CHAPTER ONE

1.1 BACKGROUND TO THE STUDY

INTRODUCTION

The Rh factor (i.e., Rhesus factor) is a red blood cell surface antigen that

was named after the monkeys in which it was first discovered. Rhesus

incompatibility, also known as Rhesus disease, is a condition that occurs when a

woman with Rh-negative blood type is exposed to Rh-positive blood cells,

leading to the development of Rhesus antibodies (Machingson, 2006). Rhesus

incompatibility can occur by 2 main mechanisms. The most common type occurs

when a Rh-negative pregnant mother is exposed to Rh-positive fetal red blood

cells secondary to fetomaternal hemorrhage during the course of pregnancy from

spontaneous or induced abortion, trauma, Invasive obstetric procedures or normal

delivery. Rhesus incompatibility can also occur when a Rh-negative female

receives a Rh-positive blood transfusion. In part, this is the reason that blood

banks prefer using blood type "O negative" or "type O, Rhesus negative," as the

universal donor type in emergency situations when there is no time to type and

cross match blood (Anderson, 2009).

The most common cause of Rhesus incompatibility is exposure from a Rh-

negative mother by Rh-positive fetal blood during pregnancy or delivery. As a

consequence, blood from the fetal circulation may leak into the maternal

circulation, and, after a significant exposure, sensitization occurs leading to

maternal antibody production against the foreign Rhesus antigen (Smiley OH,

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 2009). Once produced, maternal Rhesus immunoglobulin G (IgG) antibodies

persist for life and may cross freely from the placenta to the fetal circulation,

where they form antigen-antibody complexes with Rh-positive fetal erythrocytes

and maternal antibody production against the foreign Rhesus antigen (Smiley OH,

2009). Once produced, maternal Rhesus immunoglobulin G (IgG) antibodies

persist for life and may cross freely from the placenta to the fetal circulation,

where they form antigen-antibody complexes with Rh-positive fetal erythrocytes

and eventually are destroyed, resulting in a fetal alloimmune-induced hemolytic

anemia (Huntington, 2008). Although the Rhesus blood group systems consist of

many antigen subtypes (D, C, c, E, e), the D antigen is the most immunogenic;

therefore, it most commonly is involved in Rhesus incompatibility.

1.2 STATEMENT OF THE PROBLEM

Rhesus incompatibility is a condition that develops globally, when a

pregnant woman has Rh-negative blood and the baby in her womb has Rh-

positive blood (Anthonia, 2015). Only 15% of the population lack the Rhesus

erythrocyte surface antigen and are considered Rh-negative (Benson, 2000). The

vast majority (85%) of individuals are considered Rh-positive (Jesse, 2006).

Rhesus sensitization occurs in approximately 1 per 1000 births to women who are

Rhesus negative. The Southwest United States has an incidence approximately 1.5

times the national average, which likely is caused by immigration factors and

limited access to medical care since blood typing is a routine part of prenatal care.

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 Even so, only 17% of pregnant women with Rh-negative blood who are exposed

to Rh-positive fetal blood cells ever develop Rhesus antibodies.

During the course of Rhesus Incompatibility, the fetus is primarily affected. The

binding of maternal Rhesus antibodies produced after sensitization with fetal Rh-

positive erythrocytes results in fetal autoimmune hemolysis (Bethel, 2003). As a

consequence, large amounts of bilirubin are produced from the breakdown of fetal

hemoglobin and are transferred via the placenta to the mother where they are

subsequently conjugated and excreted by the mother. However, once delivered,

low levels of glucuronyl transferase in the infant preclude the conjugation of large

amounts of bilirubin and may result in dangerously elevated levels of serum

bilirubin and severe jaundice (Brooks, 2007).

1.3 AIM OF THE STUDY

The research work is aimed at determining the prevalence of Rhesus D

negative among the pregnant population attending the antenatal clinic in General

Hospital, Ebute-Ikorodu Local Government Area, Lagos State and also the

challenges faced by this sub-population of pregnant women.

1.4 OBJECTIVES OF THE STUDY

1. To assess the prevalence of Rhesus incompatibility that leads to Rhesus diseases

among pregnant women.

2. To create awareness among pregnant women on the causes of Rhesus

incompatibility

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 3. To health educate pregnant women during ante-natal on Rhesus incompatibility

4. To identify the commonly used Rhogam injection in pregnancy or during

delivery

5. To proffer solution to the Rhesus incompatibility that can caused varieties

complication after birth.

