Feto-maternal outcome of Rh-Negative pregnancy presenting in a tertiary healthcare centre

Abstract

Background: The term "Rhesus incompatibility" describes the mismatched Rh types of the mother and the fetus. It is linked to the onset of hemolytic disease of the newborn (HDN) ranging from haemolytic anemia to hydrops fetalis and also related to maternal Rh sensitization. The disease incidence is currently declining globally, having dropped from 1.3%–1.7% in the 1980s to 0.17% in the 1990s1. Erythroblastosis foetalis is one of the most terrible consequences of an ABO incompatible or Rh incompatible pregnancy. About 10% of all Rh-negative pregnancies result in Rh incompatibility in the Rh-negative mother carrying a Rh-positive fetus. Methods: This observational study was carried out among 60 Rh negative pregnant women attending our antenatal clinic and delivered in our institution from October 2022 to March 2024.The Rh negative women were followed up with a series of investigations such as Indirect Coombs Test (ICT), MCA-PSV and with regular antenatal care (ANC). After birth neonates were followed up with blood grouping and Rh typing, direct coombs test (DCT), duration of phototherapy, duration of NICU stay , need for immunoglobulin and exchange transfusion were recorded to evaluate the maternal and neonatal outcomes.The data was collected and tabulated in Microsoft excel sheet and the percentages were calculated. Results: This study included a total of 60 Rh negative mothers ,where 48 (80%) of them were aged less than 30 years and 12 of them (20%) were more than 30 years of age. Antenatally, 51 (85%) women were ICT negative and received RAADP, 9(15%) women were ICT positive and anti D titres were less than 1:16 followed up with MCA-PSV which was normal/less than 1.5MoM. The total preterm births were 6(10%).The total admissions to NICU were 12(20%) in our study. All the 9 babies born to ICT positive mothers turned out to be Direct Coombs test (DCT) positive and were managed with double surface phototherapy. For 2(3.3%) babies, human immunoglobulin was given. Only 1(1.6%) baby required exchange transfusion. Conclusion: We conclude that, severe hyperbilirubinemia and hydrops foetalis, which were observed previously are drastically reduced with recent advances and the use of Routine antenatal Anti D prophylaxis (RAADP). Neonatal morbidity and mortality reduced drastically with newer advances like immunoglobulin reducing the need for exchange transfusion and better NICU care. ICT positivity of 15% despite of postnatal immunisation suggest that there is chances of silent fetomaternal haemorrhage during antenatal period, health care professionals should be more knowledgeble with prenatal screening, the value of blood grouping and Rh typing, anti-D immunisation following sensitising events like MTP, abortion, ectopic pregnancy, ECV and regular implementation of RAADP in clinical practice.