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.

Maternal and perinatal outcome in Rh negative mothers

“…In our study the incidence of Rh-negative pregnancy was 2.9 % which is similar to the national average of 3% to 5%. Which was comparable to the study done by [9][10][11][12][13] The prevalence in our study was higher than other studies because our center is tertiary referral center. In Table 2, our study was comparable according to parity, Agarwal et al who found 38.4% primigravida 33.6% second gravid 20% third gravid and 8% were multigravida.…”

“…15 Table 4 show comparison study with Shradha et al 15 Only 34% patients have received anti-D in previous pregnancies and according to Eleje et al 46.5% received anti D prophylaxis in the previous pregnancy. 10 Various studies have shown the risk of alloimmunization after postpartum anti D only is 2% risk after antepartum and postpartum anti D is 0.1% Similar results were shown by the studies Trina et al and Shradha et al where antenatal anti D prophylaxis was given to 30% cases and 34% cases respectively. 16,21 Our incidence was lower than Haripriya et al because of large sample size in their study.…”

Hyperbilirubinemia and Associated Factors Among Neonates Admitted to the Neonatal Care Unit in Jimma Medical Center

“…The finding was corroborated by studies done in Nepal, 31 and Nigeria. 32 Conversely, this result was concordant with findings in Croatia, 25 and Iran. 26 Furthermore, this could be due to that male newborns have comparatively low levels of ligand which may not be able to process all the bilirubin formed from red blood cells and due to hormonal effects of transporter protein where testosterone down regulates membrane transporter protein which is involved in bilirubin metabolism.…”

“…Neonatal hyperbilirubinemia had a significant association with the feeding mode of neonates particularly with exclusive breastfeeding [AOR = 3.794; 95% CI (1.441-9.990)]. The association was described in studies conducted by Seyedi et al 38 and Eleje 32 This is due to decreased caloric intake/starvation, inhibition of hepatic excretion of bilirubin and an increase in intestinal absorption of bilirubin (enterohepatic circulation) 39 and a component of breast milk 40 are suggested mechanisms for the hyperbilirubinemia associated with breast-feeding.…”