Negative Rh factor in parents during pregnancy. The mother's Rh factor is positive, the father's is negative.

The time of bearing a child is one of the most beautiful times in a woman’s life. Every expectant mother wants to be calm about the baby’s health and enjoy the period of waiting for a new addition. But every tenth woman, according to statistics, has Rh-negative blood, and this fact worries both the pregnant woman herself and the doctors who observe her.

What is the possibility of Rh conflict between mother and baby, and what the danger lies, we will tell you in this article.

What it is?

When a woman and her future toddler have different blood counts, immunological incompatibility may begin; this is what is called Rh conflict. Representatives of humanity who have a Rh factor with a + sign have a specific protein D, which is contained in red blood cells. In a person with rhesus negative value this protein is missing.

Scientists still don't know for sure why some people have the specific Rhesus monkey protein and others don't. But the fact remains that about 15% of the world’s population have nothing in common with macaques; their Rh factor is negative.

There is a constant exchange between the pregnant woman and the child through the uteroplacental blood flow. If mom has Rh negative-factor, and the baby has a positive one, then protein D entering her body is nothing more than a foreign protein for a woman.

The mother's immune system very quickly begins to react to the uninvited guest, and when protein concentration reaches high values, Rh conflict begins. This is a merciless war that the pregnant woman’s immune defense declares on the child as the source of a foreign antigen protein.

Immune cells begin to destroy the baby's red blood cells with the help of special antibodies that he produces.

The fetus suffers, the woman experiences sensitization, the consequences can be quite sad, including the death of the baby in the mother’s womb, the death of the baby after birth, or the birth of a disabled child.

A Rh conflict can occur in a pregnant woman with Rh (-), if the baby has inherited her father’s blood characteristics, that is, Rh (+).

Much less often, incompatibility occurs based on such an indicator as blood group, if a man and a woman have different groups. That is, a pregnant woman whose own Rh factor has positive values ​​has nothing to worry about.

There is no reason to worry for families with the same negative Rhesus, but this coincidence does not happen often, because among the 15% of people with “negative” blood, the vast majority are representatives of the fair sex, men with such blood characteristics are only 3%.

Toddlers' own hematopoiesis begins in the womb at approximately 8 weeks of gestation. And from this moment on, in maternal blood tests, it is determined in the laboratory a small amount of fetal erythrocytes. It is from this period that the possibility of Rh conflict arises.

Probability tables

From a genetic point of view, the probability of inheriting the main characteristics of blood - type and Rh factor from father or mother is estimated at 50%.

There are tables that allow you to assess the risks of Rh conflict during pregnancy. And timely weighed risks give doctors time to try to minimize the consequences. Unfortunately, medicine cannot eliminate the conflict completely.

By Rh factor

By blood type

Causes of the conflict

The likelihood of developing a Rh conflict greatly depends on how and how the woman’s first pregnancy ended.

Even a “negative” mother can quite safely give birth to a positive baby, since during the first pregnancy the woman’s immune system does not yet have time to develop a killer amount of antibodies to protein D. The main thing is that before pregnancy she is not given a blood transfusion, without taking into account the Rh factor, as sometimes happens in an emergency situations to save lives.

If the first pregnancy ended in miscarriage or abortion, then the likelihood of a Rh conflict during the second pregnancy increases significantly, since the woman’s blood already contains antibodies ready to attack at a very early stage.

In women who underwent a caesarean section during the first birth, the likelihood of conflict during the second pregnancy is 50% higher compared to women who gave birth to their first child naturally.

If the first birth was problematic, the placenta had to be separated manually, and there was bleeding, then the likelihood of sensitization and conflict in a subsequent pregnancy also increases.

Danger to expectant mother Those with a negative Rh factor also represent diseases during pregnancy. Influenza, ARVI, gestosis, diabetes in the anamnesis can provoke a structural disorder chorionic villi, and the mother’s immunity will begin to produce antibodies that are harmful to the baby.

After childbirth, the antibodies that were developed during pregnancy do not disappear. They represent long-term immune memory. After the second pregnancy and childbirth, the number of antibodies becomes even greater, as well as after the third and subsequent ones.

Danger

The antibodies that maternal immunity produces are very small in size; they can easily penetrate the placenta into the baby’s bloodstream. Once in the baby’s blood, the mother’s protective cells begin to inhibit the fetal hematopoietic function.

The child suffers and experiences oxygen deficiency, since decaying red blood cells are the carriers of this vital gas.

In addition to hypoxia, hemolytic disease of the fetus may develop, and subsequently the newborn. It is accompanied by severe anemia. The fetus' internal organs enlarge - liver, spleen, brain, heart and kidneys. The central nervous system is affected by bilirubin, which is formed during the breakdown of red blood cells and is toxic.

If doctors do not take measures in time, the baby may die in utero, be born still, or be born with severe damage to the liver, central nervous system, and kidneys. Sometimes these lesions turn out to be incompatible with life, sometimes they lead to profound lifelong disability.

Diagnosis and symptoms

The woman herself cannot feel the symptoms of a developing conflict between her immunity and the blood of the fetus. There are no symptoms by which the expectant mother could guess the destructive process that is taking place inside her. However, laboratory diagnostics can detect and track the dynamics of the conflict at any time.

To do this, a pregnant woman with Rh-negative blood, regardless of the blood group and Rh factor of the father, takes a blood test from a vein to determine the content of antibodies in it. The analysis is done several times during pregnancy, the period from 20 to 31 weeks of pregnancy is considered especially dangerous.

