While expecting a child, a woman undergoes many mandatory tests. Among them is a blood test for Rh factor. If you have a positive Rh factor, then you don’t have to read the rest of the article; the Rh factor will not affect you. If you know (and it happens that you only found out for the first time during pregnancy) that you have a negative Rh factor, then I suggest reading the material below - this knowledge will not be superfluous :)
First, a little theory. Our blood contains red blood cells - erythrocytes. On their surface, as well as on all other cells of our body, there are receptors. They are needed so that cells can “recognize each other” and, so to speak, “communicate”, that is, carry out intercellular interactions. It is with the help of receptors that our body distinguishes between “our own” and “foreign” cells, since they are carriers of individual information. There are more than a hundred receptors on one red blood cell alone. One of the main receptors on the outer membrane of red blood cells is the ABO protein system - the well-known blood group system. And the main receptors of the inner membrane are the blood protein Rh factor (this protein was first discovered in rhesus monkeys, which is why it is called that).
All people, depending on the presence or absence of this protein, are divided into Rh-negative and Rh-positive. About 85% of people have this same Rh factor and are therefore Rh positive. The remaining 15% who do not have it are Rh negative.
IN ordinary life Neither the presence nor absence of the Rh factor plays any special role. They become important only during blood transfusions and during pregnancy.If the mother and child have different Rh factors, then a Rh conflict may develop, when the mother’s body “considers” the baby’s blood a foreign substance and begins to produce antibodies, attacking the child’s blood cells.
But this does not always happen, but only with a certain combination of Rh factors of the mother and baby. Since the Rh factor is inherited from mom and dad, the child may have various options his inheritance. For example, Rh-positive parents can have both Rh-negative and Rh-positive children. Children with Rh negative parents will always have Rh negative different Rh factor(mom is positive, dad is negative or vice versa), there are also different options.
Let's consider all possible combinations of Rh factors.
Mother's Rh factor is positive
Let’s say right away that if the mother’s Rh factor is positive, then, regardless of what Rh factor her husband (the child’s father) and the baby himself have, no Rh conflict arises. For example:
Rh positive mom + Rh positive dad = Rh- positive child.
The fact is that if the mother and the child have the same Rh factor, there will be no conflict and the pregnancy will proceed without complications.
If the mother and child have different Rhesus, the conflict does not develop, since the blood of a Rh-negative child does not contain the protein of the Rh system: there is simply no reason for the conflict to develop.
It turns out that a woman with a positive Rh factor does not require any additional research or treatment during pregnancy and childbirth.
Here, too, various options are possible. If the mother is Rh negative, then the Rh factor of the child's father and the Rh factor of the baby itself are of great importance. Very good option, when the mother’s negative Rh factor coincides with the negative Rh factor of the child’s father or the baby himself. For example: Rh-negative mother + Rh-negative father = Rh-negative child; or Rh-negative mother + Rh-positive father = Rh-negative child. Mother and child have the same Rh factor, and there is no conflict.
The development of conflict is only possible if Rh-negative mother + Rh-positive father = Rh-positive child.
If the pregnancy proceeds without complications, then the blood of the mother and child does not mix - there is a certain barrier-filter between the woman and the fetus (feto-placental barrier - FPB). But this barrier is broken during childbirth (with severe toxicosis and diseases in which the FPB is damaged, as well as during termination of pregnancy, ectopic pregnancy) and a certain portion of the child’s blood enters the mother’s bloodstream. The red blood cells of a Rh-positive child are perceived by the body of a Rh-negative mother as foreign “agents”; the mother’s body begins to actively defend against them and produces special antibodies, the task of which is to destroy foreign blood cells, that is, in this case baby's red blood cells. That is, it turns out that the first pregnancy is Rhesus negative woman from a Rh-positive man it occurs without complications; simply, after childbirth, antibodies to the positive Rh factor remain in the mother’s blood for life. What will happen next?
