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.