A Review of Rhesus Iso-Immunization in a Nigerian Obstetric Population
AbstractContext: Haemolytic disease of the newborn, a problem that has not been sufficiently investigated in the Nigerian population, leads to significant perinatal morbidity and mortality.
Objectives: To determine the incidence of Rhesus (Rh) isoimmunization and the utilisation rate of Rh-immunoprophylaxis in our population.
Methods: A review of the clinical records of all Rh-negative pregnancies, booked at the Federal Medical Centre, Abeokuta between July, 1996 and June, 2000. The mothers' and infants' records were analysed for age, parity, ante-natal antibody status and some selected characteristics in the infant.
Results: Seventy-seven Rh-negative pregnancies were managed, accounting for 2.6% of the total obstetric population. Those who received immuno-prophylaxis following previous abortions and deliveries were 15.4 % and 38.2% respectively. Initial testing, at booking, for sensitization was not done in 36.5% of the women, while 63.4% had no follow-up testing. The incidence of ante-natal sensitization was 1.3%. The time of onset of neonatal jaundice was 26.5 + 14.6 hours (mean + SD) in Rh-positive infants, compared to 44.4 + 17.8 hours in Rh-negative infants (p = 0.07). The haematocrit of both groups of infants were similar [42.8 + 5.8 versus 44.5 + 5.3; p = 0.6]. There was no perinatal death. The partners' Rh-status was determined in 59.7% and the infants' Rhesus group in 71.6%. Immunoprophylaxis rate was poor (44.8%). The majority of those who declined immunoprophylaxis did so for financial reasons.
Conclusion: The risk of haemolytic disease of the newborn with its attendant perinatal morbidity and mortality is real in our community, yet the rate of Rh-immunoprophylaxis remains quite low in our obstetric population.
(Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2):69-72)
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