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Rhesus incompatibility: Why children die at birth

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Kunle Emmanuel
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Rhesus incompatibility: Why children die at birth

Unread post by Kunle Emmanuel » Thu Apr 21, 2016 11:55 am

When Bukola, 27, became pregnant two months after marriage, her joy knew no bounds. She and Akin, her husband, were so elated they immediately set about preparing for arrival of their first child. Little did they know what fate had in store.

Bukola went through an uneventful gestation period and safely put to bed at a private hospital. It was then their travails began. The baby’s health became a growing concern and to the dismay of all, died few days after birth. The couple was devastated. Bukola in particular was inconsolable.

To make up for the loss, sympathisers suggested they set about having another baby immediately. A couple of months afterwards, their prayers were answered. The couple became happy again. The couple prayed fervently that for the survival of this new baby. Alas, history repeated itself. The baby died shortly after birth.

Something was definitely amiss. Investigation soon revealed the cause of the problem. Series of tests showed an incompatibility between mother and child’s blood groups. Doctors said they were Rhesus incompatible. Further investigation showed Akin and Bukola never carried out the necessary blood grouping medical tests before they were married.


Another woman, Nkechi who had her first pregnancy during her first year in the university but had it terminated, had a similar experience. At the time she opted for the elective abortion, Nkechi did not know her blood group or rhesus status. Attempts to give birth later proved futile as her babies died one after the other.

Tongues began to wag. While some said Bukola’s children were Ogbanje, others swore Nkechi’s children were Abiku . The predicament of these two women is typical of the situation many other Nigerian women often find themselves. Rhesus incompatibility is a common but serious situation. A rhesus negative woman, who gives birth to a rhesus positive baby would encounter problems. Experts say she would have difficulty having live babies.

In this part of the world, when a woman consistently loses a child few days after delivery, such children are mystically called ogbanje or Abiku and this belief has made it difficult for most victims to find solution to their problems. However, medical evidence shows that Rhesus incompatibility occurs between an unborn baby and its mother as a result of the generation of antibodies by the mother’s immune system against the baby’s red blood cells.

Normally, pregnant women do not display any symptoms of this reaction, but babies born with this condition often have anaemia and jaundice. The symptoms in newborn babies include jaundice and anaemia (a lack of red blood cells). Babies with the condition will usually need to be admitted to a neonatal unit. Treatment includes phototherapy (treatment with light) and, possibly, bloods transfusions.

If left untreated, the effects of the jaundice in the newborn baby can lead to learning difficulties, deafness, and blindness. Severe cases can lead to stillbirths. This condition also called Rh (D) disease, or haemolytic disease of the newborn can only happen if the mother has rhesus-negative blood (RhD negative), the baby has rhesus-positive blood (RhD positive), or if the mother has previously been sensitised to RhD positive blood.

In Nigeria today, statistics available have shown that Rhesus disease contributes to the incidence of 144 Nigerian women who die daily from pregnancy and childbirth complications. It has also been found that it is another major cause of the country’s high infant maternal mortality rate. Worse still, women who might have had a history of elective abortion could have been exposed to the condition.

According to a Paediatric Surgeon at the Lagos State University Teaching Hospital (LASUTH), Prof Akin Bankole, many of children had died due to the Rhesus incompatibility from their parents who were ignorant of their status.

“ A Rhesus negative woman by nature would have difficulty having live babies. Those that have could have children with the disease, they would eventually die”

Bankole explained that sensitisation occurs when a woman with RhD negative blood is exposed to RhD positive blood. This could happen during a pregnancy with a RhD positive baby, or if the woman has a blood transfusion with RhD positive blood.

The woman’s body responds to the RhD positive blood by preparing to attack it with antibodies (infection-fighting chemicals). The first time this happens it is known as sensitisation.

Unfortunately, most young ladies who may have been exposed to abortion may also have been sensitised without knowing it.

“If sensitisation has occurred, the next time the woman is exposed to RhD positive blood, her body will start to produce antibodies immediately. If she is pregnant with a RhD positive baby, the antibodies can cross the placenta and cause rhesus disease in the baby.” Although, there are measures to ensure that a Rhesus negative woman was able to deliver life babies, most Nigerian women are ignorant of their Rhesus status.

However, an injection of anti-D immunoglobulin was introduced in 1977 to prevent sensitisation, and has reduced the number of cases of rhesus disease by 90 per cent. Knowing ones rhesus status and including it into the routine screening for all pregnant women would reduce deaths in infants and mothers.

Furthermore, the disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother would receive an intramuscular injection of anti-Rh antibodies (Rho (D) Immune Globulin) so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them.


This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood. In the same vein, it’s part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation).

This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation.

Read more at: http://www.vanguardngr.com/2011/01/rhes ... -at-birth/


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Re: Rhesus incompatibility: Why children die at birth

Unread post by Kunle Emmanuel » Thu Apr 21, 2016 12:08 pm

The Rh factor is an inherited protein found on the surface of red blood cells. Most people have this protein and are called Rh-positive. However, some people don’t have protein; they are called Rh-negative.