The resulting laboratory research, antibody titer. The doctor also takes into account the degree of maturity of the fetus, because the older the baby is in the womb, the easier it is for him to resist an immune attack.

Thus, titer 1:4 or 1:8 at 12 weeks of pregnancy is a very alarming indicator, and a similar antibody titer at 32 weeks will not cause panic in the doctor.

When a titer is detected, the analysis is done more often to monitor its dynamics. In a severe conflict, the titer increases rapidly - 1:8 can turn into 1:16 or 1:32 in just a week or two.

A woman with antibody titers in her blood will have to visit the office more often ultrasound diagnostics. Using an ultrasound, it will be possible to monitor the development of the child; this research method provides fairly detailed information about whether the child has hemolytic disease, and even about what form it has.

In the case of an edematous form of hemolytic disease of the fetus, an ultrasound will reveal an increase in size in the child. internal organs and brain, the placenta thickens, the amount of amniotic fluid also increases and exceeds normal values.

If the estimated weight of the fetus is 2 times higher than normal, this is warning sign - hydrops of the fetus is not excluded, which can lead to death in the mother’s womb.

Hemolytic disease of the fetus associated with anemia cannot be seen on ultrasound, but can be diagnosed indirectly on CTG, since the number of fetal movements and their nature will indicate the presence of hypoxia.

Damages to the central nervous system will become known only after the birth of the child; this form of hemolytic disease of the fetus can lead to developmental delays in the baby and hearing loss.

Doctors at the antenatal clinic will be involved in diagnostics from the very first day a woman with a negative Rh factor is registered. They will take into account how many pregnancies there were, how they ended, and whether children with hemolytic disease have already been born. All this will allow the doctor to guess possible probability the occurrence of a conflict and predict its severity.

During the first pregnancy, a woman will have to donate blood once every 2 months, during the second and subsequent ones - once a month. After the 32nd week of pregnancy, the analysis will be done once every 2 weeks, and from the 35th week - every week.

If an antibody titer appears, which can occur at any time after 8 weeks, additional research methods may be prescribed.

In case of a high titer that threatens the life of the child, a cordocentesis or amniocentesis procedure may be prescribed. The procedures are carried out under ultrasound control.

During amniocentesis, an injection is made with a special needle and a certain amount of amniotic fluid is taken for analysis.

During cordocentesis, blood is taken from the umbilical cord.

These tests make it possible to judge what blood type and Rh factor is inherited by the baby, how severely his red blood cells are affected, what is the level of bilirubin in the blood, hemoglobin, and with 100% probability determine the gender of the child.

These invasive procedures are voluntary and the woman is not forced to undergo them. Despite the current level of development of medical technologies, interventions such as cordocentesis and amniocentesis can still cause miscarriage or premature birth, as well as death or infection of the child.

The obstetrician-gynecologist who is managing her pregnancy will tell the woman about all the risks when performing procedures or refusing them.

Possible consequences and forms

Rhesus conflict is dangerous both during the period of bearing a baby and after its birth. The disease with which such children are born is called hemolytic disease of the newborn (HDN). Moreover, its severity will depend on the amount of antibodies that attacked the baby’s blood cells during pregnancy.

This disease is considered severe; it is always accompanied by the breakdown of blood cells, which continues after birth, edema, jaundice skin, severe bilirubin intoxication.

Edema

The most severe form of HDN is the edematous form. With it, the little one is born very pale, as if “bloated”, swollen, with multiple internal edema. Such babies, unfortunately, in most cases are born dead or die, despite all the efforts of resuscitators and neonatologists, die in as soon as possible from several hours to several days.

Jaundice

The icteric form of the disease is considered more favorable. Such babies, a couple of days after their birth, “acquire” a rich yellowish skin color, and such jaundice has nothing in common with the common physiological jaundice of newborns.

The baby's liver and spleen are slightly enlarged, and blood tests show anemia. The level of bilirubin in the blood increases rapidly. If doctors fail to stop this process, the disease can develop into kernicterus.

Nuclear

The nuclear variety of HDN is characterized by lesions of the central nervous system. The newborn may experience convulsions and may involuntarily move his eyes. The tone of all muscles is reduced, the child is very weak.

When bilirubin is deposited in the kidneys, a so-called bilirubin infarction occurs. A greatly enlarged liver cannot normally perform the functions assigned to it by nature.

Forecast

Doctors are always very careful when making predictions for TTH, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the baby in the future.

Children undergo detoxification infusions in intensive care conditions; very often there is a need for a replacement transfusion of blood or donor plasma. If on the 5th-7th day the child does not die from paralysis of the respiratory center, then the forecasts change to more positive ones, although they are rather conditional.

After suffering from hemolytic disease of newborns, children suck poorly and sluggishly, they have decreased appetite, disturbed sleep, and have neurological abnormalities.

Quite often (but not always) such children experience significant mental and mental retardation. intellectual development, they get sick more often, and hearing and vision impairment may occur. Cases of anemic hemolytic disease end most successfully; after the level of hemoglobin in the baby’s blood can be raised, it develops quite normally.

A conflict that has developed not because of a difference in Rh factors, but because of a difference in blood groups, proceeds more easily and usually does not have such destructive consequences. However, even with such incompatibility, there is a 2% chance that the baby will develop quite serious disorders of the central nervous system after birth.

