA) testing to determine fetal RHD genotype in D negative, non-sensitised pregnant women. The aim is to reduce unnecessary anti-D immunoglobulin use and promote safer, more informed, and sustainable maternity care.

DISCUSSION:
Commissioned in 2018 by the Welsh Government, the programme—delayed by COVID-19—was implemented nationally on 13th May 2024. Previously, anti-D immunoglobulin was routinely administered regardless of fetal RHD status. This midwifery-led initiative now ensures anti-D is offered only when the fetus is RHD positive or the result is inconclusive. Aligned with NICE guidance, the initiative enhances informed choice and safety. Implementation was led by screening midwives across health boards, using a national toolkit and supported by collaboration with the Welsh Blood Service, maternity teams, public health professionals, and service users. Public and professional resources were co-produced to ensure clarity and accessibility across diverse populations. Service users reviewed informational resources to support their understanding and facilitate informed discussions with midwives. Effective rollout relied on strong communication, scheduled meetings, and feedback loops.

EVIDENCE WHERE RELEVANT:
A mixed-methods evaluation combined routine data with interviews from eligible women and staff. Early findings highlight: High service user satisfaction and engagement Preference for non-invasive testing Empowerment through informed decisions Improved collaboration among providers Operational challenges such as occasional repeat sampling

KEY MESSAGE:
Collaborative, cross-sector working enables service innovation Informed, personalised care empowers women Co-designed resources and strong communication drive success Targeted screening avoids unnecessary interventions The programme offers a model for future antenatal screening and policy development Poster session 2 (Group A)