Rh-negative pregnant women are at risk of having a baby with a potentially dangerous form of anemia called Rh disease. Fortunately, treatment usually can prevent Rh disease.

Hemolytic disease of the newborn (HDN) used to be a major cause of fetal loss and death among newborn babies. The first description of HDN is thought to be in 1609 by a French midwife who delivered twins—one baby was swollen and died soon after birth, the other baby developed jaundice and died several days later.

For the next 300 years, many similar cases were described in which newborns failed to survive. It was not until the 1950s that the underlying cause of HDN was clarified; namely, the newborn’s red blood cells (RBCs) are being attacked by antibodies from the mother. The attack begins while the baby is still in the womb and is caused by an incompatibility between the mother’s and baby’s blood. By the 1960s, trials in the United States and the United Kingdom tested the use of therapeutic antibodies that could remove the antibodies that cause HDN from the mother’s circulation. The trials showed that giving therapeutic antibodies to women during their pregnancy largely prevented HDN from developing (1).

By the 1970s, routine antenatal care included screening of all expectant mothers to find those whose pregnancy may be at risk of HDN, and giving preventative treatment accordingly. This has led to a dramatic decrease in the incidence of HDN, particularly severe cases that were responsible for stillbirth and neonatal death.

How does Rh disease affect a fetus or newborn?

Rh disease destroys fetal red blood cells. It once was a leading cause of fetal and newborn death. Without treatment, severely affected fetuses often are stillborn. In the newborn, Rh disease can result in jaundice (yellowing of the skin and eyes), anemia, brain damage, heart failure and death. It does not affect the mother’s health.

Causes

An Rh-negative mother and an Rh-positive father may conceive an Rh-positive baby. When this occurs, some of the fetus’s Rh-positive red blood cells may get into the mother’s bloodstream during pregnancy, labour and birth. Because red blood cells containing the Rh factor are foreign to the mother’s system, her body tries to fight them off by producing antibodies against them. This is called sensitization.

Once a woman becomes sensitized, her Rh antibodies can cross the placenta and destroy some of the red blood cells of an Rh-positive fetus. In a first pregnancy with an Rh-positive baby, there usually are no serious problems because the baby often is born before the mother is sensitized, or at least before the mother produces many Rh antibodies. However, a sensitized woman continues to produce Rh antibodies throughout her life. This means that in a second or later pregnancy, an Rh-positive baby is at risk for more severe Rh disease.
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Re: Rhesus incompatibility: Why children die at birth

Unread post by Kunle Emmanuel » Thu Apr 21, 2016 12:10 pm

How to know if a woman is Rh-negative?

A simple blood test can tell if a woman is Rh-negative. Every woman should be tested at her first prenatal visit, or before pregnancy, to find out if she is Rh-negative. Another blood test can show if an Rh-negative woman has become sensitized.

Prevention

An unsensitsed Rh-negative pregnant woman can be treated with injections (shots) of a purified blood product called Rh immune globulin (RhIg) to prevent sensitisation. She most likely receives RhIg at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that her baby is Rh-positive She does not need an injection after delivery if her baby is Rh-negative.

Symptoms

Rhesus disease only affects the baby. The mother should not feel any symptoms during pregnancy or after the baby is born. If your baby develops rhesus disease while still in the womb, it may become anaemic. The two main symptoms of rhesus disease in a newborn baby are haemolytic anaemia and jaundice.

Diagnosis

Blood testing. A sample of blood will be taken early on in your pregnancy so that it can be tested for conditions such as: anaemia, rubella, HIV and hepatitis B Your blood will also be tested to determine which ABO blood group you are, and whether your blood is rhesus (RhD) positive or negative.

If you are RhD negative, the father of your baby may also be tested to determine his blood group. If he is also RhD negative then your baby will be as well, and rhesus disease is not possible. However, if the father is RhD positive then your baby could be too and rhesus disease is a possibility. If you are RhD negative, a test will be carried out to make sure your blood is not producing antibodies (known as anti-D antibodies).

Your blood will also be checked again at 28 and 36 weeks of pregnancy. If you are RhD negative, and your blood is producing anti-D antibodies, it is possible that your baby could develop rhesus disease.

Determining Rh status of the mother

As part of routine prenatal or antenatal care, the blood type of the mother (ABO and Rh) is determined by a blood test. A test for the presence of atypical antibodies in the mother’s serum is also performed. At present, Rh D incompatibility is the only cause of HDN for which screening is routine.

Treament

Mild rhesus disease does not require any treatment but, following birth, your baby will need to be monitored on a regular basis. In some cases, the symptoms can get worse, or they may not show for up to three months. For more moderate cases of rhesus disease, phototherapy and blood transfusions can be used to speed up the removal of bilirubin from the body.