The consequences of the conflict for the mother are minimal. She will not be able to feel the presence of antibodies; difficulties can arise only during the next pregnancy.

Treatment

If a pregnant woman has a positive antibody titer in her blood, this is not a reason for panic, but a reason for starting therapy and taking it seriously on the part of the pregnant woman.

It is impossible to save a woman and her baby from such a phenomenon as incompatibility. But medicine can minimize the risks and consequences of the influence of maternal antibodies on the baby.

Three times during pregnancy, even if antibodies do not appear during pregnancy, the woman is prescribed courses of treatment. At 10-12 weeks, at 22-23 weeks and at 32 weeks, the expectant mother is recommended to take vitamins, iron supplements, calcium supplements, drugs that improve metabolism, and oxygen therapy.

If titers are not detected before 36 weeks of gestation, or they are low, and the development of the child does not cause concern to the doctor, then the woman is allowed to give birth naturally on her own.

If the titres are high and the child’s condition is serious, then delivery can be carried out ahead of schedule by cesarean section. Doctors try to support a pregnant woman with medications until the 37th week of pregnancy, so that the baby has the opportunity to “mature.”

Unfortunately, this possibility is not always available. Sometimes you have to decide on an earlier caesarean section in order to save the baby’s life.

In some cases, when the baby is clearly not yet ready to come into this world, but remaining in the mother’s womb is very dangerous for him, an intrauterine blood transfusion is performed to the fetus. All these actions are performed under the control of an ultrasound scanner; every movement of the hematologist is verified so as not to harm the baby.

On early stages Other methods of preventing complications may also be used. So, there is a technique for suturing a pregnant woman with a piece of her husband’s skin. The skin flap is usually implanted on the lateral surface of the chest.

While the woman’s immune system is putting all its effort into rejecting the foreign skin fragment (which takes several weeks), the immunological load on the child is somewhat reduced. Scientific debate continues about the effectiveness of this method, but reviews from women who have undergone such procedures are quite positive.

In the second half of pregnancy, if a conflict has been established, the expectant mother may be prescribed plasmapheresis sessions, this will slightly reduce the number and concentration of antibodies in the mother’s body, and accordingly, the negative load on the baby will also temporarily decrease.

Plasmapheresis should not frighten a pregnant woman; there are not many contraindications to it. Firstly, it is ARVI or another infection in acute stage, and, secondly, the threat of miscarriage or premature birth.

There will be about 20 sessions. Approximately 4 liters of plasma are purified in one procedure. Along with the infusion of donor plasma, protein preparations are administered, which are necessary for both mother and baby.

Babies who have suffered hemolytic disease are advised to undergo regular examinations by a neurologist, massage courses in the first months after birth to improve muscle tone, as well as courses of vitamin therapy.

Prevention

A pregnant woman is given a kind of vaccination at 28 and 32 weeks - they are given anti-Rhesus immunoglobulin. The same drug must be administered to a woman in labor after childbirth no later than 48-72 hours after the birth of the baby. This reduces the likelihood of developing conflict in subsequent pregnancies to 10-20%.

If a girl has a negative Rh factor, she should know about the consequences of an abortion during the first pregnancy. It is desirable for such representatives of the fair sex save the first pregnancy at any cost.

Blood transfusion without taking into account the Rh affiliation of the donor and recipient is not permissible, especially if the recipient has his own Rh with a “-” sign. If such a transfusion occurs, the woman should be given anti-Rhesus immunoglobulin as soon as possible.

A complete guarantee that there will be no conflict can only be given by a Rh-negative man, preferably with the same blood type as his chosen one. But if this is not possible, you should not postpone pregnancy or refuse it just because the man and woman have different blood. In such families, planning a future pregnancy plays an important role.

A woman who wants to become a mother needs, even before the onset of “ interesting situation» undergo blood tests to detect antibodies to protein D. If antibodies are detected, this does not mean that the pregnancy will have to be terminated or that pregnancy cannot be achieved. Modern medicine does not know how to eliminate conflict, but it knows very well how to minimize its consequences for the child.

The introduction of anti-Rhesus immunoglobulin is important for women who do not yet have antibodies in their blood that are not sensitized. They need to get such an injection after an abortion, after even minor bleeding during pregnancy, for example, with a slight placental abruption, after surgery for ectopic pregnancy. If you already have antibodies, then you shouldn’t expect any special effect from vaccination.

Common Questions

Is it possible to breastfeed a child?

If a woman with a negative Rh factor gives birth to a child with a positive Rh factor, and there is no hemolytic disease, then breastfeeding is not contraindicated.

Babies who have experienced an immune attack and were born with hemolytic disease of the newborn are not recommended to feed on breast milk for 2 weeks after the administration of immunoglobulin to the mother. In the future, decisions about breastfeeding are made by neonatologists.

In severe hemotylic disease, breastfeeding is not recommended. To suppress lactation, a woman after childbirth is prescribed hormonal drugs, which suppress milk production to prevent mastopathy.

Is it possible to carry a second child without conflict if there was conflict during the first pregnancy?

Can. Provided that the child inherits a negative Rh factor. In this case, there will be no conflict, but antibodies in the mother’s blood can be detected throughout the entire period of gestation, and in a fairly high concentration. They will not affect a baby with Rh (-) in any way, and there is no need to worry about their presence.

Before getting pregnant again, mom and dad should visit a geneticist who will give them comprehensive answers about the likelihood of their future children inheriting a particular blood characteristic.

