Feto-maternal outcomes of women with Rhesus iso-immunization in a Nigerian tertiary health care institution.

Abstract

Background: Fetomaternal haemorrhage may occur during pregnancy or at delivery and may lead to allo-immunization to the D antigen if the mother is Rhesus (Rh) negative and the baby is Rh-positive. Objectives: To determine the incidence, socio-demographic characteristics and pregnancy outcomes of Rh negative pregnant women in a Nigeria Tertiary health care institution. Methods: A review of the clinical records of all Rh-negative pregnant women, managed at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-east Nigeria between 1st January 2009 and 31st December 2013 was done. Data were entered into Excel Spread sheet and analysed using computer Epi-Info 2013 version 7. Results: There were a total of 5561 deliveries and 117 Rh negative pregnancies during the period, given an incidence of 2.1%. Of the 117 Rh negative pregnancies, only 89 (76.1%) case files were available for analysis. Majority, 55.1% of the women were of ABO Blood Group O while ABO blood group discordance occurred in 33.7% of male partners. Seventy-one (79.8%) of the women have had previous pregnancies and only 33(46.5%) of these received anti-D prophylaxis in the previous pregnancies. Sixty-three (70.8%) of the pregnancies were booked and 48 out of 63 (76.2%) of them booked after 20 weeks of gestation. Indirect Coombs test was done in 61 out of 63 (96.8%) women that were booked but only one (1.6%) woman tested positive. None of the women had a follow-up testing. Only the woman that tested positive for indirect Coombs test had her antibody titre subsequently determined. Forty-five (50.6%) pregnancies were carried beyond date while 88.5% of the women that had postdate were delivered via caesarean section (p<0.001) with the commonest indication being fetal distress (42.9%). Sixty-one (68.5%) babies were tested post-delivery while 49 (80.3%) of 61 babies were rhesus incompatible with the mother. Only 40 (81.6%) of the incompatible mothers had Rh anti-D immunoglobulin administered after delivery. Neonatal jaundice occurred in 21.3% of the babies. There were 14 (15.7%) perinatal deaths. Conclusions: The incidence of Rhesus negative pregnancies was 2.1% while Rh isoimmunization rate was 1.6% and the uptake of Rhesus Anti-D immunoglobulin is suboptimal. Rh negative primigravida's tend to be unbooked and had significantly higher still births than their multigravid counterparts. Rhesus negative pregnancies carried beyond their dates had a significantly higher caesarean section rates than those delivered at term or before the expected date of delivery. There is need for further studies to clearly explore these trends.

Perinatal Outcome of Pregnant Women with RhD Sensitization: A Five-Year Cross-Sectional Study at a Tertiary Care Hospital in Ethiopia

“…Although the Rh systems consist of many antigen subtypes (eg, D, C, c, E, e), the D antigen is highly immunogenic; therefore, it is most involved in Rh incompatibility abnormalities. 1 The volume necessary to cause alloimmunization varies from patient to patient. It is probably related to the Rh-positive RBC's immune capacity and the mother's immune responsiveness.…”