1.5 SIGNIFICANCE OF THE STUDY

This research work will be relevant as follows: The work will enlighten

maternal (mother) on the need for them to know the complications that can

occurred if the rhesus of the mother and fetus is not compatible. Rhesus

compatibility is very important, in order to tackle any birth complications and

Rhesus disease.

1.6 SCOPE OF THE STUDY

The study focuses only on the important of Rhogam injection for the

prevention from any possible complications from Rhesus incompatibility among

pregnant women in General Hospital, EBUTE Ikorodu Local Government Area,

Lagos State.

LIMITATIONS TO THE STUDY

1. Ethical Consideration:Conducting randomized controlled trials where some Rh-

negative pregnant women do not receive Rhogam would be unethical,as the

consequences of not administering Rhogam could be severe, including Hemolytic

Disease Of The Fetus and Newborn(HDFN).

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 Therefore,most studies are observational or retrospective

2. Population Diversity:The effect of Rhogam can vary based on genetic

diversity,healthcare

practices, and access to [Link] might not capture the full range of

outcomes in different populations particularly in areas with limited healthcare

resources.

3. Changes in Prenatal Care:Advanced in Prenatal Care and diagnostic techniques

overtime can impact the relevance of older [Link] prenatal care evolves,new

challenges and considerations might arise that are not fully addressed in existing

research.

Incomplete Understanding Of Mechanism:While the general mechanism

of Rhogam is understood,there may be incomplete Understanding of all the

immunological mechanism at play, particularly in cases of breakthrough

sensitization or Rhogam

4. Long-Term Outcomes:While Rhogam is effective in preventing immediate

complications from Rh incompatibility,there is less data on the long-term

outcomes for both the mother and [Link]-up studies are often limited in

duration,making it challenging to assess long-term safety and efficacy.

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1.7 DEFINITION OF TERMS

Rhesus incompatibility: is a condition that develops globally, when a

pregnant woman has Rh-negative blood and the baby in her womb has Rh-

positive blood Anthonia, (2015).

Rhesus negative: This is when an individual lack the Rhesus erythrocyte surface

antigen.

Rhesus incompatibility: also known as Rhesus disease is a condition that occurs

when a woman with Rh-negative blood type is exposed to Rh- positive blood

cells, leading to the development of Rhesus antibodies (Khan, 2000).

Rhesus sensitization: occurs in approximately 1 per 1000 births to women who

are Rhesus negative.

Jaundice: These is a Rhesus disease, that occurred due to the destruction of the

erythrocyte (Red blood cells) and also a condition that leads to the yellowish of

the eye, skin, and the mucous membrane due to high level of bilirubin in the

blood (Feheide, 2014).

Erythrocytes: This is also termed Red blood cells that are produced from the bone

marrow, which (in humans) is typically a biconcave disc without a nucleus.

Erythrocytes contain the pigment hemoglobin, which imparts the red color to

blood, and transport oxygen and carbon dioxide to and from the tissues (Aliu

Rahman, 2019).

Hemoglobin: Hemo-Blood, Globin- protein. That is, the red blood cells contained

oxygen which imparts the red color to blood and helps in carrying of oxygenated

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blood from the lungs to the body tissues and returns carbon dioxide from the body

tissues back to the lungs.

Hemolysis: This is a condition that occurred due to the destruction of the

erythrocyte (Red blood cells).

Pregnancy: These is a process whereby fertilized eggs (zygote) got implanted to

the endometrial linen of the uterus, (Bolaji, 2001).

Blood: Is a combination of plasma and cells that circulate through the entire body.

It is a specialized bodily fluid that supplies essential substances around the body,

such as sugars, oxygen, and hormones. It also removes waste from the cells in the

body (Laurel, 2006).

Rhesus (Rh) factor: is an inherited protein found on the surface of red blood cells.

Rhesus antibody: are proteins made by the body to attack foreign substances such

as viruses and bacteria. Red blood cell antibodies may show up in your blood if

you are exposed to red blood cells other than your own.

Rhesus disease: is a condition where antibodies in a pregnant woman's blood

destroy her baby's blood cells. It's also known as hemolytic disease of the fetus

and newborn (HDFN).

Rhesus positive: means that a protein (D antigen) is found on the surface of the

red blood cells