Complications

Scientific advancements have led to rhesus disease now being a rare condition. However, there are still some risks to both unborn and newborn babies. For unborn babies: If rhesus disease causes severe anaemia in the foetus it can cause: foetal heart failure, fluid retention, swelling and, occasionally and stillbirth (when a baby dies in the womb before being born)

Prevention

Rhesus disease can be avoided if sensitisation is prevented. If a RhD negative woman has not been sensitised to RhD positive blood, an injection of anti-D immunoglobulin can prevent her being sensitised. If no sensitisation occurs, rhesus disease cannot develop.

Anti-D immunoglobulin: Sensitisation is avoided by administering anti-D immunoglobulin. The anti-D immunoglobulin neutralises any foetal RhD positive antigens that have entered the mother’s blood. If the antigens have been neutralised, the mother’s blood will not start to produce antibodies.

You will be offered anti-D immunoglobulin after a potentially sensitising event, during which some foetal RhD antigens may have entered your blood. For example, if you experience any bleeding during your pregnancy, if you have an invasive procedure (such as amniocentesis), or experience any abdominal injury, anti-D immunoglobulin may be administered.

Routine antenatal anti-D prophylaxis: There are currently two ways that you can receive RAADP:

* a one-dose treatment: where you will receive an injection of immunoglobulin in your shoulder during weeks 28-30 week of your pregnancy
* a two-dose treatment: where you will receive two injections into your shoulder; one during the 28th week, and the other during the 34th week of your pregnancy

Anti-D immunoglobulin after birth: After giving birth, a sample of your baby’s blood will be taken from the umbilical cord. If your baby is RhD positive, and you have not already been sensitised, you will be offered an injection of anti-D immunoglobulin within 72 hours of giving birth.

The injection will destroy any RhD positive blood cells that may have crossed over into your bloodstream, either during the pregnancy or during the delivery. This will prevent sensitisation because your blood will not have a chance to produce antibodies, significantly decreasing the risk of your next baby having rhesus disease.

Complications from anti-D immunoglobulin

Some women may develop a slight short-term allergic reaction to anti-D immunoglobulin, which may include a rash or flu-like symptoms. Although the anti-D immunoglobulin taken from the donor blood will be carefully screened, there is a small risk that an infection could be transferred through the blood.

Causes of rhesus disease

Rhesus disease is caused by a specific mix of blood types between a pregnant mother and her unborn baby.

Rhesus disease is only possible if: the mother is rhesus-negative (RhD negative)
* the baby is rhesus-positive (RhD positive)
* sensitisation (see below) has previously occurred Blood types:

There are several different types of human blood. The four main blood groups are:

* blood group A
* blood group B
* blood group AB
* blood group O Each of these blood groups can either be:
* RhD positive
* RhD negative

Whether someone is RhD positive or RhD negative is determined by the presence of the rhesus D antigen (RhD). An antigen is a protein molecule that is found in your blood (see Antigens and antibodies below). People who have this antigen are RhD positive, and those without it are RhD negative. In the UK, around 85% of the population are RhD positive.

How does sensitisation occur?

The most likely time that RhD positive blood cells could have entered the mother’s blood is during an earlier pregnancy with a baby who was RhD positive. During pregnancy, sensitisation can happen in a number of ways.
These are listed below.
* Small numbers of foetal blood cells cross into the mother’s blood during a normal pregnancy. Although the mother and baby have separate circulatory systems, blood cells can cross over, occasionally leading to sensitisation.
* It is likely that the blood of the mother and baby will come into contact during delivery, which can lead to sensitisation. * If there has been bleeding in the pregnancy – for example, during a threatened miscarriage, it may cause sensitisation. * If an invasive procedure has been necessary during pregnancy – such as amniocentesis, or chorionic villus sampling (CVS), it may cause sensitisation.
* If the mother has had an abdominal injury – for example, in a road traffic accident, it may cause sensitisation. Sensitisation can also occur after a previous miscarriage, or ectopic pregnancy, or if a RhD negative woman has received a transfusion of RhD positive blood.

What does sensitisation do?

Sensitisation has no adverse effects on the mother. Providing that she has not previously been sensitised in another way, it is also unlikely to affect the first RhD positive baby that she has. If sensitisation occurs during the delivery of a woman’s first RhD positive baby, it is unlikely that she will produce enough antibodies to affect the baby before it is delivered. However, if sensitisation has happened earlier, or in a previous pregnancy, RhD positive babies are at risk of developing rhesus disease.

By Sola Ogundipe

Source: http://www.vanguardngr.com/2011/01/rhes ... -at-birth/
Read more at: http://www.vanguardngr.com/2011/01/rhes ... -at-birth/
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Re: Rhesus incompatibility: Why children die at birth

Unread post by Matron Ben » Wed Jul 26, 2017 8:13 pm

This is a vital topic. Women with this condition who deliver in other places other than a government hospital, usually say the enemies are d ones killing their children. Hence, we advocate that pregnant women should go to skilled midwives who can detect a prospective victim through blood group test during ante natal care.

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