Rhesus (Rh) incompatibility is one of the most important types of high-risk pregnancy that are encountered in general obstetric practice. Rh incompatibility refers to the discordant pairing of maternal and fetal Rh type[1]. An individual is classified as Rh-negative when there is no expression of Rh D antigen on their circulating erythrocytes. While Rh blood group system consist of many antigen subtypes such as C, D, c, E and e, the D antigen is the most immunogenic and is most commonly involved in Rh incompatibility. In the context of Rh incompatibility, there is Rh-negative mother’s sensitization to the D antigen following the admixture of Rh-positive fetal and maternal blood during an abortion, trauma, invasive obstetric procedures, or delivery[2]. Once alloimmunization occurs, the mother starts producing anti-D antibodies, which can lead to severe consequences for the fetus, ranging from mild hemolytic anemia to hydrops fetalis. This risk is higher for future pregnancies with a Rh-positive fetus, who have been found to be at a high risk of developing severe hemolytic anemia and hydrops fetalis.

The global incidence of Rh incompatibility is around 10% of all Rh-negative pregnancies, with sensitization being reported in around 5% of these cases[3]. With recent advances in the field of obstetrics, especially with regards to antenatal diagnostics the incidence of this condition has seen further decline, with current estimates varying from 0.4% to 2.7% among pregnant women[4-5].

It has been observed that in case of Rh incompatibility, the maternal sensitization to Rh D antigen occurs in Rh negative mothers when they are carrying a Rh-positive fetus. However, if the exposure to the Rh D antigen occurs during the mother’s first pregnancy, the adverse consequences of Rh incompatibility do not typically affect that initial pregnancy because the fetus often is delivered before the development of the anti-D antibodies. Once the mother has been sensitized, future pregnancies are at risk for the development of hemolytic disease of the newborn (HDN) secondary to Rh incompatibility if the fetus is Rh-positive[6]. In Rh-negative mothers who have been potentially exposed to fetal Rh-positive blood, fetomaternal hemorrhage is the most important assessment to be done. In a patient’s first affected pregnancy, surveillance of maternal antibody titers is recommended. Titers are repeated every month until 24 weeks of gestation and repeated more frequently in the third trimester.

The present study was carried out in patients attending antenatal clinic and admitted in Obstetric unit of Department of Obstetrics and Gynecology in NSCB Medical College Jabalpur. On admission, history of the patients was taken regarding her age, address, occupation and detailed obstetrical history. Any history of neonatal jaundice in previous newborns and type of treatment with outcome was noted.

Complete general examination of the patients was done which include degree of anemia, pulse, BP, and pedal edema. Systemic examination will be done to exclude other medical disorders viz. respiratory disease, CVS disorders, chronic hypertension, chronic nephritis and any other chronic illness. Obstetrical examination complete examination including fundal height, lie and position of the foetus, presentation, AFI assessment was done and FHS noted. Internal examination was done in patients who presented with labor pains.

INCLUSION CRITERIA

• Singleton pregnancy.
• Pregnant women with Rh-negative blood group.
• Partner's blood group Rh positive.

EXCLUSION CRITERIA:

• Failure to give consent.
• Multiple Pregnancy.
• Partner’s blood group Rh-negative.

Table No. 1: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO THEIR AGE (n=213)

It was observed that most of the study participants were of the age group 21-30 years (83.6%). The mean age of the participants was 27.3±4.2 years.

TABLE 2: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO THEIR LOCALITY AND BOOKING STATUS (n=213)

It was observed that majority of the women (66.11%) were booked (3 or less visits) at elsewhere (PHC/CHC/DISTRICT HOSPITAL/PRIVATE CLINICS) during their antenatal period. And (26.32%) patients received 4 or more visits at tertiary center NSCB medical College during their antenatal period. And 7.57% women were unbooked they were not received even single visit to the Doctor.

TABLE 3: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO THEIR LOCALITY AND BOOKING STATUS (n=213)

It was observed that majority of the women (66.11%) were booked (3 or less visits) at elsewhere (PHC/CHC/DISTRICT HOSPITAL/PRIVATE CLINICS) during their antenatal period. And (26.32%) patients received 4 or more visits at tertiary center NSCB medical College during their antenatal period. And 7.57% women were unbooked they were not received even single visit to the Doctor.

TABLE 4: DISTRIBUTION OF STUDY PARTICIPANTS ACCORDING TO THEIR

PRESENCE OF COMORBIDITIES (n=213)

*Multiple comorbidities possible in a single participant

It was observed in the participants that the most common comorbidity was anemia, present in 80.75% of patients, followed by hypertension, present into 31.95% of the participants

The study sample's demographic characteristics revealed significant insights into the population of Rh-negative pregnant women. The age distribution indicated that the majority of participants were between 21-25 years (42.32%) and 26-30 years (41.03%), suggesting that Rh-negative pregnancies predominantly occur in women of childbearing age. This finding aligns with previous studies by Okeke et al., who observed a similar age distribution among Rh-negative women in their study (74% between 20 and 30 years)[7].

