TO DETERMINE FETOMATERNAL OUTCOME IN RH NEGATIVE PREGNANCY

Background: The present study was conducted to determine the fetomaternal outcome among Rh-negative pregnancies presenting to a secondary care hospital of North India. Methods: A prospective observational design was carried out among Rh negative mothers presenting to the Department of Obstetrics and Gynecology of Swaroop Rani Hospital, Prayagraj, from December 2021 to July 2022. On admission each mother was interviewed using a questionnaire. ABO/Rh grouping of the mothers as well as their husbands/partners were done. Rh antibody titers of the patients were done at first visit and repeated at 28 and 32 weeks respectively. The labor of each of the mothers was monitored carefully, with the mode of delivery and outcome of labor being recorded in the proforma. For the Rh typing of the neonate, cord blood was collected after delivery and sent for ABO/Rh grouping. Both the mother and the neonate were followed up till their discharge/death, and any adverse maternal or neonatal outcome in this period were noted. Results: During the study period, 46 mothers were assessed. The mean age was 23.9±1.4 years. Most of the mothers were multipara. 4.4% of them had a raised Rh antibody titer. Of the mothers, 13% delivered preterm and most required lower segment cesarean section (56.5%). 93.5% of the deliveries resulted in live births. The incidence of Rh incompatibility among the Rh-negative mothers was 83.7%. The mean birth weight was 2.8±0.4 kgs, with most of the babies being male (60.5%). The most common complications developing in the neonates was anemia (21%) and neonatal hyperbilirubinemia (9.3%). Only one (2.3%) of the neonates born to the mothers died due to post-birth complications. Conclusions: Rh incompatibility was observed to be high among the mothers assessed in the study, with 4.4% having raised anti-D titers. Anemia and neonatal hyperbilirubinemia were found to be the most common problems associated with such pregnancies.

STUDY OF CORRELATION OF ABO AND RH INCOMPATIBILITY WITH RISK OF NEONATAL HYPERBILIRUBINEMIA IN A TERTIARY CARE HOSPITAL

Background: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occurs in 'A' and 'B' blood group babies of O '+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia. So early intervention, at proper time, is mandatory to prevent these sequelae Methods: The aim is to determine the frequency of ABO and Rh blood group incompatibilities and associated incidence of hyperbilirubinemia for the purpose of instituting intervention for better neonatal outcomes. It was a descriptive cross-sectional study that includes 102 neonates born to mother with O or Rh-negative blood group admitted in the post-natal ward for routine newborn care. Serum bilirubin was documented in icteric neonates. Results: The incidence of ABO incompatibility in our study was 33.33% and of Rh incompatibility was 4.9%. In ABO and Rh incompatibility group, 41.17% and 20% new born respectively developed clinical jaundice. In ABO incompatibility group, majority, 64.28% did not require treatment, whereas in Rh incompatibility group 100% required treatment. In both ABO and Rh incompatibility exchange transfusion was not required. In ABO and Rh incompatibility, all new-born treated well and no kernicterus was seen. Conclusions: In ABO incompatibility, if jaundice develops, it remains in physiological limits. In presence of some aggravating conditions may present as pathological jaundice. It results in significant morbidity but no mortality, so prevention of aggravating factors is very important, in case of ABO and Rh incompatibility

Etiological study of jaundice in neonates

: Jaundice is the commonest abnormal finding with an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to hospitals in the newborn period. In preterm babies, the percentage is exceedingly high due to their physiological handicaps and other hazards of prematurity like Asphyxia, septicemia, respiratory and circulatory Insufficiency. Non-physiological or pathological jaundice is also known to occur in (8-9)% of newborns. Its timely detection and optimal management are crucial to prevent brain damage and subsequent neuro-motor retardation. Aims of this study to find out the etiology of jaundice in neonates, admitted in neonates unit attached to SMS medical college Jaipur.Method: This Observational study was conducted in Neonatal Intensive Care Unit (NICU) and Post Natal Ward attached to SMS medical college Jaipur, after approval from the hospital ethical committee, over a period of 12 months(October 2011 to September 2012. Study was carried on 500 neonates presenting clinically with neonatal hyperbilirubinemia.Result: The onset of jaundice was seen maximum between live hour 24-72 hours (n=290, 58% cases), followed by live hour 72 hours-14 days (n=160, 32%). At more than 2 weeks there was only 3 case (0.6%). The etiological factors in the causation of jaundice in the decreasing order of frequency were exaggerated physiological jaundice accounts for (28%), ABO-incompatibility (24.4%), Rh-incompatibility (13.8%), Idiopathic (10.4%), cephalhematoma (10.2%), septicemia (6%), intrauterine infections (4%), BMJ (1.8%), Galactocemia (0.8%) and G6PD' Deficiency (0.6%) respectively.Conclusion: Hyperbilirubinemia is more severe in newborns, therefore precautionary measure should be adopted by both parents, and clinicians to diagnose and treat the diseases properly.

A Case of the False-negative D Phenotype in a Neonate with a Strongly Positive Direct Antiglobin Test Rest

Accurate D antigen blood typing is needed owing to the clinical importance of the Rh blood group. We describe a female infant who was suspected to suffer from Rh incompatible hemolytic disease of the newborn, and who showed a strong positive direct antiglobin test (DAT) result and false red blood cell (RBC) agglutination in D typing. Using chloroquine dissociation of IgG, we confirmed that the antibodies coating her RBCs were of anti-D type. D typing with 0.8% RBC suspensions in saline using saline gel cards showed 2+ RBC agglutinations. After increasing the incubation time of dissociation by chloroquine for up to 4 hr, the dissociated RBCs began to show agglutination in both the tube technique (2+) and the gel card technique (4+) for D typing, although the DAT rest was still positive. Therefore, in order to prevent mistyping as a false-negative D blood group, whenever the D blood typing of a patient with a strong positive DAT rest does not show RBC agglutination, retesting of the D blood typing is recommended by using saline-suspended RBCs or dissociated RBCs.

A Case of Rh-incompatible Allogeneic Bone Marrow Transplantation: Transplant of E- and c-positive Bone Marrow in a Recipient with Anti-E and Anti-c Antibodies / 대한수혈학회지

The effects of Rh incompatibility in bone marrow transplantation (BMT) has not been studied extensively as ABO incompatibility. But it has been known that Rh incompatibility does not impair the engraftment of donor bone marrow. The recipient's blood groups were AB, DCe, who has anti-E and anti-c in her serum. The sibling donor blood groups were B, DCEce. There was a minor ABO incompatibility and Rh incompatibility due to anti-E and anti-c between donor and recipient. We performed the plasma and RBC depletion of marrow using the cell separator before it was infused. The clinical course after BMT was not eventful except mild delayed hemolysis and delayed hematopoietic recovery, which may be attributable to low marrow cell dose.