Share This Article:

Abortion, ectopic pregnancy and miscarriages in Sub Saharan Africa: Challenges of Rhesus isoimmunisation in Rhesus negative women

Abstract Full-Text HTML Download Download as PDF (Size:209KB) PP. 15-26
DOI: 10.4236/ojog.2013.39A003    5,127 Downloads   7,816 Views   Citations

ABSTRACT

The implementation of a program on routine antenatal anti-D prophylaxis (RAADP) in the developed world has led to a significant decline in the residual numbers of Rhesus negative women becoming sensitized. However, a significant number of Rhesus D negative women in SSA are not fortunate because of lack of access to prophylactic immunoglobulin D and thus they continue to be affected. The management of Rhesus negative pregnancy in Sub-Saharan Africa is associated with several daunting challenges: absence of a policy on universal access to Rh D immunoglobulin, lack of fetomaternal testing facilities, unaffordability of prophylactic anti-D immunoglobulin, poor uptake of quality antenatal care, poor health infrastructure, sub optimal management of potentially sensitizing events during pregnancy, shortage of qualified medical personnel, poor data management, high incidence of illegal abortion and quackery. There is a need for the formulation of necessary guidelines on Rhesus immunoprophylaxis in SSA. Health authorities need to implement evidence-based policy on universal access to anti-D immunoglobulin. There is also the need to optimize the knowledge of obstetricians on anti-D prophylaxis, implementation of the readily available and affordable Kleihauer fetomaternal haemorrhage testing for all women who experience a potentially sensitizing event antenatally post 20 weeks gestation and postnatally. These factors can facilitate the effective management of Rh negative pregnancy in the region and reduce the risk of Rhesus D immunization and Rhesus D haemolytic disease of the foetus and newborn.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Erhabor, O. , Isaac, Z. , Yakubu, A. and Adias, T. (2013) Abortion, ectopic pregnancy and miscarriages in Sub Saharan Africa: Challenges of Rhesus isoimmunisation in Rhesus negative women. Open Journal of Obstetrics and Gynecology, 3, 15-26. doi: 10.4236/ojog.2013.39A003.

References

[1] Daniels, G., Finning, K., Martin, P. and Summers, J. (2006) Foetal blood group genotyping: Present and future. Annals of the New York Academy of Sciences, 1075, 88-95. http://dx.doi.org/10.1196/ annals.1368.011
[2] (2002) Pregnancy and routine anti-D prophylaxis for D-negative women. Nice, May.
[3] Harkness, M., Freer, Y., Prescott, R.J. and Warner, P. (2008) Implementation of NICE recommendation for a policy of routine antenatal anti-D prophylaxis: A survey of UK maternity units. Transfusion Medicine, 18, 292-295. http://dx.doi.org/10.1111/j.1365-3148.2008.00882.x
[4] Katiyar, R., Kriplani, A., Agarwal, N., Bhatla, N. and Kabra, M. (2007) Detection of fetomaternal haemorrhage following chorionic villus sampling by Kleihauer Betke test and rise in maternal serum alpha feto protein. Prenatal Diagnosis, 27, 139-142. http://dx.doi.org/10.1002/pd.1632
[5] Johnson, P.R., Tait, R.C., Austin, E.B., Shwe, K.H. and Lee, D. (1995) Flow cytometry in diagnosis and management of large fetomaternal haemorrhage. Journal of Clinical Pathology, 48, 1005-1008. http://dx.doi.org/10.1136/jcp.48.11.1005
[6] Knowles, S. and Poole, G. (2002) Human blood group systems. In: Murphy, M.F. and Pamphilon, D.H., Eds., Practical Transfusion Medicine, Blackwell Science, London, 24-31.
[7] Jeremiah, Z.A. (2005) An assessment of the clinical utility of routine antenatal screening of pregnant women at first clinic attendance for haemoglobin genotypes, haematocrit, ABO and Rh blood groups in Port Harcourt, Nigeria. African Journal of Reproductive Health, 9, 112-117. http://dx.doi.org/ 10.2307/3583417
[8] Mwangi, J. (1999) Blood groups distribution in an urban population of patient targeted blood donors. East African Medical Journal, 76, 615-618.
