Sunday Magazine

‘I didn’t know blood group incompatibility can cause endless miscarriages’

Blood group issues in marriage can be traumatic –Experts



Women who have been unfortunate and found themselves experiencing serial spontaneous abortions or miscarriages due to Blood Group or Rhesus (Rh) Factor incompatibility have often been mistreated and unfairly blamed. In some societies, they have been ostracised for being barren and condemned for being witches, whereas the real culprit is ignorance about the importance of Rh factor compatibility in marriage. CHIJIOKE IREMEKA reports



Wide spread ignorance about the importance of blood group or Rh Factor Compatibility in marriage is the reason many couples go through weighty psychological trauma as well as financial burden in the homes, and not knowing what to do, they visit wanton spiritualists and blaming relatives for their woes.


Also, this has reverberated the need for methodical sensitisation and education of more men and women on the supreme importance of knowing their Rh factor compatibility as they do to their genotype before getting married.


Today, many people are aware of genotype test before getting married but not Rh factor test.


Thus, often a time, many intending couples pay less attention to blood group compatibility rather put much consideration on genotype before tying the marriage knot, believing it’s a more destructive situation not knowing that simple partner’s blood group incompatibility can cause a woman many years of repeated miscarriages or abortions even marriage breakups.


Sunday Telegraph’s investigations revealed that the partner’s blood group incompatibility has a high capacity of ruining one’s marriage when presented with recurrent miscarriages or abortions, which many couples, in a number of cases, believe to be witch-hunted by their evil uncles, mothers-in-law, co-wives, colleagues, and their neighbours among others, yet they may be the architect of their problems.


Sunday Telegraph finding further revealed that this condition which always sends some spiritual couples to the native doctors, praying pinnacles and high mountains, seeking for spiritual solution to medical problems, can be prevented if only the couple goes for blood group compatibility test before walking to the altar or registry to seal their marriages.


The ignorance of this magnitude, experts said, can cause years of childlessness for a woman until she discovers the root cause of her multiple miscarriages, and when care is not taken, this condition may inadvertently affect her marriage if the marriage is to an unsympathetic man.


“In a number of cases, you will hear that some women have been experiencing miscarriages in the second or third trimester of their pregnancies or even earlier or later than that, a very painful period to lose a pregnancy as the expectant parents would have been ready to welcome the newborn in their homes, but Rh incompatibility may be lurking until an experienced physician diagnoses them of it,” said a consultant gynecologist, Dr. Chris Afolabi.


He said that an ordinary indirect Coombs test or other tests can do well to confirm if such miscarriages are as a result of blood group or Rh factor incompatibility or not, saying that the test gives an insight on what happened and manner of treatment to be administered.


According to him, the blood Rhesus (Rh) factor incompatibility occurs during pregnancy if the mother is Rh– (Negative) and the baby is Rh+ (Positive), saying that it comes into play when a woman who is Rh- factor negative is impregnated by a man who is Rh+. Explaining further, he said: “When a woman is O- and her partner is O+, when the woman gets pregnant, the baby is most likely to have the blood group of the father which is O+.


When a woman with the O-blood carries the baby with O+ blood, their blood must not and if anything like abortion occurs and the O-blood of the mother touches the O+ blood of the baby, some antibodies will develop inside the blood of the mother as a result of this, then next pregnancies of the woman will be attacked by the antibodies and the babies will be killed, leading to more abortions.


“So, when this happens, it becomes a dangerous situation that can cause a woman years of tears due to multiple abortions or miscarriages that will follow when no treatment is administered,” he said. Most times, according to the World Health Oraganisation (WHO), this happens during the delivery of the first child, though not problematic to the first pregnancy, but the subsequent pregnancies will be attacked and aborted due to the antibodies created by the mother’s body to get rid of foreign elements in its system.


Other instances that can trigger the mother’s production of Rh-antibodies including miscarriages, abortions, ectopic pregnancy, abdominal trauma during pregnancy, and any form of bleeding during pregnancy.


Sunday Telegraph findings further showed that if there is a foreign antigen in the bloodstream, the immune system will create antibodies that attach to the antigens and signal an attack on them and killing the baby which manifests in miscarriages or otherwise abortions. The miscarriages can continue for the rest of the woman’s life unless she discovers this and solves it or God chooses to show her mercy.