But during the next pregnancy, if unborn child will have again Rh positive-factor, Rh conflict develops. The mother's antibodies penetrate the baby's bloodstream and destroy his red blood cells. This process may begin in utero. Will appear in the child's blood a large number of bilirubin pigment, which is a breakdown product of red blood cells and is toxic in high concentrations. The fetal body will defend itself: the spleen and liver will begin to work harder, and they will increase significantly in size. If a child has few red blood cells left, he will develop anemia - low levels of red blood cells and hemoglobin in the blood. Other pathological processes will also occur. This disease is called hemolytic disease of the fetus. If the process of destruction of the child’s red blood cells begins or continues after birth, then this will be hemolytic disease of the newborn. There are several degrees of severity of this disease, and in severe cases, treatment involves a replacement blood transfusion to the child. And sometimes it is even performed in utero. Therefore, it is so important to determine the mother’s Rh factor during the first pregnancy and prescribe rhesus conflict prevention in a timely manner. Severe degree hemolytic disease is not easy to treat, and even in the case of a favorable outcome, there may be consequences for the baby’s health.
In order to prevent the development of Rh conflict in the future, a woman with Rh-negative blood should be given anti-Rh gammaglobulin within the next 72 hours after the first birth (the sooner the better).
This substance blocks foreign “positive” red blood cells and removes them from the body.
In Russia, the Ministry of Health has been preventing Rhesus conflicts for many years and recommends observing the following rules. 1.If a woman with Rh-negative blood had a termination of pregnancy before 12 weeks or ectopic pregnancy
, then it is impossible to find out the child’s Rh factor. In such a situation, she needs to be given anti-Rhesus gammaglobulin within the next 72 hours after surgery.
3. In children of all mothers with Rh-negative blood, the Rh factor must be determined within 2 hours after birth. If the child's Rh factor is positive, the mother must be given anti-Rh gammaglobulin within 72 hours.
4. Also, the administration of anti-Rhesus gammaglobulin is indicated for the prevention of Rh-conflict if invasive research methods were performed (amniocentesis, cordocentesis) and in case of an unfavorable course of pregnancy (bleeding due to placental abruption, etc.).
5. If a woman was not given anti-Rh gamma globulin after the first pregnancy and antibodies appeared in the blood, then there is no point in administering this drug during subsequent pregnancies, since the antibodies have already been developed. But strict medical control is still necessary.
We have compiled a reminder to help you expectant mother:
1. Find out your Rh factor and the Rh factor of the child’s father.
2. If you have a negative Rh factor, then after the first and each subsequent pregnancy, ask to establish the child’s blood type and, if necessary, administer anti-Rh gammaglobulin to you within the first 72 hours.
3.If you have a negative Rh factor, regularly donate blood to check for antibodies.
4.If the expectant mother has a negative Rh factor, then she and her baby need a thorough ultrasound examination (especially pay attention to the placenta, liver and tummy of the baby).
5.Choose a birth center or a medical clinic to monitor your pregnancy, where doctors know how to manage a pregnancy with a negative Rh factor.
6. Immediately before giving birth, find out if there is anti-Rhesus gammaglobulin in the maternity hospital.
Not so long ago, negative Rh blood factor during pregnancy was a serious threat to its course. Doctors predicted that the expectant mother, especially if she was pregnant with her second or third child, would experience a whole range of negative consequences for the baby. If a woman, having a negative Rh factor, for some reason decided to artificial interruption pregnancy, abortion could cause further childlessness.
Today the situation has changed dramatically. Modern diagnostic and therapeutic methods allow minimizing the risk of negative indicators of this parameter in the mother.
What is the Rh factor?
The blood of humans and animals contains red blood cells, on the surface of which there is an antigen or protein called the Rh factor. This is a constant indicator and cannot change during life. Sometimes there is evidence that after medical manipulations in a person this blood parameter changes. But it has been scientifically proven that changing it is impossible. The answer to the question of why such information appears is the erroneous results of determining the presence of an antigen before or after medical manipulation.
If a person’s red blood cells have this antigen, the Rh factor is called positive; if it does not, it is called negative. More than 85% of the world's population are Rh positive carriers. Information about whether a person has an antigen or not is necessary when giving a blood transfusion or providing emergency care. medical care, surgical intervention. These parameters are sometimes used to determine the sex of the unborn child, but there is no data confirming the accuracy of such methods.