[9] Loua, A., Lamah, M.R., Haba, N.Y. and Camara, M. (2007) Frequency of blood groups ABO and Rhesus D in the Guinean population. Transfusion Clinique et Biologique, 14, 435-439. http://dx.doi.org/ 10.1016/j.tracli.2007.12.008
[10] Tagny, C.T., Fongué, V.F. and Mbanya, D. (2009) The erythrocyte phenotype in ABO and Rh blood groups in blood donors and blood recipients in a hospital setting of Cameroon: Adapting supply to demand. Revue Médicale de Bruxelles, 30, 159-162.
[11] Bergstrom, S., Pereira, C., Hagstrom, U. and Safwenberg, J. (1994) Obstetric implications of rhesus antigen distribution in Mozambican and Swedish women. Gynecologic and Obstetric Investigation, 38, 82-86. http://dx.doi.org/10.1159/000292454
[12] Correa, P., Linhard, J., Diebolt, G. and Diadhiou, F. (1969) Study of bilirubin in amniotic fluid associated with fetomaternal isoimmunization at Dakar. Bulletin de la Société Médicale d’Afrique Noire de Langue Francaise, 14, 262-266
[13] Verkuyl, D.A. (1987) Economics of anti-rhesus prophylaxis in an African population. Central African Journal of Medicine, 33, 32-37.
[14] Hitzeroth, H.W. and Op’t Hof, J. (1988) On the prevention of rhesus immunisation in the RSA. South African Medical Journal, 19, 502-506.
[15] Pereira, C., Axemo, P., Bergstrom, S. and Safwenberg, J. (1992) Parity-related prevalence of Rhesus antigens among Mozambican parturients. Gynecologic and Obstetric Investigation, 34, 129-132. http://dx.doi.org/10.1159/000292744
[16] Cakana, A.Z. and Ngwenya, L. (2001) Is antenatal antibody screen worthwhile in the Zimbabwean Population? Central African Journal of Medicine, 47, 26-28.
[17] Kotila, T.R., Odukogbe, A.A., Okunlola, M.A., Olayemi, O. and Obisesan, K.A. (2005) The pregnant Rhesus negative Nigerian woman. Nigerian Postgraduate Medical Journal, 12, 305-307.
[18] Toure, E.A., Horo, F.M., Sein, K., Konan, B.R. and Kone, M. (2006) Management of rhesus alloimmunisation by spectrophometry: About one case at the Yopougon Teaching Hospital, Cote-d’Ivoire. Bulletin de la Société de Pathologie Exotique, 99, 245-249.
[19] Wee, W.W. and Kanagalingam, D. (2009) The use of anti-D immunoglobulins for Rhesus prophylaxis: Audit on knowledge and practices among obstetricians. Singapore Medical Journal, 50, 1054-1057.
[20] Darmstadt, G.L., Lee, A.C., Cousens, S., et al. (2009) 60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths? International Journal of Gynecology & Obstetrics, 107, S89-S112. http://dx.doi.org/10.1016/j.ijgo.2009.07.010
[21] Belinga, S., Ngo, S.F., Bilong, C., Manga, J., Mengue, M.A. and Tchendjou, P. (2009) High prevalence of anti-D antibodies among women of childbearing age at Centre Pasteur of Cameroon. African Journal of Reproductive Health, 13, 47-52.
[22] Cortey, A. and Brossard, Y. (2006) Prevention of fetomaternal rhesus-D allo-immunization. Practical aspects. Journal de Gynécologie, Obstétrique et Biologie de la Reproduction (Paris), 35, S123-S130. http://dx.doi.org/10.1016/S0368-2315(06)76509-7
[23] Urbaniak, S. (1998) The scientific basis of antenatal prophylaxis. BJOG: An International Journal of Obstetrics & Gynaecology, 105, 11-18. http://dx.doi.org/10.1111/j.1471-0528.1998.tb10286.x
[24] Fung, K.F.K., Eason, E., Crane, J., et al. (2003) MaternalFetal Medicine Committee, Genetics Committee. Prevention of Rh alloimmunization. Journal of Obstetrics & Gynaecology, 25, 765-773.