Dad's Rh factor is unknown

When the expectant mother is registered at the antenatal clinic, immediately after her negative Rh is detected, the father of the future baby is also invited to the consultation to take a blood test. This is the only way the doctor can be sure that he knows exactly the initial data of the mother and father.

If the father’s Rh is unknown, and for some reason it is impossible to invite him to donate blood, if the pregnancy resulted from IVF with donor sperm, then a woman will have her blood tested for antibodies a little more often than other pregnant women with the same blood. This is done in order not to miss the moment of the beginning of a conflict if it occurs.

And the doctor’s offer to invite my husband to donate blood for antibodies is a reason to change the doctor to a more competent specialist. There are no antibodies in the blood of men, since they do not become pregnant and do not have any physical contact with the fetus during their wife’s pregnancy.

Is there an impact on fertility?

There is no such connection. The presence of negative Rh does not mean that it will be difficult for a woman to get pregnant.

Fertility levels are influenced by completely different factors - bad habits, caffeine abuse, excess weight and diseases of the genitourinary system, aggravated medical history, including a large number of abortions in the past.

Are medical or vacuum abortion safe for terminating a first pregnancy in an Rh-negative woman?

This is a common misconception. Moreover, unfortunately, such a statement can often be heard even from medical workers. The method of performing an abortion does not matter. Whatever it is, the baby’s red blood cells still enter the mother’s bloodstream and cause the formation of antibodies.

If the first pregnancy ended in abortion or miscarriage, how great are the risks of conflict in the second pregnancy?

In fact, the magnitude of such risks is a rather relative concept. No one can say with one percent accuracy whether there will be a conflict or not. However, doctors have certain statistics that estimate (approximately) the likelihood of sensitization of the female body after an unsuccessful first pregnancy:

• miscarriage at a short term - +3% to a possible future conflict;
• artificial termination of pregnancy (abortion) – +7% to the probable future conflict;
• ectopic pregnancy and surgery to eliminate it – +1%;
• delivery at term with a live fetus – + 15-20%;
• delivery by cesarean section – + 35-50% to a possible conflict during the next pregnancy.

Thus, if a woman’s first pregnancy ended in abortion, the second in a miscarriage, then while carrying the third, the risk is estimated at approximately 10-11%.

If the same woman decides to give birth to another baby, provided that the first birth went well naturally, then the probability of a problem will be more than 30%, and if the first birth is completed caesarean section, then more than 60%.

Accordingly, any woman with a negative Rh factor who is planning to become a mother again can weigh the risks.

Does the presence of antibodies always mean that a child will be born sick?

No, this doesn't always happen. The child is protected by special filters that are in the placenta; they partially restrain aggressive maternal antibodies.

A small amount of antibodies will not cause much harm to the child. But if the placenta ages prematurely, if the amount of water is small, if a woman is sick with an infectious disease (even a common ARVI), if she takes medications without supervision from the attending physician, then the likelihood of a decrease in the protective functions of the placenta filters increases significantly, and the risk of giving birth to a sick baby will increase. .

It should be borne in mind that during the first pregnancy, antibodies, if they appear, have a fairly large molecular structure, it can be difficult for them to “break through” the defense, but with a second pregnancy, the antibodies are smaller, more mobile, fast and “evil”, so the immunological attack becomes more probable.

Everything related to issues of genetics has not yet been studied well enough, and any “surprise” can be obtained from nature.

History knows several cases when a mother with Rh (-) and a father with a similar Rh gave birth to a child with positive blood and hemolytic disease. The situation requires careful study.

For more information about the likelihood of Rh conflict during pregnancy, see the following video.

When does a pregnant woman usually first think about such a concept as “Rhesus conflict”? Usually when she finds out that she has negative Rh blood. And questions arise: what is it and is it possible to avoid Rh conflict during pregnancy?

Maria Kudelina, a doctor and Rh-negative mother of three children, answers these questions.

What is Rh conflict during pregnancy?

Rhesus conflict is possible during pregnancy. This is a conflict between the mother's immune system and the child's blood when the immune system The mother begins to destroy the child’s blood elements (red blood cells). This happens because there is something on the baby's red blood cells that is not on the mother's red blood cells, namely the Rh factor. And then the mother’s immune system perceives the child’s red blood cells as something foreign, like bacteria and viruses, and begins to destroy them. This can happen when the mother's blood is Rh negative and the baby's blood is Rh positive.

According to statistics, approximately 15% of people are Rh negative, and 85% are Rh positive. Rh conflict is possible during pregnancy when the mother is Rh negative and the child is Rh positive. If both parents are Rh negative, then the child will also be Rh negative and the conflict is excluded. If the father is Rh positive, if the mother is Rh negative, the child can be either Rh negative or Rh positive.

When does Rh conflict occur during pregnancy?

Let's say the mother is Rh negative and the child is Rh positive. Will Rhesus conflict necessarily occur during pregnancy? No. For a conflict to arise, it is necessary that Rh-positive blood entered the blood of an Rh-negative mother. Normally, this does not happen during pregnancy; the placenta does not allow blood cells to pass through.

In what situations is this possible?

The baby's Rh-incompatible blood can enter the mother's Rh-negative blood in the following cases:

• during a miscarriage,
• medical abortion,
• ectopic pregnancy,
• if a woman has had bleeding during pregnancy.

