Most cases of rhesus isoimmunization are not reported. This is due to the association of cultural and religious belief  to some of these cases. A lot of women have lost a number of pregnancies due to rhesus isoimmunization. Some do complain that anytime they become pregnant, it ends as miscarriage.

Unfortunately, most of those affected do not seek medical intervention due to their cultural and religious belief. They hold on to fate. Some even visit several unqualified ‘so called health workers’ where they are deceived after putting in a lot of expenses. It is heartbreaking to know that this preventable condition has caused chaos in a lot of families.

This article will educate you on what rhesus isoimmunization is, its complications and how it could be prevented. We will also discuss some case studies I have come across during my practice. 

About rhesus factor

Every individual has a genotype, blood group and rhesus factor. Each is significant in its own way and any of these can cause incompatibility. Rhesus factor is inherited from any of your parents. You need to note that rhesus factor does not affect your health, its significance is seen during pregnancy and blood transfusion.  

There are 2 types of rhesus factor; rhesus negative and rhesus positive. Over two third of people worldwide are rhesus positive. This implies rhesus negative individuals are minute in number compared to their positive counterparts. 

Why are they rhesus negative? This is because they lack a protein on their red blood cells. 

What is rhesus isoimmunization?

This is also called rhesus incompatibility. It occurs in rhesus negative individuals. Although it can occur in men during blood transfusion,  its significance is more in women during pregnancy. It does not occur in all rhesus negative women.

This incompatibility is seen when an individual with rhesus negative blood is exposed to rhesus positive blood. For example, a man or woman who is rhesus negative, rushed to the hospital and required blood transfusion but unfortunately was transfused with rhesus positive blood will likely develop rhesus incompatibility. So also a rhesus negative pregnant woman carrying a rhesus positive baby in her womb will likely develop rhesus incompatibility. 

How rhesus isoimmunization occurs?

A rhesus negative woman married to a rhesus positive man can be pregnant with a rhesus positive baby. If a rhesus negative woman is pregnant with a rhesus positive baby, she can become exposed to rhesus positive blood of the baby during delivery, miscarriage, abortion or any bleeding in pregnancy.

This rhesus positive blood sensitizes the woman to produce soldiers that will fight the source of the rhesus positive blood. It takes some time for these soldiers to be produced and usually the first pregnancy escapes the disastrous effect of this sensitization. Once a woman is sensitized, she remains sensitised for life. 

Complications that occur in rhesus isoimmunization 

The risk of complications in already sensitized women increases with each subsequent rhesus positive pregnancy. Some babies who are lucky do not die in the womb. Rather, they are given birth to with low blood. Some might even be jaundiced after delivery requiring expert intervention. The unlucky ones die in the womb.

Rhesus incompatibility does not cause ill health to the mother. Rhesus incompatibility is unlikely to occur if a rhesus negative woman marries a rhesus negative man.

How then can rhesus isoimmunization be prevented?

Any rhesus negative woman married to a rhesus positive man should ensure RHOGAM injection is taken within 72hours after a delivery or miscarriage, or bleeding during pregnancy. This will help prevent sensitization of the woman’s blood to that of the fetus.

You need to also note that your doctor may request for some tests early in your pregnancy to be sure your blood has not been sensitized. Although some tests could detect the rhesus factor of a baby in the womb, they are not widely available. A rhesus negative woman carrying a rhesus negative baby will not need RHOGAM as there will be no sensitization. Unfortunately, the test is not readily available. 

This is why every rhesus negative woman married to a rhesus positive man is advised to take RHOGAM within 72hours after delivery, preferably 24hrs after delivery. 

What if you are already sensitized?

There are rhesus negative women who have  delivered or had abortion in the past and did not take RHOGAM. This was done out of ignorance. Some of these women carrying another pregnancy are already sensitized and have a lot of questions on the fate of this present pregnancy.

Yes, it is possible for the present and subsequent pregnancies to survive it BUT you need an expert management. You need to register in a teaching hospital where all hands are on deck and be sincere with your history to your managing team. 

Case studies

I will like to share 3 of the cases I have come across during my practice. The first will surprise you.

Mrs A was seen at a health facility with her 5th pregnancy. She is rhesus negative. All her children are alive and well and she has never taken RHOGAM because she is not aware of it. I believe you should be able to guess why or are you actually surprised?

The reason is her husband is rhesus negative. For another woman, it might be that all her children are rhesus negative. Should we say she is lucky? Maybe. If her husband were to be rhesus positive, only the first child would have been spared. Others might have ended up as miscarriage, or might even die in the womb. The one that escaped death might come out with complications in need of expert intervention.

The second case is that of Mrs B carrying her second pregnancy and she is rhesus negative. She is married to a rhesus positive man. Her first child is rhesus positive and he is alive and well, please note that she did not take RHOGAM after the first delivery. She visited the clinic at 29weeks  because she couldn’t feel her baby’s kick any longer.

An urgent scan done revealed the baby is dead in the womb. What could have happened? Her body was sensitized after her first pregnancy whose effect is being seen in the second pregnancy.  

The third case is that of Mrs C, a rhesus negative woman married to a rhesus positive man. She ensured her RHOGAM injection within 72hours after each delivery.  Now she has 4 children, all are alive and well.

Conclusion 

Rhesus isoimmunization can leave a physical and psychological impact on a woman. Don’t wait for this. Ensure you take your RHOGAM injection after each delivery if you are a rhesus negative woman married to a rhesus positive man.