[25] Beliard, R. (2006) Monoclonal anti-D antibodies to prevent alloimmunization: Lessons from clinical trials. Transfusion Clinique et Biologique, 13, 58-64. http://dx.doi.org/10.1016/j.tracli.2006.03.013
[26] Grimes, D.A. (2003) Unsafe abortion: The silent scourge. British Medical Bulletin, 67, 99-113. http://dx.doi.org/10.1093/bmb/ldg002
[27] Dixon-Mueller, R. (1990) Abortion policy and women’s health in developing countries. International Journal of Health Services, 20, 297-314. http://dx.doi.org/10.2190/V08N-UE7N-TNBH-RA4P
[28] Shah, I. and Ahman, E. (2009) Unsafe abortion: Global and regional incidence, trends, consequences, and challenges. Journal of Obstetrics and Gynaecology (Canada), 31, 1149-1158.
[29] Ahman, E. and Shah, I. (2002) Unsafe abortion: Worldwide estimates for 2000. Reproductive Health Matters, 10, 13-17. http://dx.doi.org/10.1016/S0968-8080(02)00012-5
[30] Sedgh, G., Henshaw, S., Singh, S., Ahman, E. and Shah, I.H. (2007) Induced abortion: Estimated rates and trends worldwide. Lancet, 370, 1338-1345. http://dx.doi.org/10.1016/S0140-6736(07) 61575-X
[31] Abiodun, O.M., Balogun, O.R., Adeleke, N.A. and Farinloye, E.O. (2013) Complications of unsafe abortion in South West Nigeria: A review of 96 cases. African Journal of Medicine & Medical Sciences, 42, 111-115.
[32] Shah, N., Hossain, N., Noonari, M. and Khan, N.H. (2011) Maternal mortality and morbidity of unsafe abortion in a university teaching hospital of Karachi, Pakistan. Journal of Pakistan Medical Association, 61, 582-586.
[33] Nwogu-Ikojo, E.E. and Ezegwui, H.U. (2007) Abortionrelated mortality in a tertiary medical centre in Enugu, Nigeria. Journal of Obstetrics & Gynaecology, 27, 835-837. http://dx.doi.org/10.1080/014 43610701718883
[34] Shah, I. and Ahman, E. (2004) Age patterns of unsafe abortion in developing country regions. Reproductive Health Matters, 12, 9-17. http://dx.doi.org/10.1016/S0968-8080(04)24002-2
[35] Okonofua, F. (2006) Abortion and maternal mortality in the developing world. Journal of Obstetrics and Gynaecology (Canada), 28, 974-979.
[36] Ibrahim, I. A. and Onwudiegwu, U. (2012) Socio-demographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: A four-year review. West Indian Medical Journal, 61, 163-167.
[37] Singh, S. (2006) Hospital admissions resulting from unsafe abortion: Estimates from 13 developing countries. The Lancet, 368, 1887-1892. http://dx.doi.org/10.1016/S0140-6736(06)69778-X
[38] Rasch, V. (2011) Unsafe abortion and post abortion care—An overview. Acta Obstetricia et Gynecologica Scandinavica, 90, 692-700. http://dx.doi.org/10.1111/j.1600-0412.2011.01165.x
[39] Ikechebelu, J.I. and Okoli, C.C. (2003) Morbidity and mortality following induced abortion in Nnewi, Nigeria. Tropical Doctor, 33, 170-172.
[40] Jabara, S. and Barnhart, K.T. (2003) Is Rh immune globulin needed in early first-trimester abortion? A review. American Journal of Obstetrics Gynecology, 188, 623-627. http://dx.doi.org/10.1067/ mob.2003.208
[41] Hannafin, B., Lovecchio, F. and Blackburn, P. (2006) Do Rh-negative women with first trimester spontaneous abortions need Rh immune globulin? American Journal of Emergency Medicine, 24, 487-489. http://dx.doi.org/10.1016/j.ajem.2006.01.020
[42] Dayton, V.D., Anderson, D.S., Crosson, J.T. and Cruikshank, S.H. (1990) A case of Rh isoimmunization: Should threatened first-trimester abortion be an indication for Rh immune globulin prophylaxis? American Journal of Obstetrics & Gynecology, 163, 63-64. http://dx.doi.org/10.1016/ S0002-9378(11)90668-1
[43] Maas, D.H. (1979) Anti-D prophylaxis after abortions and interruptions. Fortschritte der Medizin, 97, 148-152.
