ABSTRACT
Since the introduction of routine postpartum prophylaxis in the 1960s, the crude incidence of Rhesus isoimmunization has been declined all over the world. Iraq and due to many years of sanctions and wars had many occasions where there was a limited supply of this valuable injection. To evaluate the effectiveness of our preventive postnatal prophylactic protocol for Rhesus isoimmunization. A Cohort observational study conducted at a private clinic and AL-Elwyia Maternity Teaching Hospital between the start of April 2010 till the end of June 2011. A total of 500 women were enrolled in the study; who were Rhesus D-ve pregnant women, married to Rhesus D+ve husbands, and had a Rhesus D+ve neonate and received the usual postpartum prophylactic dose after the previous deliveries when needed. Maternal plasma level of IgG-D concentration was determined by performing Indirect Coomb's test to the mother on admission and neonatal blood group and plasma level of IgG-D concentration was determined by performing direct Coomb's test to the neonate. All the previous and current relevant obstetrical and gynecological events were included in the study and analyzed. Data analysis was done using SPSS which included percentages according to cross tabulation of background of sample groups and Chi- square test for the associations. The prevalence rate of positive Indirect Coomb's test in the study sample was [10.4%] [95% confidence interval ranging between 7.9 to 13.5%], and it was strongly related to gravidity, were gravidity group [G5+] increased the rate of positive Indirect Coomb's test to [25.4%], which is significantly higher than that of primigravida[G1]. A positive past history of early pregnancy loss significantly increased the rate of having a positive Indirect Coomb's test by [29.9%]. There is an urgent need in our country to improve our current postnatal prophylactic program based on the high sensitization rate which is so far from the global rate
ABSTRACT
According to the United Nations Population Fund [UNFPA] 2003 report, there is an increase in spontaneous and unsafe abortions in Iraq. However, there is no data on the exact number of unintended pregnancies that end in an illegally performed abortion. The current work presents an observational longitudinal study that was performed in Al Elwyia Maternity Teaching Hospital, throughout the year 2007. The relative frequency of unsafe abortions among all abortions treated in our hospital before 24 weeks of gestation for any indication during the year 2007, was 322/3100= 104/1000 abortions, with 95% confidence interval for prevalence [93-115]/1000 abortions. All those women had a direct interview with a special questionnaire and clinical examination which was conducted thereafter. Most of our patients, with unsafe abortions; [62.1%] were found to be between 20-30 years of age. [99.4%] were parous. The most common mode of termination was combined medical and surgical methods; done by health professionals other than doctors [87.0%]; with a confidence interval [83.3 - 90.7]. In [63.0%] of cases; the diagnosis of pregnancy was confirmed by ultrasound and abortion was confirmed to be illegal; mainly by history from the patient / husband and or relative companion in [91%], with a confidence interval [87.9 - 94.1]. Failed contraception used due to improper pill intake represented [53%] of cases. Decision for abortion was taken by the wife herself in [64%] and was due to financial reasons mainly. The most common presentation was septic abortion [86%] with a confidence interval [63.5 - 73.7]. [70.8%] who required 1 -3 units of blood transfusion. Unsafe abortion is still an ethical, religious and medical problem all over the world; including our country and the main determining factor for termination of pregnancy amongst those women appeared to be the fact that it was unwanted and/or unplanned; either because of inappropriate timing, the relationship itself, as well as social and economic implications which are important issues. Improper contraceptive use was an important contributing factor. In addition, misuse of Misoprostol, which became available over the counter for patients, midwifes and nurses, needs careful attention. There is a real need to update/upgrade our national family planning and the access to contraception policy, modifying this policy to meet our emerging social conditions