A conflict is also possible if the mother has ever received an Rh-positive blood transfusion before. It is also possible for the baby's blood to reach the mother during normal childbirth.

Thus, during the first successful pregnancy, the risk of Rh conflict is very small. A significant risk arises with repeated pregnancies.

Anti-Rhesus immunoglobulin - how it works

Modern medicine has the ability prevent the occurrence of Rhesus conflict when Rh positive blood enters the mother's blood. Most often, Rh conflict can be prevented by administering anti-Rhesus immunoglobulin (Rho D immunoglobulin) to the Rh-negative mother. within 72 hours after contact with Rh-positive blood, until the mother’s blood had time to develop its own antibodies.

More often this happens after childbirth, in the event that if no anti-Rhesus antibodies were detected in the mother's blood during pregnancy. The injection may not be given if the result of a child’s blood test reveals that he is also Rh negative.

When synthetic immunoglobulin is administered, the red blood cells of the Rh-positive fetus that enter the mother's body are destroyed before her own immune system can respond to them. Mom own antibodies to the child’s red blood cells are not formed. Synthetic antibodies in the mother's blood are usually destroyed within 4-6 weeks after administration. And by the next pregnancy, the mother’s blood is free of antibodies and is not dangerous for the child. While own Mother's antibodies, if formed, remain for life and can lead to problems in subsequent pregnancies.

Prevention of Rhesus conflict is carried out by the attending physician, taking into account individual characteristics every case.

What should Rh negative women do during pregnancy?

During pregnancy in a woman with negative Rh blood tests are done every month for the presence of anti-Rhesus antibodies in her blood. If anti-Rh antibodies appear in the blood of a pregnant woman, this indicates that the blood of a Rh-positive child has entered the mother’s blood and a Rh conflict is possible. In these cases, the doctor’s monitoring of the progress of pregnancy and the condition of the child becomes more thorough; blood tests must be done regularly to measure the level of antibodies (antibody titer in case of Rh conflict). If anti-Rh antibodies were not detected during pregnancy, this means that everything is fine, there is no Rh conflict and nothing else needs to be done before giving birth.

What to do after childbirth

Ideally, after birth, the baby is taken as soon as possible blood analysis and determine your blood type and Rh factor. In Russian maternity hospitals, the child’s blood is most often taken from a vein. If the baby turns out to be Rh negative, the mother may be very happy and in this case there is no need to inject her with anything.

If The child has Rh positive , and the mother did not have anti-Rh antibodies during pregnancy - to prevent a possible Rh conflict during the next pregnancy, an intramuscular injection is given with anti-Rhesus immunoglobulin within the next three days, until the mother’s immune system had time to start producing its own antibodies. This drug can be purchased as prescribed by a doctor at a pharmacy after childbirth, if it is not available in the maternity hospital. Ask your relatives to help you and monitor this important issue for you, if necessary reminding you about your Rh factor to the doctor observing you in the maternity hospital.

If antibodies have already developed in the mother’s blood, then thanks to immune memory they will remain for life. What does this mean? During subsequent pregnancy the likelihood of Rh conflict increases- a hemolytic disorder, which can lead to various consequences: from neonatal jaundice and the need for blood transfusions to miscarriages, premature births and stillbirths. Fortunately, there are modern methods treatment. But still Rhesus conflict is easier to prevent than to treat.

Rhesus conflict and breastfeeding

In cases where there is definitely no Rh conflict (mother and child with the same Rh negative blood or a Rh positive child, but no signs of Rh conflict were detected during pregnancy), breastfeeding is no different from normal cases.

Jaundice after childbirth is not a mandatory sign of conflict, so you should not rely on it. Physiological jaundice appears in a newborn not due to Rh conflict or breastfeeding, but as a result of the replacement of fetal hemoglobin with normal human hemoglobin. Fetal hemoglobin is destroyed and causes yellowing of the skin. This is a normal physiological situation and usually does not require intervention.

If a Rhesus conflict does arise, then modern medicine has enough ways to help the child. Even diagnosis of hemolytic disease is not a contraindication To breastfeeding. These children need more frequent and prolonged breastfeeding.

Ban on breastfeeding in case of hemolytic disease, as a rule, is associated with the fear that the antibodies contained in the milk will make the situation worse. However, under the influence of the aggressive environment of the stomach, the antibodies ingested with milk are almost immediately destroyed. Based on the child's condition, the doctor determines the possibility and method of breastfeeding: whether it will be sucking from the breast or feeding with expressed milk. And only if the child’s condition is serious, he can receive nutrition in the form of solutions injected into a vein.

There may not be a conflict

For women with Rh-negative blood, it is especially important that the first pregnancy proceeds safely and ends in a successful birth. After giving birth you need to do child's blood test for group and rhesus. And if the child has Rh-positive blood, and no antibodies were detected in the mother, she is given anti-Rh immunoglobulin over the next three days. With the second and subsequent pregnancies, it is also necessary to monitor the absence of antibodies in the mother’s blood.

Be careful and everything will be fine!

Let's talk about a situation where the mother's Rh factor is positive and the father's is negative.

For many people far from medicine, the concept of “Rh factor” is familiar only as something related to blood. And in most cases, they don’t need to know the details; in life, this can only be useful in planning pregnancy and blood transfusions. In the second option, it is enough to inform the doctors about the blood type and Rh of the victim who will need a transfusion. With planning for children, everything is somewhat more complicated.

