Evaluation of postnatal prophylactic program for rhesus isoimmunization

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