[44] Krause, H.G. and Goh, J.T. (1996) Positive Kleihauer result following an ectopic pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology, 36, 324-325. http://dx.doi.org/10.1111/j. 1479-828X.1996.tb02721.x
[45] Fung, K.F.K., Eason, E., Crane, J., Armson, A., De La Ronde, S., Farine, D., Keenan-Lindsay, L., Leduc, L., Reid, G.J., Aerde, J.V., Wilson, R.D., Davies, G., Désilets, V.A., Summers, A., Wyatt, P. and Young, D.C. (2003) Prevention of Rh alloimmunization. Maternal-Foetal Medicine Committee, Genetics Committee. Journal of Obstetrics Gynaecology Canada, 25, 765-773.
[46] Stubblefield, P.G. (1986) Surgical techniques of uterine evacuation in firstand second-trimester abortion. Clinics in Obstetrics and Gynaecology, 13, 53-70.
[47] Ahman, E. and Shah, I. (2002) Unsafe abortion: Worldwide estimates for 2000. Reproductive Health Matters, 10, 13-17. http://dx.doi.org/10.1016/S0968-8080(02)00012-5
[48] Rogo, K.O. (1993) Induced abortion in sub-Saharan Africa. East African Medical Journal, 70, 386-395.
[49] Bio Products Laboratory (2001) The clinical and cost effectiveness of routine antenatal prophylaxis for rhesus negative women in pregnancy. A submission to the National Institute for Clinical Excellence.
[50] Baxter Healthcare (2001) The clinical and cost effectiveness of anti-D prophylaxis for Rhesus negative women in pregnancy. Submission to the National Institute for Clinical Excellence.
[51] Chilcott, J., Tappenden, P.L., Lloyd J.M., Wight, J., Forman, K., Wray, J. and Beverley, C. (2004) The economics of routine antenatal anti-D prophylaxis for pregnant women who are rhesus negative. An International Journal of Obstetrics & Gynaecology, 111, 903-907. http://dx.doi.org/10.1111/j.1471-0528.2004.00226.x
[52] Tagny, C.T., Mbanya, D., Tapko, J.B. and Lefrère, J.J. (2008) Blood safety in Sub-Saharan Africa: A multi-factorial problem. Transfusion, 48, 1256-1261. http://dx.doi.org/10.1111/j.1537-2995.2008. 01697.x
[53] Lawani, O.L., Anozie, O.B. and Ezeonu, P.O. (2013) Ectopic pregnancy: A life-threatening gynecological emergency. International Journal of Women’s Health, 5, 515-521. http://dx.doi.org/ 10.2147/IJWH.S49672
[54] Gharoro, E.P. and Igbafe, A.A. (2002) Ectopic pregnancy revisited in Benin City, Nigeria: Analysis of 152 cases. Acta Obstetricia et Gynecologica Scandinavica, 81, 1139-1143. http://dx.doi.org/10.1034/ j.1600-0412.2002.811207.x
[55] Panti, A., Ikechukwu, N.E., Lukman, O.O., Yakubu, A., Egondu, S.C. and Tanko, B.A. (2012) Ectopic pregnancy at Usmanu Danfodiyo University Teaching Hospital Sokoto: A ten year review. Annals of Nigerian Medicine, 6, 87-91. http://dx.doi.org/10.4103/0331-3131.108128
[56] Anorlu, R.I., Oluwole, A., Abudu, O.O. and Adebanjo, S. (2005) Risk factors for ectopic pregnancy in Lagos, Nigeria. Acta Obstetricia et Gynecologica Scandinavica, 84, 184-188.
