Pregnancy outcome For Rh-D Alloimmunized Pregnancies at Two Teaching Hospitals (Tash And Gmh), Addis Ababa, Ethiopia, 2023
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Date
2023-10
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Addis Ababa University
Abstract
Background: Rh alloimmunization refers to the process by which antibodies are produced against the Rh antigens that are found on the surface of red blood cells (RBCs). The disease burden is worse in developing countries, where universal anti D prophylaxis for Rh negative mothers is very suboptimal. The annual burden of still birth, neonatal death & severe hyperbilirubinemia is projected to be 41,000, 90,000, and 97,000 respectively. In a recent studyat the three teaching hospitals of AAU the prevalence of Rh Alloimmunization is found to be17.1%. This study provides measured pregnancy outcome for those mothers who are alloimmunized with Rh D antigen.
Objective: The aim of this study was to show the pregnancy outcome for RH-Dalloimmunized pregnancies in the setup of two public hospitals (TASH and GMH) in AddisAbaba, Ethiopia.
Methodology: A hospital-based retrospective cross-sectional study was conducted on 52pregnant women with Rh-D alloimmunization and managed at Tikur Anbesa Specialized Hospital (TASH) and Gandi Memorial Hospital (GMH) from January 2019 to January 2023. The data were collected by means of structured questionnaires. The data were entered, coded, and analyzed using Statistical Package for Social Science (SPSS) version 25. Descriptive statisticswere used to assess the pregnancy outcome of pregnant women with RhD alloimmunization.Cross-tabulation was done to see the relation between variables.
Results: From the 52 pregnancies (4 with hydrops, 48 without hydrops), 44.2% had an intrauterine transfusion (IUT) during pregnancy, while 55.8% were not transfused. Among these,42.3% of them didn’t receive anti D prophylaxes in all pregnancies and 44% of them had unknown titer at booking. The median number of IUTs per fetus was two. Nearly twenty-eight(27.7%) had developed jaundice, 21% had developed anemia, and 8.5% had developed both jaundice and anemia. There were four perinatal deaths: two stillbirths and two early neonatal deaths. The general neonatal survival after alloimmunization was 90.4%; in the absence of hydrops 95.7% of the fetuses survived, whereas in the presence of hydrops, it dropped to 25%.
Conclusion and Recommendation: Rh D alloimmunization associated perinatal morbidity and mortality is a significant but less recognized problem. Neonatal jaundice is the major morbidity, whereas fetal hydrops is the major contributor for the perinatal mortality. AntiD antibody coverage should be improved and antibody titers need to be determined for all Rhalloimmunized pregnancies at booking. A prospective study with a large sample size is needed to identify factors affecting the survival of hydropic fetuses after IUT.
Key terms: RH-D alloimmunization, intrauterine transfusio
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Keywords
RH-D alloimmunization intrauterine transfusion hydrops, ,