Why does the Rh factor have important in people's lives, and how does it affect everyone? Many live for decades and have no idea why it is needed. Just a medical word associated with the body, with the blood type. All. How does it affect pregnancy, why should you worry when the mother’s Rh factor is positive and the father’s is negative?

What is the Rh factor?

When doctors first began to carefully study human blood and compare it with other fluids, they experimentally discovered that when mixing drops of blood from different people, not all of them combined harmoniously. Sometimes two tests that are identical at first glance, when combined, coagulate or form a precipitate. The microscope and several other studies soon provided answers. The blood began to be divided into groups, then according to Rh factors. It turned out that most people have a special protein in it, which plays a role in the functioning of the body. And 15% of the population does not have it! At the same time, they feel good and do not complain. For their blood, the absence of this protein is normal. And when they tried to mix the two samples, they gave a strange reaction. So scientists realized that blood with and without protein cannot interact.

The nature of the mechanism remains a mystery, but science has given it a name. Blood with the presence of protein is called Ph+, and without it - Ph-. And people with different Rhesus values ​​cannot become donors to each other.

How do blood differences affect pregnancy? The expectant mother and her child have been together for 9 months. They are a single organism, and the fetus takes all the nutrients from the mother, giving her everything processed. Takes food, oxygen. But at the same time, everyone has their own, separate organism. The mother’s Rh factor is positive, the father’s is negative, what will happen and how this affects the development of the fetus, doctors tell us during the examination. The development of Rh conflict poses a great danger. True, it is high in women who have blood without protein when carrying a child with a “plus” Rh factor.

Consequences of Rh conflict during pregnancy

Why does conflict arise at all? different types blood? Expecting a child is a natural process and the mother’s body must protect the fetus, nourish it with everything it needs and share its DNA. However, some mechanisms go against the laws of nature. When the Rh factors of the interconnected organisms of the mother and the baby living inside her are different, her blood can perceive the protein that comes to it from the child as a new virus. The protective system operates as standard - the danger is studied, then the production of antibodies begins, with which the woman’s immune system tries to fight what it considers a dangerous protein, harming the baby.

The consequences depend entirely on the activity of antibody production. The worst are fetal rejection, premature birth, birth dead child. Moderate - an attack by the defense system destroys the red blood cells of the fetus, pulling out and destroying an unfamiliar protein. This prevents the small body's blood from circulating, carrying oxygen and nutrients. This causes oxygen starvation, decreased immunity of the baby, etc.

Mom is positive, dad is negative

Knowing the laws of genetics, future parents are usually worried. Should they think about replenishment at all? The mother's Rh factor is positive, the father's is negative, and the child has approximately a 50% chance of inheriting either a "plus" from the mother or a "minus" from the father. However, doctors are not worried about this situation. After all, a woman has antibodies in her body. Therefore, she can easily carry a child with a lack of protein. There is simply no reason for the defense system to react - there is no danger.

It happens when both parents do not have protein in their blood. Two minuses. Doctors will just shrug their shoulders. There is no way for a child to inherit a plus, because he takes half of the DNA of each parent. Therefore, 100% will be born with a “minus”. The pregnancy will go well. Then, as the baby grows up, he will need to choose his partner more carefully, especially if a girl is born.

What to do?

Future parents, if they turn to specialists when planning a replenishment, explain the importance of the Rh factor and what actions they should take. However, doctors are confident. Even a woman with a rare blood group (AB) and a negative Rh factor should not give up on her dream of becoming a mother. Advances in medicine allow specialists to “keep the pulse” throughout pregnancy and correct the functioning of the mother’s immune system with medications. And the first child is usually born without problems.

When the mother's Rh factor is positive and the father's Rh factor is negative, a natural conception will produce a baby that has a 50% chance of getting the father's Rh factor. But there is nothing to fear.

The procedure for a couple with different Rh factors, when the protein is not in the father’s blood, may differ little from the preparation for replenishment of ordinary spouses:

• a visit to a therapist at a medical center, who, having learned about the couple’s plans, writes referrals to both;
• visiting a gynecologist and all other specialists whose positions are indicated in the directions;
• passing the necessary tests, one of which will reveal Rh factors. The specialist will explain to them the importance and future prospects;
• Then the mother is prescribed several vaccinations without identifying serious diseases, etc.

Often women come to the doctor with a fait accompli, they are future mothers different dates. People are accustomed to worrying little about health when symptoms do not bother them. And the preparatory period before planning a replenishment seems to them only physical and moral preparations (diet, special daily routine for women, refusal of all bad habits). The couple is saving money, planning the location of the future nursery, choosing names. They feel healthy and do not consider it right to consult a doctor before planning.

However, most people may simply not know their blood type. For ordinary life they do not feel the need for such knowledge. Unless the man served in the army and received his license, the woman too. But, when planning to become parents, you need to find out what Rh factor your partners have. And when a woman finds herself with a “minus”, take double precautions.

The mother's Rh factor is positive, the father's is negative, which one the child will have depends on the choice of genetics.

In a responsible and balanced approach to planning pregnancy and childbirth, future parents need to take into account not only the health of their bodies, but also many factors that can affect the health of the unborn baby. One of these factors is incompatible blood groups of future parents.

In medicine, the following are distinguished:

• 1 blood group – 0 (I).
• – A (II).
• – B (III).
• – AB (IV).

Depending on whether the antigen, best known as , is present or absent on the surface of red blood cells, the blood can be either Rh positive (Rh+) or Rh negative (Rh-).