It is reliably known that the discovery of a negative Rh factor du in a patient means that, if necessary, he is given a blood transfusion only with a negative indicator.
During pregnancy, the Rh factor is very important. If the mother is negative and the husband is positive, the baby may inherit the father's antigen. This is fraught with the development of Rh conflict, which the mother’s body will fight with the active production of antibodies, perceiving the growing baby as a foreign body. If measures are not taken, the course of such a pregnancy will end negatively.
The compatibility of Rh factors and blood groups with each other is determined using a special table.
(Table picture)
When both spouses have the same positive or negative Rh factor, they have nothing to worry about. It is necessary to take measures during pregnancy only when different meanings this indicator among young parents.
Features of pregnancy with negative Rhesus
If parents have different antigen levels, and there is a possibility of Rh conflict during pregnancy, this is not a reason for frustration. Close supervision by specialists and regular testing, as well as knowledge of how to give birth with a negative Rhesus, will help you get through this stage without risks for the child.
During the first pregnancy
Only during pregnancy does a woman encounter unfamiliar, foreign antigens for the first time. There is a high probability that the production of antibodies against antigens will not begin at all. During the first pregnancy, the process of their production (if it has begun) proceeds slowly. Decreased immunity due to shift hormonal levels and the slowness of white blood cells contribute to the fact that the Rh conflict either does not begin at all or is mild.
During the second and subsequent pregnancies
When faced with foreign antigens, the body acquires “cellular memory”. This means that the next time it encounters a foreign antigen, the formation of antibodies in the female body will occur much faster. With each subsequent time, the speed of the process increases, increasing the inevitability of the development of Rh conflict.
Memorization occurs not only after a successful pregnancy, but also after a miscarriage, abortion, or medical intervention involving a blood transfusion.
If a Rh conflict has developed in the body of a young mother, modern medical methods can correct the situation in time. She is advised to constantly be under the supervision of specialists.
Consequences of negative Rh factor during pregnancy
A pregnant woman with negative Rh is required to take an antibody test every month. The obstetrician-gynecologist pays close attention to accompanying pregnancy with such a history. Until the thirty-second week, a venous blood test for the presence of antibodies is carried out every month. After the thirty-second week, it should be taken every couple of weeks. From 35 weeks - weekly.
Otherwise, bearing a baby by a mother with negative Rh is no different from the course of a normal pregnancy. The rapidity of antibody development determines whether immunoglobulin will need to be administered to the expectant mother.
Impact on baby's health
If not accepted preventive measures, dangerous pathological processes are launched:
- A decrease in the number of red blood cells in the fetus, which are responsible for transporting oxygen, which gradually develops oxygen starvation. First of all, it affects the development of the heart and brain.
- The amount of bilirubin increases. It is produced when red blood cells are destroyed. An increasing amount of bilirubin causes serious intoxication of the fetus.
- Increased production of red blood cells by the spleen and liver of the child, causing an enlargement of these organs and their pathological development.
- The development of an imbalance in the composition of the blood, impaired production of blood particles, the development of pathologies in the development of the spinal cord, congenital hemolytic anemia. Hemolytic disease of the newborn (HDN) is manifested by pale skin and general weakness.
Methods for diagnosing problems with negative Rh factor during pregnancy
The presence of antibodies in a young mother is determined at the very beginning of pregnancy. Many women know about their rhesus long before conception and the onset of " interesting situation" The obstetrician-gynecologist puts such a mother on special registration. Having identified negative result antibody test, the doctor prescribes a monthly venous blood donation for the expectant mother to monitor the rate of antibody formation. The closer the due date, the more often the young mother has to undergo tests to control the situation.
In addition to blood tests, the pregnant woman is prescribed routine ultrasound examinations, during which close attention is paid to the condition of the baby’s liver and spleen, as well as the condition of the placenta.
If any pathologies are detected, cardiotocography (CTG) and Doppler ultrasound are additionally performed. These studies allow us to evaluate the work of cardio-vascular system the child, and whether a sufficient amount of oxygen is supplied to him through the uteroplacental bloodstream.
