Rhesus incompatibility: Why children die at birth

EVERY time she gets pregnant, she doesn’t deliver the baby. She must be a witch to be sacrificing her babies.” “Her mother-in-law doesn’t like her, so her babies will continue to die.” “No, it is the husband’s sister; she said it at the beginning that she would never have a baby.”

Thousands of women daily listen to these statements because of the myths that surround why children die at birth in Nigeria. Their babies are mystically called Ogbanje or Abiku and this belief has made it difficult for many of these women to find a solution to their problems.

Dr Titi Adeyemo, a haematologist with the Lagos University Teaching Hospital, Idi-Araba, speaking at a webinar hosted by Rhesus Solution Initiative with the theme “Rhesus Incompatibility, the Myths and the Simple Solution of Awareness,” stated that rhesus incompatibility between mother and child and consequently, the rhesus disease that results, are preventable contributors to these deaths.

Rhesus incompatibility is a common but serious situation. 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.

According to Dr Adeyemo: “During pregnancy, the placenta prevents the mixing of the mother’s and baby’s blood. But, some things happen that allows the baby’s blood to leak into the mothers’ bloodstream, making her develop an antibody against the baby’s red blood cells.

“The antibodies she develops are small proteins molecules that the placenta cannot filter from crossing the placenta and attack the baby’s blood cells. And this is why you have serious health problems, including the death of the baby if there is no intervention. Even if the baby avoids death while still in the womb, the baby can die soon after birth.”

According to her, the mixing of the mother and baby’s blood can occur during labour and childbirth, when there is intermittent bleeding in pregnancy or a medical procedure that involves taking a little bit of the placenta for testing or attempt to manually turn the baby to become head first to be ready for birth. Also, it can occur after a miscarriage, ectopic pregnancy, induced abortion or criminal abortion.

Dr Adeyemo, added, “So during pregnancy, a woman who has been alloimmunised, will start to make antibodies in every of her subsequent pregnancy. Her body is going to recognize the baby as an invader and starts to attack the baby’s blood cells.

“This eventually causes serious anaemia in the unborn baby because the baby’s red blood cells are being destroyed faster than the baby’s body can replace them. Without oxygen, the baby cannot grow. In severe cases, the baby will die while still inside the womb or die soon after birth. Apart from the severe anaemia, it will also cause jaundice in the baby. This is what we call rhesus disease.

“So that is why the doctors say we have to quickly do blood transfusion to manage jaundice. If the jaundice is not managed, especially when it is severe, bilirubin, a by-product of the destroyed red cells, can easily cross into baby’s brain to cause a permanent brain damage, including cerebral palsy.”

Nonetheless, Dr Adeyemo stated that these problems that arise in pregnancy due to rhesus incompatibility and rhesus disease are preventable if every woman know and are aware of their blood group and Rhesus factor before reaching childbearing age.

She declared that managing a woman that has been alloimmunised is very tasking and expensive to ensure she ends up with a healthy, live baby afterwards.

“The main goal of treatment is to stop a rhesus negative woman from making rhesus antibody in the first place,” she declared.

All they need is one or two doses of an anti-D immunoglobulin medication to prevent the antibodies from forming. The anti-D immunoglobulin will prevent the mother’s immune system to recognise this rhesus positive cell of her baby as a foreign invader.

As a result, the mother’s body does not make her own rhesus antibodies. The treatment is good only for the pregnancy for which it is giving. Each pregnancy and delivery of a rhesus positive baby requires a repeat dose.

Moreover, she said rhesus incompatibility is usually not a problem during a woman’s first pregnancy with a rhesus positive baby. This is because for the first pregnancy, she does not have an antibody and the body does not know anything about any rhesus factor, and she may be lucky and deliver the baby without any problems.

“Subsequent pregnancies are going to suffer from rhesus disease because she will continue to produce rhesus antibodies throughout her life. That is why that medication has to be given within 72 hours of the delivery to prevent her from developing antibodies that will be a problem for her subsequent pregnancies.”

Dr Adeyemo, however, stated that ensuring all women gets a rhesus antibody screen is important because the possibility of rhesus negative woman ending up with a rhesus positive baby is very high.

According to her, “the number of people who are rhesus positive in the society is 19 in every 20 people, meaning the possibility of a rhesus negative woman’s husband been rhesus positive is 19 out of 20. That also means that the probability that her baby is rhesus positive is a 19 out of every 20. The baby can inherit the rhesus factor either from the father, the mother or both parents.”

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