Rh incompatibility associated with the development of hemolytic disease of the fetus and newborn (HDFN) can cause of range of conditions, such as hemolytic anemia and hydrops fetalis, but recent advancements aid in better outcomes for the mother and baby, according to a study recently published in the International Journal of Science and Research Archives.
Rates of HDFN have been declining dramatically worldwide in the past few decades. One of the most serious adverse events related to the disorder is erythroblastosis fetalis, which may be reported in those with an ABO-incompatible or an Rh-incompatible pregnancy. Approximately 10% of all Rh-negative pregnancies lead to Rh incompatibility in an Rh-negative mother who is carrying an Rh-positive fetus.
Prenatal screening for HDFN includes blood typing, maternal Rh antibody via an indirect Coomb’s test (ICT) and ultrasound-guided amniocentesis. Blood typing, indirect bilirubin level, reticulocyte count and direct Coomb’s test (DCT) all are available for use in postnatal screening. Immunoprophylaxis with Rh immunoglobulin (RhIg) can be administered at 28 weeks’ gestational age and within 72 hours of delivery or termination of pregnancy.
Anti-RhIg is recognized as being the most extensively utilized and successful preventive method for reducing the incidence of Rh isoimmunization. The utilization of postnatal screening has also been associated with substantially lower rates of Rh isoimmunization following the use of routine antenatal anti-D prophylaxis (RAADP).
Read more about HDFN testing and diagnosis
In the current analysis, the researchers sought to assess feto-maternal outcomes in Rh-negative pregnancies. The study was performed among a total of 60 Rh-negative pregnant women who attended the antenatal clinic and delivered at the Akash Institute of Medical Sciences and Research Centre, Devanahalli, Karnataka, India, between October 2022 and March 2024.
All study participants underwent follow-up with ICT, middle cerebral artery-peak systolic velocity (MCA-PSV), and regular antenatal care. Following birth, blood grouping/Rh typing, DCT, duration of phototherapy, duration of stay in the neonatal intensive care unit (NICU) and the need for RhIg and exchange transfusion (ET) were recorded in all neonates, in an effort to evaluate maternal and neonatal outcomes.
Of the 60 Rh-negative mothers, 48 were younger than 30 years of age, and 12 were older than 30 years of age. Antenatally, 85% (51 of 60) of the participants were ICT-negative and received RAADP. Overall, 15% (9 of 60) of the mothers were ICT-positive with anti-D titers of less than 1:16. Results of MCA-PSV were normal/less than 1.5 MoM.
Rates of total preterm births were reported in 10% (6 of 60) of the mothers. Total NICU admissions were recorded in 20% (12 of 60) of the neonates. All of the nine infants who were born to ICT-positive mothers were DCT-positive and underwent double-surface phototherapy. Human immunoglobulin was administered in two of the babies, and only 1 newborn needed to receive an ET.
Rates of severe hyperbilirubinemia and hydrops fetalis have been dramatically reduced by the use of RAADP and other recent advancements.
“Health care professionals should be more knowledgeable [about] prenatal screening, the value of blood grouping and Rh typing, anti-D immunization following [sensitizing] events [such as] MTP [medical termination of pregnancy], abortion, ectopic pregnancy, ECV [external cephalic version,] and regular implementation of RAADP in clinical practice,” the authors concluded.