If the analysis for anti-Rhesus bodies shows their rapid growth, invasive diagnostic methods are used. This diagnostic method is dangerous due to leakage of water surrounding the fetus, the risk of infection, and the formation of a hematoma on the umbilical cord.
Analysis amniotic fluid- the most reliable study, which indicates the exact amount of bilirubin produced by the baby, which allows us to assess the condition of the fetus. Taking material from the umbilical cord also provides reliable information about the composition of the fetal blood.
Specifics of childbirth
If the incompatibility of Rh factors did not lead to the rapid formation of antibodies and the pregnancy proceeded normally, without pathologies, the baby may be born naturally. During the process of delivery, the mother's body may intensify the production of antibodies due to the loss of a certain amount of blood. To do this, in the delivery room, the obstetrician-gynecologist must have on hand a portion of blood of the same type and Rh as that of the woman in labor. To eliminate the risk of pathologies during the birth process, the woman in labor is allowed to receive an injection of immunoglobulin.
In cases where the child inherited not the mother’s Rh, but the male, and a Rh conflict arose while carrying the baby, a decision is made to deliver by caesarean section. A problematic pregnancy is supported and maintained until 37-38 weeks, and upon reaching this period, a planned operation is performed.
In severe situations, a newborn baby is given a blood transfusion of the same type and Rh as the mother. A newborn is not fed in the first days breast milk, but mixtures. This is due to the fact that breast milk still contains antibodies. If they enter the baby's body, they will begin to destroy the red blood cells of his blood.
Immunoglobulin is injected into the body of a young mother within 72 hours after birth. This will prevent the conflict from developing in subsequent pregnancies. The same measures should be taken after an abortion or miscarriage. It is extremely important to complete the injection within three days.
Even if the first birth and the period of gestation passed without complications and the woman is planning the next pregnancy from a man with positive Rh, memory cells will still be produced in her body, so for the next birth the injection drug will need to either be purchased independently or check its availability in the maternity hospital. home.
You can learn more about what Rh conflict is, why it is bad, and how pregnancy proceeds with such a history from the video:
Conclusion
A negative Rhesus in a mother is not a reason to give up motherhood, and incompatibility of Rhesus with a beloved man is not a reason to part with him. In the vast majority of cases, bearing a baby under such circumstances proceeds without pathologies. Rhesus conflict occurs in only ten percent of pregnant women. Serious problems with development and health are observed in only two or three children out of a thousand.
Every woman with a negative Rh factor knows that this circumstance can affect both conception and the course of her pregnancy in the future. But not everyone knows who is at risk and how to prevent the development of immunological incompatibility between mother and fetus.
Rh factor is an antigen contained in human red blood cells. If it is present, its carrier is a person with a positive Rh factor, and if not, it is a person with a negative Rh factor. There are only about 15% of such people. This antigen received its name from the rhesus macaques in which it was first discovered. The Rh factor appears in fetal red blood cells around the eighth week of pregnancy. When an Rh-negative woman becomes pregnant from an Rh-negative man, they can only give birth to an Rh-negative child, in which case there will be no immunological incompatibility. Trouble can only begin when an Rh-negative woman carries a child from a man with a positive Rh factor. Why? A special protein, which is present in the child’s blood and absent in the mother’s blood, begins to enter the woman’s body during pregnancy. Her body regards it as a foreign object and produces protective antibodies against it. These antibodies, when they enter the baby's blood, begin to destroy fetal blood cells. When red blood cells break down, they release a substance called bilirubin. In large quantities, it can adversely affect the health of the child.
If this is a woman’s first pregnancy and she has not had any miscarriages, abortions, or blood transfusions before, then the likelihood that a Rh conflict will occur is quite small. IN otherwise the body of a Rh-negative woman has already developed antibodies to the foreign protein, as if “remembering” them. And if pregnancy occurs, he will begin to reject the fetus. If the pregnancy can be maintained, there is a risk of developing hemolytic disease in the child.
When an expectant mother comes to register for pregnancy antenatal clinic, her blood is immediately taken to determine the Rh factor. If it is positive, then she is not in danger of Rh conflict. The situation changes if Rh is negative. Then the blood of the future father must be taken for analysis.