[57] Igberase, G.O., Ebeigbe, P.N., Igbeboji, O.F. and Ajupo, B.I. (2005) Ectopic pregnancy: An 11-year review in a tertiary center in the Niger Delta. Tropical Doctor, 35, 175-177. http://dx.doi.org/ 10.1258/0049475054620888
[58] Monga, A. (2006) Ectopic pregnancy. In: Monga, A. and Baker, P., Eds., Gynaecology by Ten Teachers, 18th Edition, Hodder Education, London, 97-99.
[59] Baffoe, S. and Nkyekyer, K. (1999) Ectopic pregnancy in Korle Bu Teaching Hospital, Ghana: A three-year review. Tropical Doctor, 29, 18-22.
[60] Sivalingam, V.N., Duncan, W.C., Kirk, E., Shephard, L. A. and Horne, A.W. (2011) Diagnosis and management of ectopic pregnancy. Journal of Family Planning & Reproductive Health Care, 37, 231-240. http://dx.doi.org/10.1136/jfprhc-2011-0073
[61] Sara, H.G. and Uzelac, P.S. (2007) Early pregnancy risks. In: DeCherney, A.H., Nathan, L., Goodwin, M.T. and Laufer, N., Eds., Current Diagnosis and Treatment: Obstetrics and Gynecology, 10th Edition, McGraw-Hill, Columbus, 259-272.
[62] Drife, J.S. (1990) Tubal pregnancy: Rising incidence, earlier diagnosis, more conservative management. BMJ, 301, 1057-1058. http://dx.doi.org/10.1136/bmj.301.6760.1057
[63] Abdul, F.I. (2000) Ectopic pregnancy in Ilorin: A review of 278 cases. Niger Journal of Medicine, 9, 92-96.
[64] Igwegbe, A., Eleje, G. and Okpala, B. (2013) An appraisal of the management of ectopic pregnancy in a Nigerian tertiary hospital. Annals of Medical and Health Sciences Research, 3, 166-170.
[65] Laiyemo, R. and Etokowo, G. (2008) Management of suspected ectopic pregnancy: An audit from East Kent NHS Hospital Trust. Journal of Obstetrics & Gynaecology, 28, 209-212.
http://dx.doi.org/10.1080/01443610801912485
[66] Lubusky, M., Procházka, M., Simetka, O. and Holusková, I. (2010) Guideline for prevention of RhD alloimmunization in RhD negative women. Ceska Gynekologie, 75, 323-324.
[67] Lubusky, M., Procházka, M., Simetka, O. and Holusková, I. (2013) Guideline for prevention of RhD alloimmunizationin RhD negative women. Ceska Gynekologie, 78, 132-133.
[68] Everett, C. (1997) Incidence and outcome of bleeding before the 20th week of pregnancy: Prospective study of general practice. British Medical Journal, 315, 32-34. http://dx.doi.org/ 10.1136/bmj.315.7099.32
[69] Jurkovic, D. (1998) Modern management of miscarriage: Is there a place for non-surgical treatment? Ultrasound in Obstetrics & Gynecology, 11, 161-163. http://dx.doi.org/10.1046/j.1469-0705.1998. 11030161.x
[70] Kripke, C. (2006) Expectant management versus surgical treatment for miscarriage. American Family Physician, 74, 1125-1126.
[71] Tang, O.S. and Ho, P.C. (2006) The use of misoprostol for early pregnancy failure. Current Opinion in Obstetrics and Gynecology, 18, 581-586. http://dx.doi.org/10.1097/GCO.0b013e32800feedb
[72] Trinder, J., Brocklehurst, P., Porter, R., Read, M., Vyas, S. and Smith, L. (2006) Management of miscarriage: Expectant, medical, or surgical? Results of randomized controlled trial (miscarriage treatment (MIST) trial). British Medical Journal, 332, 1235. http://dx.doi.org/10.1136/bmj. 38828.593125.55
[73] Weinberg, L. (2001) Use of anti-D immunoglobulin in the treatment of threatened miscarriage in the accident and emergency department. Emergency Medicine Journal, 18, 444-447. http://dx.doi.org/ 10.1136/emj.18.6.444
[74] Joint Working Group of the British Blood Transfusion Society and the Royal College of Obstetricians and Gynaecologist (1999) Recommendations for the use of anti-D immunoglobulin for Rh prophylaxis. Transfusion Medicine, 9, 93-97. http://dx.doi.org/10.1046/j.1365-3148.1999.009001093.x
[75] Bowman, J.M. (1988) The prevention of Rh immunization. Transfusion Medicine Reviews, 2, 129-150. http://dx.doi.org/10.1016/S0887-7963(88)70039-5
[76] Zipurski, A. and Israels, L.G. (1967) The pathogenesis and prevention of Rh immunization. Canadian Medical Association Journal, 97, 1245-1257.