An Immunologist and a medical laboratory scientist, Odinaka Ndukwe, said mother’s antibodies circulate in the fetus to help it survive while the immune system develops, but when there is a blood type incompatibility, those antibodies may go on the attack.


The fetus’ blood cells may also circulate into the mother’s, also prompting an attack too. She noted that Rhesus factor is a protein found on the surface of the red blood cells, which is hereditary, passed down from the parent to the child, saying, “If your blood contains this proteins, you are Rh positive, if your blood doesn’t, you are Rh negative. Most people are Rh+.


As a matter of fact, only 15 per cent of world population is Rh- and the majority of them are women.” Ndukwe stated that every human being has a blood type, saying that there are four major  blood groups in life which are group A, group B, group O and group AB.


“These groups differ primarily on the presence or absence of antigens that can stimulate an immune response. In addition to these four groups, a protein called Rh factor that may be either present (+) or absent (-) within each group. “This further defines blood groups into eight common types: A+, A-, B+, B-, O+, O-, AB+ and AB-.


Your blood type is something you inherit, so it’s predetermined at birth. You cannot change your blood type later in life,” she added. However, in a bid to have a first hand experience of how devastating this incompatibility could be, Sunday Telegraph went in search , perhaps, find a medical practitioner who has a firsthand link to any patient(s) on this blood group incompatibility issue.


The search was after all, not in vain, as Dr. (Mrs.) Cynthia Obiora of the Epe General Hospital, Lagos State, came in handy. Dr. (Mrs.) Obiora, a graduate of the University of Nigeria, Nsukka (UNN), Enugu State, sought and got the permission of one of her patients.


She said: “I have the permission of Mrs. Rose Ashafa(not real names), to share her painful life journey for others to learn from her pungent experience. “I was in my consulting room on the fateful day when a young married woman, about 25 years old, walked in, looking depressed.


She sighed as she sat. The perplexity on her face said it all. There was a big burden being carried in her heart,” the doctor said.


The doctor, however, mustered the courage to ask how she may help the patient, who answered in her frustration, “Doctor, this is my fifth miscarriage in five years of marriage.



Who did I offend?” The doctor further tried to establish whether those five pregnancies were really confirmed with pregnancy tests or scans which the patient answered in affirmation with tears in her eyes and shaky voice.


Dr. Obiora’s next question demanded to know at what stage those five miscarriages actually occurred and the patient said, ‘Around five to six months, doctor,’ with tears streaming down her eyes again, according to the doctor.


The consulting doctor stated that with the emotional atmosphere in the consulting room, she had to pause the discussion to allow her calm down and express her pains in tears, offering her handkerchief to wipe her tears.


Of course, who would blame a woman who was lucky to get married to a supportive and loving young man at age of 20 all for her to face this kind of hurdle with five miscarriages in five years?



The agony could only be imagined. Conversely, Dr. Obiora narrates: “After the situation had calmed down, we continued our conversation because we had to get to the root of the matter before we could proffer a solution to this perennial calamity that had plagued this young family.


“From all she had said so far there was one thing that kept ringing in my mind and that was the issue of blood group incompatibility. I went ahead to ask her about her blood group but she was surprised, asking what does her blood group have to do with the problem?


She eventually said, ‘O-, saying that her husband’s is O+. Now, the guess on my mind was becoming clearer.” “I asked further, ‘Have you ever had an abortion before, may be before marriage?


But she looked at me and was silent, put her right hand on her chin, removed it and retreated into her chair. She breathed heavily again. “After a while she said, ‘in my 200 level, I had three abortions for my boyfriend on campus. I was not ready for any pregnancy then. But doctor, does that have something to do with my present miscarriages?’


“Well, maybe, madam,’ I answered and asked again, ‘Do you know the blood group of your campus boyfriend? Again, she answered with mixed feelings, ‘doctor I don’t know his blood group; we just dated for like two years, he was my only boyfriend before I met my husband.’


“Can you call him and ask?” I told her but she reacted: ‘Who? My ex? Nooo, doctor we no longer talk; he was not happy I left him for my present husband.’ I appealed to her to, at least, try and make the call. “She reluctantly called him and after calling three times, he picked the call and said, ‘Yes madam, what do we owe this call?’ The voice from the other side resonated angrily ‘or have you come to break our hearts again?’