If both parents have negative Rh factors, their child will also inherit this feature, and the pregnancy will proceed as usual. The attention of doctors requires the situation when the mother is “minus” and the father is “plus”. An expectant mother with a negative Rh factor will be tested throughout her pregnancy for the presence of antibodies to the baby's Rh factor.
Up to 32 weeks – every month
At 32–35 weeks – once a week
From the 35th week - weekly
If antibodies are detected at any stage, the woman is hospitalized in a hospital. If an increase in titer or the so-called “jumping titer” occurs, an amniocentesis procedure is required - puncture of the amniotic sac to examine the amniotic fluid to determine the level of bilirubin in it. If it is quite high, your doctor may prescribe one of the following procedures.
Plasmapheresis. The woman's plasma is taken, purified, and then infused back. This method is the least effective, but the simplest.
Blood transfusion to the fetus. It is believed that this is the most effective way to combat Rhesus conflict. Its tangible disadvantage is that such a procedure is performed only in large medical centers in Moscow and St. Petersburg. The principle is this: under ultrasound control in umbilical vein Substances that relax the fetal muscles are injected, and then Rh-negative blood is injected through a needle. Rh-negative donor red blood cells are not destroyed by maternal antibodies. After two to three weeks, the transfusion is repeated. Essentially, donor blood temporarily replaces the fetus's own blood. If this procedure does not help, the question of early birth arises. Therefore, doctors are trying with all their might to extend an Rh-conflict pregnancy to at least 34 weeks, because by this time the baby’s lungs have already developed enough for him to breathe on his own.
Many women, while pregnant, are faced with a diagnosis such as Rh conflict. Most people know that this is something dangerous, both for the mother and for the unborn baby. But not everyone knows what Rh conflict during pregnancy actually is, what the signs of the conflict are, and what the consequences are.
Theory about the conflict of Rh factors during pregnancy
The Rh factor is an antigen that, among others, has been found on the surface of blood cells (red blood cells). But not all people have it available. So, if there are proteins on the surface of your red blood cells called “Rh factors”, then you are Rh positive, and if this antigen is missing, then you are Rh negative.
It turns out that people are divided into carriers of Rh-positive and Rh-negative factors.
You cannot rely on the name of the rhesus to determine which one is good and which one is bad. They're just different. However, people who have a positive Rh factor may not remember about it, and women who have a negative Rh factor should study information about the Rh conflict.
If, suppose, red blood cells with proteins of the Rh system enter the blood of such a person, they are perceived immune system as "strangers". The body urgently begins to produce antibodies. And a Rhesus conflict arises.
The risk of such a pathology occurs when a person is transfused with blood incompatible with his Rhesus and in pregnant women if the mother is Rh negative and the baby is Rh positive.
What is the probability
If the mother has negative Rh blood and the father has positive blood, then almost 75% of pregnant women develop an Rh conflict. In other cases, for example, if, on the contrary, dad is negative, and mom is positive, then there will be no conflict.
However, if the likelihood of a conflict developing is high, this is not a reason to refuse to have a child together. Firstly, competent prevention can reduce the consequences of this event to nothing. Secondly, not everyone develops this pathology during pregnancy.
If such a problem arose during your first pregnancy, then it is important to know how this pregnancy ended in the first place. If there is a miscarriage, then sensitization (antibodies in the blood) will occur in 3-4% of cases, after an abortion - in 5-6%, after an ectopic - in 1%, and after a normal birth - in 10-15%.
A particular risk for sensitization is cesarean section or cases of placental abruption. That is, the more red blood cells from the fetal blood enter a woman’s blood, the greater the risk. In any case, it is necessary to prevent such dangerous consequences Rhesus conflict, as hemolytic disease of the fetus.
First pregnancy
In the case of Rh conflict during the first pregnancy, the woman does not yet have antibodies, and therefore there is no strong conflict, because this is the first meeting of charged blood cells different rhesus. If a significant amount of red blood cells enters the mother’s blood, then a so-called “cell memory” arises, which, during the second and all subsequent pregnancies, quite quickly produce antibodies against foreign blood cells.