A person's blood type is a constant characteristic. It is determined by genetic laws and does not change under the influence external factors. perhaps as early as the third month of intrauterine development.

As a rule, most doctors deny the fact that future parents have incompatible blood groups for conceiving a child. A woman’s inability to fertilize, carry a pregnancy and give birth to a healthy baby is more due to the immunological and genetic incompatibility of a man and a woman, as well as the production of sperm by the female body against the partner’s sperm.

Parents' blood groups for pregnancy may be incompatible due to the Rh factor. This factor should never be neglected in matters of pregnancy planning.

For conception, the Rhesus antigen has no significance. It also does not affect the development and bearing of the baby if a woman is pregnant for the first time or if she and her husband have Rhesus - positive blood type.

Only in the case when the father of the unborn child is Rh positive, this can lead to incompatibility of the blood groups of the mother and the pregnant child, and, as a result, to the development of such a life-threatening condition for the baby as an isoimmune conflict for the Rh factor , better known as during pregnancy.

Conflict during pregnancy occurs because the mother’s Rh negative blood reacts to red blood cells developing baby, on the membranes of which specific proteins are present, as if they were a foreign organism. As a result, the female body begins to actively produce antibodies directed against the fetus.

The consequences of Rh conflict for a pregnant woman can be irreversible and include:

• in the threat of miscarriage in early pregnancy or premature birth;
• in the formation of intraorgan edema in the fetus, which can lead to intrauterine growth retardation;
• in the development of a hemolytic disease in a newborn, characterized by the destruction () of its red blood cells by maternal blood cells, which continues to circulate in the child’s body for some time after birth.

For the woman herself, the development of an autoimmune conflict does not pose any danger. She will feel good even if developing fetus will begin to suffer in utero.

Therefore, it is extremely important for pregnant women who have had antibodies detected in their blood using the Coombs test to strictly follow all the recommendations of the doctor monitoring the development of pregnancy, promptly donate blood for examination and not neglect an ultrasound examination, since this will help identify the appearance of edema in the baby and the onset of development. hemolytic disease.

Are there always complications?

If a woman with Rhesus - negative factor becomes pregnant for the first time in her life, there are still no specific antibodies. Therefore, the pregnancy will proceed completely normally, and there will be no threat to the health and life of the unborn baby. Immediately after giving birth, she will be given anti-Rhesus D serum, which will help stop the formation of these antibodies.

In addition, since antibodies in the blood of a Rh-negative woman do not disappear over time, but on the contrary, their number only increases with each subsequent pregnancy, the administration of this serum is indicated after each pregnancy, regardless of how it ends (childbirth, spontaneous or drug-induced abortion).

If a woman with a negative Rh factor already has antibodies in her blood, the administration of serum is strictly contraindicated.

Types of conflicts

There is also the concept of incompatible blood groups during pregnancy in mother and child, which can also lead to the development of conflict, but according to the ABO system.

This type of complication is as common as Rhesus incompatibility, but its consequences are less catastrophic. It can develop if the mother, that is, does not contain agglutinogens, and the child inherits any other group from the father, and accordingly his blood contains antigens A and B, both individually and together.

A conflict in the ABO system can develop even during the first pregnancy, but the fetus will not develop pathological conditions, and there will be no signs of anemia. But just as in the case of Rhesus conflict, in the first days after birth the level of bilirubin in the child’s blood will be significantly increased and in order to eliminate the manifestations of pathological jaundice in him it will be necessary to carry out the same therapeutic measures, as in the case of isoimmune conflict due to the Rh factor.

The blood groups of the child and the mother may also be incompatible for the birth of a child if the expectant mother has a history of a disease such as thrombocytopenia, that is, a decrease in the number of platelets in her blood. In this case, the woman experiences the formation of antibodies directed against the platelets of the fetus.

Conclusion

Upon initial contact antenatal clinic The expectant mother will initially receive a referral to donate blood to determine her blood type and Rhesus affiliation. In the case of Rh(-) factor, her husband will receive the same direction. If the Rh factors of the future parents coincide, there will be no development of an autoimmune conflict.

When different rhesus– factors of the spouses, pregnancy will proceed under increased control by the gynecologist, in order early definition signs of the development of Rh conflict during pregnancy between mother and fetus, as well as increasing signs of hemolytic disease in the baby. If they are detected, the woman will need urgent hospitalization and specific treatment.

Under no circumstances should you be upset and refuse to become pregnant and give birth to a baby if, for one reason or another, the blood groups of the future parents are incompatible.

Subject to careful medical supervision of the development of pregnancy, compliance with all recommendations and prescriptions of the gynecologist, it is possible, if not avoided, then to minimize all negative consequences caused by different blood types of future parents. We hope you learned what incompatible blood groups are for pregnancy.

Every woman undergoing examinations when planning pregnancy is told about the importance of the Rh factor. This is taught in school, but such things are quickly forgotten and most people have a vague idea of ​​the composition of their blood. They only remember the groups and that blood cannot be transfused to a person without checking compatibility, otherwise the body will not accept it. The mother's Rh factor is negative, the father's is positive, how significant is this for the couple?

When planning to become a mother, women undergo a number of examinations, and doctors examine the blood especially carefully. For specialists, the analysis gives a clear picture of what is happening in the body, because any infection or inflammatory process will certainly make itself felt. Maybe not right away, but certainly. However, doctors determine by blood not only physical state woman, but also her Rh factor. And they warn all owners of the “minus” factor about future difficulties with pregnancy. However, why does this happen, what is the risk?