“I could hear because the phone was on loud speaker. She mustered courage and went straight to ask him about his blood group. The boyfriend was surprised that she didn’t know his blood group in their two years together.


“So, Madam you meant all the times we were together you didn’t know my blood group? How would you even know when your mind was occupied with another man? Why are you asking me anyway? What has my blood group got to do with your marriage?” he asked spitefully.


“When I saw the bitterness between the two of them was still fresh and this was delaying my diagnosis, I signaled to her to allow me talk to him. So, I collected the phone and introduced myself and appealed to him to respond to her. Then he said O+. I sank into my seat. My diagnosis was almost complete; the only thing left was to do a test to confirm it.


“I explained to her that all these revelations from both her past boyfriend and present husband blood group and her own blood group might have caused the collision in former pregnancies she aborted and could cause the present repeated miscarriages.


“She said in surprise, ‘I was thinking it’s the only genotype that couples have problems with in marriage? But I told her a couple could also have problems with miscarriages if their blood groups were not compatible. “She was really shocked to know this for the first time.


The next question on her mind was ‘does this mean I will not be able to have a child again in my life and I will continue to have miscarriages like this? She burst into tears again. “I consoled and reassured her that there was still chance of having her own baby, telling her that more efforts would just be needed but the chance of having another miscarriage was still there.


“I gave her a test called Indirect Coombs Test to do to know if clash had actually occurred in her blood due to past abortions, which she agreed to on the condition that I explain what the test is all about.


“Then, I took time to explain to her. She sat back into her chair again and sighed for the third time. She was overwhelmed by all these revelations about blood group issues in marriage. It sounded unbelievable to her that blood group could give couples this much problem in marriage.


“After she had regained herself, she promised to do the test and bring the result later. Two weeks later, she brought the result; it was positive, confirming my diagnosis. I broke the news to her, she wept again but I counseled, consoled and promised her that we would do our best in subsequent pregnancies to see she has her own child.


“This is where we need to sit up. I think we, the medical practitioners, are not educating the people enough on the role of blood group compatibility in marriage and we need to sit up to save these lives that are waiting as well as end the torture couples go through due to ignorance of this condition.”


Advising on the treatment of Rh incompatibility, Dr. Chidi Afulukwe said: “At your first prenatal visit, your doctor will suggest a blood type and Rh factor screening. If you are Rh-, your doctor will test your blood again later in your pregnancy to see if you have formed antibodies against Rh factor. That would indicate that your baby is Rh+.


“If your doctor identifies a potential for Rh incompatibility, your pregnancy will be monitored closely for any related issues and may need extra care. Although your blood and your baby’s blood typically do not mix during pregnancy, a minimal amount of your baby’s blood and your blood could come in contact with each other during delivery  “If there’s an Rh incompatibility and this happens, your body might produce Rh antibodies against Rh factor.


These antibodies will not cause problems to an Rh+ baby during the first pregnancy. But they can cause issues if you have a subsequent pregnancy and are carrying another child that is Rh+.


“If there was an Rh incompatibility in a first pregnancy, and there’s an Rh incompatibility in second and other future pregnancies, these maternal antibodies can damage the baby’s red blood cells. And when this occurs, your baby might need a red blood cell transfusion either during your pregnancy or immediately after delivery.


“Proviso Rh incompatibility has been diagnosed, your doctor will most likely recommend Rh immune globulin (RhoGAM) in your seventh month of pregnancy, and then again within 72 hours after delivery if your baby’s blood type is confirmed as Rh positive upon delivery.”


He noted that Rh immune globulin contains Rh IgG antibody, so your body does not react to your baby’s Rh positive cells as if they were a foreign substance, and your body will not produce its own Rh antibodies.




Other instances that can trigger the mother’s production of Rh-antibodies including miscarriages, abortions, ectopic pregnancy, abdominal trauma during pregnancy, and any form of bleeding during pregnancy


However, people with the blood type O+ represent about 37.4% of the adult population, according to the Stanford School of Medicine, in the United States, others with type O- represent about 6.6% of the adult population, and blood type A+ represents about 35.7% of the adult population.


It noted that people with the blood type A- represent about 6.3% of the adult population, people with the blood type B+ represent about 8.5% of the adult population, people with the blood type B- represent about 1.5% of the adult population. People with the blood type AB+ represent about 3.4% of the adult population, people with the blood type AB- represent about 0.6% of the adult population.


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