The main signs of Rh conflict during pregnancy are the results of tests during pregnancy and immediately after the birth of the baby. The fact is that the mother’s antibodies, penetrating the placenta, enter the baby’s blood and attack the red blood cells. At the same time, a large amount of bilirubin begins to be produced in the baby’s blood, which turns the baby’s skin yellow.
This effect is called " hemolytic jaundice"and is the main sign of conflict. The most terrible consequence of Rh conflict during pregnancy is brain damage. The child's red blood cells are constantly destroyed by the mother's antibodies, while the spleen and liver increase in size.
As a result, they also cease to cope with such an attack and oxygen starvation occurs, new disorders and deviations are formed. If the case is very severe, edema (dropsy) may develop and the fetus may die.
Treatment
Treatment of Rh conflict during pregnancy is carried out by perinatal centers, where mother and baby are under constant supervision. If there is a possibility of developing this pathology, then the woman’s blood is regularly drawn and the antibody titer is monitored. If the pregnancy can be extended to 38 weeks, a planned caesarean section is performed.
If there is a risk premature birth, then through the anterior wall of the mother’s peritoneum an intrauterine blood transfusion is made into the umbilical cord vein in the amount of 30-50 ml of erythrocyte substance. All this is done under ultrasound control.
Prevention
To avoid negative consequences, especially if there is a risk of Rh conflict during a second pregnancy, it is useful to carry out prevention. Most the best prevention Rh conflict during pregnancy is the prevention of Rh conflict. For this purpose, specific D-immunoglobulin is used.
Immediately after birth, the baby's blood is taken for analysis and its Rh factor is determined. And if the baby is negative, then the mother must be administered this drug within 72 hours to prevent the development of Rh conflict in subsequent pregnancies.
The course of pregnancy is influenced by many factors. Rhesus conflict between mother and fetus carries high risks. However, not everyone understands the reasons for this phenomenon, which causes fear of the unknown. Therefore, every expectant mother is obliged to know why the Rh factor is dangerous and in what cases the Rh conflict “mother-fetus” occurs.
Rhesus conflict - what is it?
To understand the essence of the problem, it is important to first understand the importance of the Rh factor. It is a special protein located on the surface of red blood cells. This protein is present in the blood of 85% of all people, but is absent in the rest. Therefore, the first of them are considered to have a positive Rh factor, and the second - a negative one.
Thus, it determines the immunological characteristics of the body and has absolutely no effect on human health. The Rh factor is usually designated Rh+ and Rh-. This term was first introduced in 1940 by scientists Alexander Wiener and Karl Landsteiner. Rh conflict between mother and fetus is an immunological incompatibility in the Rh blood factor if the mother is negative and the fetus is positive. The danger of Rh conflict is that it can cause intrauterine fetal death, stillbirth, and miscarriage. This phenomenon can appear in an expectant mother with negative Rh both during pregnancy and during childbirth. An immune conflict between mother and fetus occurs if the fetus inherits Rh+ from the father.
Causes of Rh conflict between mother and fetus
For the body of the expectant mother, the blood of a baby with Rh+ poses a serious threat, so it produces antibodies that react to the fetal red blood cells and destroy them. Rh conflict between mother and fetus is explained by the transplantental penetration of fetal red blood cells with a positive Rh factor into the blood of the mother with a negative indicator.
The immunological conflict is largely determined by the outcome of a woman’s first pregnancy. During pregnancy, Rh conflict can be caused by blood transfusions in which the Rh factor was not taken into account, previous abortions, or miscarriages. Also, the baby's Rh-incompatible blood can enter the mother's bloodstream during childbirth, so the mother's body becomes susceptible to the negative Rh factor, and the likelihood of Rh conflict during the second pregnancy increases. The risk of isoimmunization increases during cesarean section. Blood incompatibility can be caused by bleeding during pregnancy and childbirth as a result of damage to the placenta.
Probability of Rh conflict by blood group
The Rh factor is a genetically determined and dominant inherited trait. If the mother is Rh negative and the father is positive with homozygosity, the child always receives Rh+. In this case, the risk of blood group conflict is very high. And in the case of heterozygosity of the father, the probability of transmitting negative or positive Rh to the fetus is equal.
