Perinatal outcomes and hematologic parameters of neonates born to Rh-negative mothers with and without isoimmunization
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251988Keywords:
Rh isoimmunization, Hemolytic disease of the newborn, Hyperbilirubinemia, Neonatal anemia, Perinatal outcomesAbstract
Background: Rh isoimmunization remains a significant cause of neonatal morbidity and mortality in Rh-negative pregnancies. It causes hemolytic disease of the fetus and newborn (HDFN), leading to anemia, hyperbilirubinemia, and perinatal complications. This study compares hematologic parameters and perinatal outcomes of neonates born to Rh-negative mothers with and without isoimmunization.
Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Bangladesh, from July 2019 to December 2019. Eighty Rh-negative pregnant women were enrolled, comprising five isoimmunised and seventy-five non-isoimmunised mothers. Data on neonatal haemoglobin, serum bilirubin, direct Coombs test results, Apgar scores, and treatment requirements were collected. Maternal factors were documented, including gravidity, antenatal care, and anti-D prophylaxis. Statistical analyses used SPSS version 25.0, with p-values <0.05 considered significant.
Results: Neonates of isoimmunised mothers had lower haemoglobin levels (mean <12 g/dl in 60% vs. 0%, p<0.001), elevated bilirubin ≥4 mg/dl (80% vs. 20%, p<0.001), and 100% direct Coombs test positivity compared to none in non-isoimmunised neonates. Phototherapy and exchange transfusion were required in 80% and 60% of isoimmunised neonates, significantly higher than the non-isoimmunised group. Poor Apgar scores (<6 at 5 minutes) were more frequent in isoimmunised neonates (40% vs. 12%). High gravidity, inadequate antenatal care, and absent anti-D prophylaxis were prevalent among isoimmunised mothers.
Conclusion: Rh isoimmunization markedly worsens neonatal hematologic and perinatal outcomes. Strengthened antenatal screening, universal anti-D prophylaxis, and enhanced neonatal care are critical to reducing HDFN burden in at-risk populations.
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References
Dutta DC. Pregnancy in Rh negative woman. In: H. Konar, eds. Text Book of Obstetrics.8th ed, Kolkata, New Central Book Agency Limited. 2014:386-400.
Landsteiner K, Wiener AS. An agglutinable factor in human blood recognized by immune sera for rhesus blood. Proceed Soc Experim Biol Med. 1940;43(1):223-5. DOI: https://doi.org/10.3181/00379727-43-11151
Flegel WA. The genetics of the Rhesus blood group system. Blood transfusion. 2007;5(2):50.
Hira RM, Dhali LK, Dhali ND, Akash DK. ABO and Rh-D blood group distribution in a rural population of Bangladesh. Medisc. 2015;2(1):22-6. DOI: https://doi.org/10.3329/mediscope.v2i1.24736
Agarwal K, Rana A, Ravi AK. Treatment and prevention of Rh isoimmunization. J Fetal Medi. 2014;1(02):81-8. DOI: https://doi.org/10.1007/s40556-014-0013-z
Hendrickson JE, Delaney M. Hemolytic disease of the fetus and newborn: modern practice and future investigations. Transfusion Med Rev. 2016;30(4):159-64. DOI: https://doi.org/10.1016/j.tmrv.2016.05.008
Aitken SL, Tichy EM. RhOD immune globulin products for prevention of alloimmunization during pregnancy. American J Health-Sys Pharm. 2015;72(4):267-76. DOI: https://doi.org/10.2146/ajhp140288
Koelewijn JM, Vrijkotte TG, Van Der Schoot CE, Bonsel GJ, De Haas M. Effect of screening for red cell antibodies, other than anti‐D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands. Transfusion. 2008;48(5):941-52. DOI: https://doi.org/10.1111/j.1537-2995.2007.01625.x
DeCherney AH, Nathan L, Laufer N, Roman AS, Goodwin M, Nathan L, Roman AS. Current diagnosis and treatment. Obst and Gynecol. 2013;10.
Bowman JM. Hemolytic disease (erythroblastosis fetalis). Maternal–fetal medicine, 4th edn. Philadelphia: WB Saunders. 1999:759-61.
Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Nelson textbook of pediatrics e-book. Elsevier Health Sciences. 2007.
Moitra B, Kumari A, Sahay PB. Obstetrical and perinatal outcome in rhesus antigen negative pregnancy. International J Sci Study. 2015;2(11):124-9.
Eleje GU, Ilika CP, Ezeama CO. Fetomaternal outcomes of women with Rhesus isoimmunization in a Nigerian tertiary health care institution. J Preg Neonatal Med. 2017;1(1):21-7.
Nagamuthu EA, Mudavath P, Prathima P, Bollipogu S. Prevalence of rhesus negativity among pregnant women. International J Res Med Sci. 2016;4(8):3305-9. DOI: https://doi.org/10.18203/2320-6012.ijrms20162284
Khatun J, Begum R. Effect of Rhesus negative in pregnancy. Medicine. 2018;30(1):23-5. DOI: https://doi.org/10.3329/medtoday.v30i1.35561
Tripathi R, Singh N. Maternal and perinatal outcome in Rh negative mothers. Int J Reproduct, Cont, Obst Gynecol. 2018;7(8):3141-7. DOI: https://doi.org/10.18203/2320-1770.ijrcog20183306