What is the Rh factor?

People who are far from medicine have only briefly heard of the “Rh factor”; in life they encounter such tests only a couple of times: determining their blood type is done for a driver’s license; at school they can conduct such a test when planning a pregnancy. Only in the latter case is the Rh factor extremely important. The first two will only note its significance.

The Rh factor is a type of antigen, it is found in red blood cells. Not every person has the antigen. If yes, the value is positive, if not, negative. Here is the peculiarity of “+” and “-” - the mother’s Rh factor is negative, the father’s is positive, reviews - people with a “-” factor are only 15% of the population.

Why find out when planning a pregnancy? As you know, the fetus inherits the DNA of its parents, taking equally from each. Everything is inherited: hair color, eyes, height, possibly weight, foot size, appearance, and, of course, body characteristics. How to use simple calculations to determine in percentage terms what blood type a child will have was taught in high school biology along with a lesson on dominant and recessive traits. The value of the Rh factor, or rather, the presence or absence of it, is also taken by the child from the parents. Usually, by the 8th week of pregnancy, the fetus develops its own blood type with its own immunity.

Consequences of Rh conflict during pregnancy

The doctor usually takes tests from both parents and determines the risk of Rh conflict.

When both parents do not have an antigen in the blood, both with the “-” factor, there is no problem, the child also does not receive it, from nowhere. Pregnancy proceeds normally, without complications. The blood of the fetus and mother is the same, both have no antigen and immune compatibility is complete.

Trouble threatens if the mother’s Rh factor is negative and the father’s is positive, table. The child can receive a special protein from the father and then the mother’s blood will encounter a substance foreign to itself. The entire period of gestation, the mother and the future child are one whole, but each has its own body. The two immune systems constantly intersect, and protein from the baby can get to the mother. When faced with an unfamiliar substance, the parent body reacts in a standard way - it tries to fight by producing special antibodies. They follow the protein and, having found the source in the child’s blood, try to destroy it, causing harm to the fetus. Bilirubin comes out of the destroyed red blood cells of a small organism. When the substance accumulates in large quantities, it can cause great harm, not counting the destroyed red blood cells themselves.

Mom is negative, dad is positive Rh factor

How can doctors help in this situation? After all, the body cannot be prohibited from destroying foreign protein; many processes are carried out without the influence of the mind, and even being safe and good place for the life and development of the fetus, the mother’s body will overnight turn into an enemy.

The specialist first calculates the chance of such a conflict occurring between Rh factors. When a woman has her first pregnancy and has not experienced miscarriages or experienced transfusions, then the chance to calmly give birth to a child, even with the opposite rhesus, is quite high.

The mother's Rh factor is negative, the father's is positive, pregnancy 2 will be more dangerous. After all, at first the body encountered an unusual substance, but did not actively react. The immune system recognized the protein and remembered its composition and quantity. She will be ready for the next “round” by launching the production of antibodies. This usually happens with vaccinations. The body encounters the virus, learns to fight it, but shows little activity. But when the disease returns, the defense system has already produced antibodies and the fight will be in full swing! This is what doctors fear. Usually, if a woman is constantly seen by one specialist, he warns her about the danger of a second pregnancy. There is a high risk of fetal rejection or the embryo will subsequently develop hemolytic disease; it will be born with a weakened immune system, which was forced to fight for a small life in the womb.

Women with the presence of this protein will never experience such problems. Even with a father who has a “-” Rh factor. She calmly carries a child with missing protein.

What to do?

Unfortunately, a person cannot change his blood type or Rh factor value. But a woman is also not able to give up motherhood. How to find a compromise? Calm a raging body?

The mother's Rh factor is negative, the father's is positive - the second birth can go well, and the child will appear healthy if you carefully follow the doctors' recommendations. Experts are also not ready to give up on women with a “minus”. During the entire 9-month period, my mother undergoes tests that monitor the activity of her immune system. Fortunately, people have different bodies and different defense systems. The amount of antibodies produced by the body indicates the degree of development of the conflict.

• up to 32 weeks - monthly;
• 32-35 – once every seven days;
• from 35 - every week.

Having identified an ongoing Rhesus conflict, the doctor hospitalizes the woman. Depending on the situation, the specialist prescribes drugs that can act on the immune system, but it is important to be careful here, because it cannot be completely suppressed. It should protect the mother’s body from viruses. If necessary, the specialist pierces the woman’s stomach to collect amniotic fluid. The bilirubin it contains will show how actively the mother’s immune system “works.” Next it will take the following actions:

Plasmapheresis is also familiar to people suffering from anemia and allergies. When the blood plasma is collected, purified and returned again. The simplest way to “calm down” a conflict.

The mother’s Rh factor is negative, the father’s is positive, pregnancy 3 with a problem of conflict between two defense systems, doctor’s actions:

Blood transfusion is considered the most effective option. When some blood is taken from the mother and placed on the fetus. However, such a procedure can only be carried out in a large medical center. Through umbilical vein first, substances are introduced that help relax the baby’s muscles, then maternal blood without protein content. The procedure is repeated. To some extent, donor blood will replace the child's own blood.

As a last resort, when calming measures do not help, the doctor will prescribe early birth. Therefore, it is important for doctors to “hold out” such a pregnancy longer, thus increasing the child’s chances of survival.