About 5 to 7 per cent of Indians have Rh-negative blood, a figure significantly lower than the 15 per cent observed in Western populations. This blood type itself poses no health issues. However, for a woman planning a pregnancy, it is crucial information that her obstetrician needs from the very first visit.
Understanding the Rh Factor
The Rh factor refers to a protein known as the RhD antigen, which is found on the surface of red blood cells. Individuals who carry this protein are Rh-positive, while those who do not are Rh-negative. Complications arise only in one specific scenario: when an Rh-negative mother carries an Rh-positive baby. This situation is more likely if the father is Rh-positive and the baby inherits his blood type.
How Sensitisation Occurs
During pregnancy, delivery, miscarriage, or any procedure that disturbs the placenta, a small amount of the baby's blood can enter the mother's circulation. The mother's immune system perceives the unfamiliar Rh protein as foreign and begins producing antibodies against it. This process is called sensitisation.
The first pregnancy is typically safe because sensitisation takes time. The real concern arises with the next pregnancy. If the second baby is also Rh-positive, the mother's existing antibodies can cross the placenta and attack the foetus's red blood cells. This leads to haemolytic disease of the foetus and newborn, which can cause severe anaemia, jaundice, brain damage, or stillbirth.
Prevention with Anti-D Immunoglobulin
An injection of anti-D immunoglobulin prevents the mother's body from producing antibodies. Without it, 16 per cent of at-risk pregnancies develop complications. With it, the figure drops dramatically to 0.1 per cent.
FOGSI Recommendations
The Federation of Obstetric and Gynaecological Societies of India (FOGSI) recommends that every Rh-negative pregnant woman receive an anti-D injection at 28 weeks of pregnancy and a second dose within 72 hours of delivery if the baby is Rh-positive. The injection is also necessary after a miscarriage, abortion, ectopic pregnancy, or any invasive procedure such as amniocentesis or chorionic villus sampling. Even minor trauma to the abdomen during pregnancy can warrant a dose.
Importance of Early Screening
Every woman should know her blood group before conceiving. The partner's Rh status should also be checked, as an Rh-negative father eliminates the risk. Antenatal visits should not be skipped because the indirect Coombs test, which screens for antibodies in the mother's blood, is part of standard care.
Challenges in India
In India, access to anti-D immunoglobulin remains uneven. Smaller hospitals may not always stock it, and many women in rural areas are not screened early enough in pregnancy. An Rh-negative woman should confirm that her chosen facility administers the injection according to FOGSI recommendations to optimise pregnancy outcomes.
Dr. Ameya C Purandare, President of AMOGS 2026-28 and Consultant Obstetrician & Gynaecologist at Purandare Hospital, emphasises the importance of adherence to these guidelines.
