Rhesus disease prevention: 50 years of story

Rhesus disease prevention started 50 years ago, in 1968, when anti-D globulin was introduced to prevent the so-called Rhesus disease. When a pregnant woman is negative for the Rhesus blood factor, but her unborn child is positive, since he or she got that factor from the father, than the mother may start producing anti-bodies against the Rh factor. This may  result in the destruction of fetal erythrocytes, the red blood cells, and that may ultimately result in fetal anemia, edema and death. Destruction of fetal blood cells may, after birth, also result in neonatal jaundice and brain damage. The so-called Rh disease is typically a disease of the second child, since first contact between blood from the mother and that of her child usually occurs during the birth process. In other words anti-bodies will be made by the mother after the first delivery, or sometimes after a first miscarriage or bleeding or trauma during pregnancy.

RHESUS DISEASE TREATMENT

When a Ph negative mother delivers from a Rh positive child, than she should be treated within 48 h after delivery with anti-D globulin, which destroys remaining fetal blood cells in her circulation before she gets the chance of developing anti-bodies. In practice this means that in Rh negative women the Rh factor of her child will be determined directly after birth from blood taken from the umbilical cord. Anti-D globulin is only necessary  if the child Rh positive. After a miscarriage, bleeding or trauma, anti-globulin is given without further testing.

This procedure was implemented in many countries in 1968 and has eradicated almost all cases of Rh disease. More recently prevention was further refined by given anti-D globulin around 30 wks of gestation, to prevent Rh disease due to contact between maternal and fetal blood during pregnancy. The latter procedure may even be restricted to Rh negative women who carry a Rh positive child, since it is now possible to determine the fetal Rh factor in maternal blood in the first trimester of pregnancy.

All-in-all a true success story: an almost complete prevention of a disease than can induce severe damage to the unborn. A success story indeed in the socalled Western world. However, unfortunately it is still an unfinished success story since nowadays worldwide and annually still almost 200.000 babies die, either before or after birth, and another 100.000 suffer brain damage, due to Rh disease. This is not because treatment does not work, but it is due to the fact that anti-D globulin treatment may be forgotten to give, either after a delivery or miscarriage, to the fact that it may not be availabe in some countries, that it may be too expensive ( in some private market settings), or that a less effective alternative treatment is being given.

So, there is still a quite some work to be done. Health care officials, gynaecologists and midwives have to improve their efforts in preventing Rh disease. FIGO, the world organization of national obstetric/gynaecological societies is determined to lead the way forward.