This finding is consistent with several previous studies emphasizing the importance of regular antenatal care in managing Rh-negative pregnancies effectively. For instance, Gupta et al[8]. highlighted the critical role of adequate prenatal care in reducing perinatal mortality among Rh-negative women. Their study showed a marked difference in outcomes between booked at tertiary center and booked elsewhere cases (40%), with unbooked cases exhibiting higher perinatal mortality rates (33%). This is supported by the findings of Agarwal et al., who noted that unbooked women are more likely to experience complications due to inadequate monitoring and timely interventions (47.92% of Rh-negative pregnancies resulted in cesarean sections)[9].

Regular antenatal visits allow for early detection and management of potential issues such as Rh isoimmunization, thereby improving both maternal and perinatal outcomes. Furthermore, Moitra et al. found that routine antenatal anti-D prophylaxis significantly reduces the incidence of isoimmunization and its associated complications (isoimmunization significantly lower in mothers who received anti-D in previous pregnancies). the study by Chacham et al. reported that unbooked Rh-negative pregnancies are associated with higher rates of neonatal complications, such as hyperbilirubinemia (68.36%) and the need for phototherapy. Elije et al. also noted that unbooked pregnancies tend to have poorer outcomes due to delayed or missed interventions (21.39% of babies born to unbooked mothers developed neonatal jaundice)[10]. This study's finding of a high proportion of unbooked Rh-negative pregnancies highlights the urgent need to address barriers to accessing antenatal care, such as socioeconomic factors, lack of education, and healthcare infrastructure deficiencies.

The study found that only 24.02% of the Rh-negative pregnant women delivered by lower segment cesarean section (LSCS), while the remaining 75.87% had vaginal deliveries (VD). This cesarean section rate aligns with the findings of Agarwal et al., reported LSCS rate of 47.22% in their study of Rh-negative pregnancies, indicating that complications such as isoimmunization and fetal distress often necessitate cesarean sections to ensure maternal and fetal safety. The mode of delivery in Rh-negative women is often influenced by complications such as isoimmunization and fetal distress, necessitating a cesarean section to ensure the safety of both the mother and the baby[11-12]. Among the maternal complications during delivery or LSCS, the most common was preterm rupture of membranes (13.12%), followed by antepartum hemorrhage (11.60%) and postpartum hemorrhage 7.11%). These findings are consistent with the study by Khatun et al., which also observed a high incidence of preterm rupture of membranes and hemorrhage among Rh-negative pregnancies (16.04%). Antepartum hemorrhage, observed in 11.66% of the participants, can significantly impact maternal and fetal outcomes[13-14].

The study sample's demographic characteristics revealed significant insights into the population of Rh-negative pregnant women. The age distribution indicated that the majority of participants were between 21-25 years (42.32%) and 26-30 years (41.03%), suggesting that Rh-negative pregnancies predominantly occur in women of childbearing age. This finding aligns with previous studies by Okeke et al., who observed a similar age distribution among Rh-negative women in their study (74% between 20 and 30 years)[7].

This finding is consistent with several previous studies emphasizing the importance of regular antenatal care in managing Rh-negative pregnancies effectively. For instance, Gupta et al[8]. highlighted the critical role of adequate prenatal care in reducing perinatal mortality among Rh-negative women. Their study showed a marked difference in outcomes between booked at tertiary center and booked elsewhere cases (40%), with unbooked cases exhibiting higher perinatal mortality rates (33%). This is supported by the findings of Agarwal et al., who noted that unbooked women are more likely to experience complications due to inadequate monitoring and timely interventions (47.92% of Rh-negative pregnancies resulted in cesarean sections)[9].

Regular antenatal visits allow for early detection and management of potential issues such as Rh isoimmunization, thereby improving both maternal and perinatal outcomes. Furthermore, Moitra et al. found that routine antenatal anti-D prophylaxis significantly reduces the incidence of isoimmunization and its associated complications (isoimmunization significantly lower in mothers who received anti-D in previous pregnancies). the study by Chacham et al. reported that unbooked Rh-negative pregnancies are associated with higher rates of neonatal complications, such as hyperbilirubinemia (68.36%) and the need for phototherapy. Elije et al. also noted that unbooked pregnancies tend to have poorer outcomes due to delayed or missed interventions (21.39% of babies born to unbooked mothers developed neonatal jaundice)[10]. This study's finding of a high proportion of unbooked Rh-negative pregnancies highlights the urgent need to address barriers to accessing antenatal care, such as socioeconomic factors, lack of education, and healthcare infrastructure deficiencies.

The study found that only 24.02% of the Rh-negative pregnant women delivered by lower segment cesarean section (LSCS), while the remaining 75.87% had vaginal deliveries (VD). This cesarean section rate aligns with the findings of Agarwal et al., reported LSCS rate of 47.22% in their study of Rh-negative pregnancies, indicating that complications such as isoimmunization and fetal distress often necessitate cesarean sections to ensure maternal and fetal safety. The mode of delivery in Rh-negative women is often influenced by complications such as isoimmunization and fetal distress, necessitating a cesarean section to ensure the safety of both the mother and the baby[11-12]. Among the maternal complications during delivery or LSCS, the most common was preterm rupture of membranes (13.12%), followed by antepartum hemorrhage (11.60%) and postpartum hemorrhage 7.11%). These findings are consistent with the study by Khatun et al., which also observed a high incidence of preterm rupture of membranes and hemorrhage among Rh-negative pregnancies (16.04%). Antepartum hemorrhage, observed in 11.66% of the participants, can significantly impact maternal and fetal outcomes[13-14].

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