In the eighth week, hematopoiesis occurs, during which red blood cells are likely to enter the mother's bloodstream. In this case, the mother’s protection is triggered, since the fetal antigen is considered foreign. Therefore, the pregnant woman’s body produces anti-Rh antibodies, which causes Rh conflict between mother and fetus. The risk of an immunological conflict during gestation is quite small and amounts to only 0.8%, but it is very dangerous and therefore requires special study and attention. Prediction of Rh conflict during pregnancy will allow you to determine the approximate Rh of the unborn child by analyzing the parents' blood group. The table clearly illustrates the likelihood of blood incompatibility.
Consequences and threats of Rh conflict during pregnancy
Immune conflict between mother and fetus is fraught with serious consequences for the child. Antigens produced by the mother's body, having detected a foreign body with an incompatible Rh factor, penetrate the fetal bloodstream through the hematoplacental barrier and destroy the child's hematopoiesis process, inhibiting the formation of red blood cells.
This behavior of antibodies can cause an extremely dangerous condition for the fetus, threatening the life of the unborn child, which is characterized by acidosis, hypoxia, and anemia. An excessive amount of fluid accumulates in the baby’s body and the development of almost all systems and organs is disrupted. If measures are not taken in a timely manner, there is serious intrauterine fetal death, stillbirth, or the birth of a child with a hemolytic disease, which will continue to progress due to the accumulation of anti-Rh antibodies in the baby’s body, the production of which was caused by the conflict between mother and fetus during pregnancy. It can also cause developmental pathologies, which are expressed in excessive enlargement internal organs, brain, heart, toxic damage to the central nervous system.
Symptoms
There is no Rh conflict between mother and fetus during pregnancy clinical manifestations and specific symptoms. The problem can only be identified through a laboratory blood test, which shows the presence of antibodies to the negative Rh factor.
In the fetus, blood incompatibility manifests itself in the development of internal organs and body systems, which can lead to its death in the period from 20-30 weeks of pregnancy, as well as miscarriage, stillbirth, and premature birth.
In addition, a full-term baby may exhibit an edematous, icteric and anemic form of hemolytic pathology. Rh conflict in the fetus manifests itself in the appearance of immature red blood cells in the blood and pathologies in the development of internal organs. Symptoms are determined by the amount of antibodies produced by the mother's body. The disease occurs in a severe form when swelling of the fetus appears - there is an increase in the size of internal organs, the appearance of ascites, an increase in the placenta and the volume of amniotic fluid. The child's weight can be increased up to two times, and the disease is often accompanied by dropsy.
Laboratory research
Rhesus conflict "mother-fetus" during pregnancy allows you to prevent early diagnosis, primarily in the form of identifying the Rh factors of the father and mother before the onset of future pregnancy or in its early stages.
Prediction of Rh conflict is based on data on previous blood transfusions, the course and outcome of the first pregnancy, the presence of abortions, miscarriages, fetal death inside the womb, hemolytic disease of the child, which makes it possible to accurately identify the likelihood of the risk of isoimmunization.
Laboratory blood tests to determine anti-Rh bodies and titer are carried out for all women with suspected Rh conflict during pregnancy. The child's father should also be tested. If the likelihood of an Rh conflict is high, a pregnant woman needs to be tested every month. From 32 weeks lab tests are carried out twice a month, and from the 36th - every week until delivery. If a Rh conflict is detected during pregnancy, studies will determine the level of antibodies in the mother’s body. The earlier the pathology is diagnosed, the lower the risk of complications, since the effect of Rh conflict accumulates over time.
Ultrasound and invasive methods for assessing fetal risk
In order to diagnose the immunological conflict between the fetus and mother in more detail, an ultrasound examination is performed at least four times from 20 to 36 weeks of pregnancy, as well as before delivery. Ultrasound allows you to track the developmental features of the fetus, as well as identify the presence of pathologies.
During the study, the condition and size of the placenta, the volume of the fetal abdomen, amniotic fluid, and dilated veins of the umbilical cord are assessed.
