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Nigeria’s silent Rhesus factor incompatibility crisis

In just one Nigerian family, two generations lost pregnancies to Rhesus incompatibility the couples weren't aware of. Dr Vickie recounts the real-life experience

By Dr. Victoria Adepoju

August 07, 2019

It is happening again to my daughter. I had eight miscarriages during my time. I eventually gave up on trying to have children and my husband married another wife.

I was young and naive. In the euphoria of youthful age, I got pregnant and aborted twice before settling down with my husband. I never knew I was Rhesus negative.

I had my first baby successfully at home with no complications, my family members were happy for me. The naming ceremony was the talk of the town that had all my family members in attendance. My husband was the most grateful, he got me the best of clothes, shoes and gold chain to match. I was happy.

But the problem started when I got pregnant again hoping for my second child. I bled throughout the pregnancy — from the tenth week until I delivered. But the baby was dead inside my womb.

The doctors tried their best for my family to secure my pregnancy but all efforts failed.

I was sad because, despite the stress I went through during the pregnancy, I was almost at the finish line when they discovered the baby was probably dead.

We did a confirmatory ultrasound scan repeatedly before we agreed to an artificially stimulated labour, and, behold, my baby was truly gone.

It was in the hospital that I was discovered to be rhesus negative.

“What does that mean,” I asked the doctor. “You have no rhesus antigen,” he responded.

People with this type of blood are supposed to receive a particular injection after first exposure to pregnancy irrespective of the outcome—abortion, miscarriage or normal birth—except the husband and the baby are both Rhesus negative.

I got my husband and baby tested, their blood groups were checked. My husband was positive for Rhesus antigen but my baby girl tested negative.

According to the doctor, my baby survived because she was rhesus negative, just like me. But any Rhesus positive baby might not survive because I never knew about the injection when I had the two previous abortions.

Subsequent pregnancies never reached three months before resulting in miscarriages. I went from one doctor to another. I also visited churches and mosques. Herbalists gave me concoctions to drink. They all failed to rectify the situation.

Getting pregnant was never my problem, but keeping the pregnancy became impossible. My baby girl is going through the same issue now. Doctor, is there any solution?

The truth about Rhesus

Rhesus positive is the most common blood type and the investigation to do is blood group. Rhesus (Rh) factor is an inherited protein found on the surface of red blood cells. If your blood has the protein, you are Rh positive. If your blood lacks the protein, you’re Rh negative.

Having an Rh negative blood type is not an illness and usually does not affect your health. However, it can affect your pregnancy. Your pregnancy needs special care if you’re Rh negative and your baby is Rh positive (Rh incompatibility). A baby can inherit the Rh factor from either parent.

Usually, mother and baby’s blood does not mix during pregnancy. However, a small amount of baby’s blood could come in contact with mother’s blood during delivery or in cases of bleeding or abdominal trauma during pregnancy. If the mother is Rh negative and the baby is Rh positive, the mother’s body might produce proteins called Rh antibodies after exposure to the baby’s red blood cells.

The concern is with your next pregnancy as the antibodies produced will not be a problem during the first pregnancy. If the next baby is Rh positive, these Rh antibodies can cross the placenta and damage the baby’s red blood cells. This could lead to life-threatening anemia, a condition in which red blood cells are destroyed faster than the baby’s body can replace them. Red blood cells are needed to carry oxygen throughout the body, therefore the baby can die in the womb unknowingly and miscarriage will follow.

Rh immune globulin is the injection given to women that have had exposure to babies blood before the body would start to produce Rh antibodies. The immune globulin prevents the mother’s body from producing Rh antibodies during your pregnancy.Antibody screening is another test the mother might need for monitoring during the first trimester, during week 28 of pregnancy and at delivery. The antibody screen is used to detect antibodies to Rh positive blood. Most importantly, being close to the obstetricians in pregnancy is of utmost importance for a successful delivery outcome.