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Perinatal outcomes and hematologic parameters of neonates born to Rh-negative mothers with and without isoimmunization

Background Rh isoimmunization remains a significant cause of neonatal morbidity and mortality in Rh-negative pregnancies. It causes hemolytic disease of the fetus and newborn (HDFN), leading to anemia, hyperbilirubinemia, and perinatal complications. This study compares hematologic parameters and perinatal outcomes of neonates born to Rh-negative mothers with and without isoimmunization.

Methods This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Bangladesh, from July 2019 to December 2019. Eighty Rh-negative pregnant women were enrolled, comprising five isoimmunised and seventy-five non-isoimmunised mothers. Data on neonatal haemoglobin, serum bilirubin, direct Coombs test results, Apgar scores, and treatment requirements were collected. Maternal factors were documented, including gravidity, antenatal care, and anti-D prophylaxis. Statistical analyses used SPSS version 25.0, with p-values <0.05 considered significant.

Results Neonates of isoimmunised mothers had lower haemoglobin levels (mean <12 g/dl in 60% vs. 0%, p<0.001), elevated bilirubin ≥4 mg/dl (80% vs. 20%, p<0.001), and 100% direct Coombs test positivity compared to none in non-isoimmunised neonates. Phototherapy and exchange transfusion were required in 80% and 60% of isoimmunised neonates, significantly higher than the non-isoimmunised group. Poor Apgar scores (<6 at 5 minutes) were more frequent in isoimmunised neonates (40% vs. 12%). High gravidity, inadequate antenatal care, and absent anti-D prophylaxis were prevalent among isoimmunised mothers.

Conclusion Rh isoimmunization markedly worsens neonatal hematologic and perinatal outcomes. Strengthened antenatal screening, universal anti-D prophylaxis, and enhanced neonatal care are critical to reducing HDFN burden in at-risk populations.