[77] Huggon, A.M. and Watson, D.P. (1993) Use of anti-D in an accident and emergency department. Archives of Emergency Medicine, 10, 306-309.
[78] Roberts, H. and Mitchell, R. (1991) The use of anti-D prophylaxis in the management of miscarriage in general practice. Health Bulletin, 9, 245-249.
[79] Erhabor, O. and Adias, T.C. (2010) Rhesus isoimmunisation in sub Saharan Africa indicates the need for universal access to anti Rh D immunoglobulin and effective management of D negative pregnancies. International Journal of Women’s Health, 2, 429-437.
[80] Karanth, L., Jaafar, S.H., Kanagasabai, S., Nair, N.S. and Barua, A. (2013) Anti-D administration after spontaneous miscarriage for preventing Rhesus alloimmunisation. The Cochrane Database Systematic Reviews, 3, CD009617.
[81] Katiyar, R., Kriplani, A., Agarwal, N., Bhatla, N. and Kabra, M. (2007) Detection of fetomaternal haemorrhage following chorionic villus sampling by Kleihauer Betke test and rise in maternal serum alpha feto protein. Prenatal Diagnosis, 27, 139-142. http://dx.doi.org/10.1002/pd.1632
[82] NHS Evidence (2009) Guidelines for the estimation of fetomaternal haemorrhage. Working Party of the British Committee for Standards in Haematology. Transfusion Taskforce.
[83] Robson, S.C., Lee, D. and Urbaniak, S (1998) Anti-D immunoglobulin in RhD prophylaxis. An International Journal of Obstetrics & Gynaecology, 105, 129-134. http://dx.doi.org/10.1111/j.1471-0528.1998.tb10039.x
[84] British Committee for Standards in Haematology (2006) Guidelines for the use of prophylactic anti-D immunoglobulin. BCSH.
[85] Howarth, D.J., Robinson, F.M., Williams, M. and Norfolk, D.R. (2002) A modified Kleihauer technique for the quantification of fetomaternal haemorrhage. Transfusion Medicine, 12, 373-378.
http://dx.doi.org/10.1046/j.1365-3148.2002.00406.x
[86] Duguid, J.K.M., Bromilow, I.M., Eggington, J., Martlew, V.J., McFadyen, I.R. and Clarke, C.A. (1996) Kleihauer Testing and flow cytometry. A comparative study for assessment of feto-maternal haemorrhage. Haematology, 1, 79-83.
[87] Davies, B.H., Olsen, S., Bigelow, N.C. and Chen, J.C. (1998) Detection of foetal red cells in fetomaternal haemorrhage using a foetal haemoglobin antibody by flow cytometry. Transfusion, 38, 749-756. http://dx.doi.org/10.1046/j.1537-2995.1998.38898375514.x
[88] Johnson, P.R., Tait, R.C., Austin, E.B., Shwe, K.H. and Lee, D. (1995) Flow cytometry in diagnosis and management of large fetomaternal haemorrhage. Journal of Clinical Pathology, 48, 1005-1008. http://dx.doi.org/10.1136/jcp.48.11.1005
[89] Radel, D.J., Penz, C.S., Dietz, A.B. and Gastineau, D.A. (2008) A combined flow cytometry-based method for fetomaternal haemorrhage and maternal D. Transfusion, 48, 1886-1891.
http://dx.doi.org/10.1111/j.1537-2995.2008.01780.x

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.