Additional research methods are ECG, cardiotocography, phonocardiography, which make it possible to determine the level of hypoxia in the fetus during Rh-conflict. Valuable information is provided by invasive assessment methods - the study of amniotic fluid by amniocentesis and umbilical cord blood by cordocentesis. Diagnosis of amniotic fluid makes it possible to determine the titer of anti-Rhesus bodies, the sex of the child, and the maturity of the fetal lungs. The exact degree of pathology is diagnosed by cardocentosis based on the blood type and Rh factor of the fetus. In addition, studies show the presence of serum protein, the content of hemoglobin, bilirubin, reticulocytes, antibodies fixed on red blood cells.
Treatment
If a conflict between mother and fetus based on blood type is detected, almost the only effective way The treatment is to give a blood transfusion to the fetus through the umbilical vein inside the womb. The procedure is carried out under ultrasound control. This measure allows you to alleviate the condition of the fetus, prolong pregnancy, and reduce the manifestations of anemia and hypoxia.
To weaken the influence of Rh conflict, oxygen therapy is also carried out, a course of nonspecific therapy is prescribed, which includes vitamins, preparations containing iron, calcium, and antihistamines. If the fetus is in serious condition, a caesarean section is performed at 37-38 weeks of pregnancy. A pregnant woman is also prescribed plasmapheresis, which reduces the level of antibodies in the blood to the red blood cells of the fetus.
After birth, the child is given a replacement blood transfusion to replace decayed red blood cells and is prescribed treatment for hemolytic pathology - droppers that remove toxic substances from the body and reduce the level of breakdown of red blood cells, radiation ultraviolet rays. Treatment requires an intensive course of therapy, observation by neonatologists, and sometimes the child is admitted to the intensive care unit. Feeding a baby with breast milk is not recommended during the first 2 weeks after birth if hemolytic disease is detected.
Childbirth with Rhesus conflict
Most often, the outcome of pregnancy is in the presence of Rh conflict - Therefore, the task of doctors is to extend the gestation period of the child and comprehensively monitor the process of its development. For diagnosis, ultrasound, Doppler, and CTG are performed throughout the entire pregnancy. If further pregnancy poses a serious danger to the fetus, a decision is made to give birth ahead of schedule.
In most cases, pregnancy with Rh-conflict results in a caesarean section. Natural childbirth is extremely rare and only if the condition of the fetus is assessed as satisfactory and the baby’s life is not in danger. C-section considered the safest and most gentle for the fetus. During childbirth, the presence of a neonatologist is necessary to carry out resuscitation if necessary. Obstetric care should be carried out in a room well equipped with all the necessary medical equipment and under the supervision of highly qualified doctors.
Preventive measures
Mother-fetus conflict during pregnancy can cause serious consequences for the child. Therefore, preventive measures aimed at preventing Rh conflict and the development of isoimmunization are of great importance. When receiving a blood transfusion, it is important to consider compatibility with the donor, it is necessary to preserve the first pregnancy, and also to prevent abortions. Careful pregnancy planning is of no small importance. A study of blood type and Rh factor will help prevent Rh conflict during pregnancy. A blood group compatibility chart helps you avoid problems in the future. You should be careful about the course of your pregnancy. As a prophylaxis, an intramuscular injection of anti-Rhesus immunoglobulin from a blood donor is used for women with a negative Rh factor and with increased susceptibility to a positive antigen. This drug destroys red blood cells that come from a carrier of a positive Rh factor, thereby reducing isoimmunization and the risk of Rh conflict.
Injections are carried out after termination of pregnancy, miscarriages, surgery to prevent intrauterine pregnancy. It is also administered to pregnant women at risk at 28 weeks and again at 34 to reduce the likelihood of developing hemolytic disease of the fetus. Injections are also prescribed within 2-3 days after birth, which reduces the risk of Rh conflict in subsequent pregnancies. Immunoglobulin is administered during each pregnancy if there is a high probability of having a child with a positive Rh factor.
Thus, Rh conflict between mother and fetus is not a reason to terminate pregnancy. The likelihood of developing a Rh conflict is extremely low, so there is no reason to despair. Thanks to modern advances in immunology, it is always possible to bear a strong and healthy baby.
