Rhesus conflict in a person occurs if. What contributes to the development of Rh sensitization? Dad's rhesus unknown

26.07.2019

In order for pregnancy to proceed favorably for both mother and child, many different factors must be taken into account.

One of the most important studies is the analysis of alloimmune antibodies. It allows you to determine the maternal Rh factor, which is a protein located on the surface of red blood cells - erythrocytes. The absence of this protein indicates the presence of a person with negative Rh blood, which occurs in 15% of people on earth.

In everyday life, few people think about the indicator of the Rh factor, because it is just an immunological indicator. But when a woman is in position and expecting a baby, his absence can adversely affect the course of pregnancy.

Rhesus conflict is a kind of interaction between positive (with the presence of protein on the membrane) and negative (with its absence on the cell membrane) blood particles, namely erythrocytes, resulting in their agglutination (gluing), accompanied by a violation of normal blood counts.

Causes and risk factors

It is important to understand that different Rh factors in the mother and fetus are not a cause for concern.

Rhesus conflict develops only when the woman's body already has antibodies that have a negative effect on the development of the child. The production of antibodies during pregnancy in a mother and fetus with different Rh (negative / positive) may not begin or appear only by the middle to the end of pregnancy. In the case when the mother's antibodies begin to penetrate through the bloodstream and attack the erythrocytes (the red blood cells of the child), we are talking about the Rh conflict.

During a normal pregnancy, the blood flow of the fetus and mother do not interact in any way, and, accordingly, red blood cells do not penetrate into a foreign environment.

A woman's body begins to produce antibodies when her blood has been in contact with positive blood. This process is called sensitization. It most often occurs in an Rh-negative mother and a Rh-positive fetus.

The development of the Rhesus conflict can occur in the following situations:

During childbirth, bleeding occurs - the mother's blood comes into contact with the baby's blood. At the first birth, there is no threat to the baby that has appeared, but during a subsequent pregnancy, a risk factor arises, since the mother's body has already begun to produce antibodies.

It has been proven that after natural childbirth, antibodies are produced in about 10-15% of cases. The percentage increases with caesarean section.

Injuries during pregnancy can lead to damage to the vessels of the fetus or placenta, resulting in a mixture of blood and, accordingly, the formation of antibodies that are detrimental to fetal red blood cells.
If a woman has a miscarriage after 6 weeks. In case of spontaneous termination of pregnancy in the period up to 6 weeks, when the embryo does not yet have its own red blood cells, the sensitization process will not develop.
The development of antibodies can be affected by abortion and ectopic pregnancy. After a medical abortion, antibodies can occur in about 6% of cases, and in ectopic pregnancy - in 1%.
There are cases when a woman's sensitization process began even before pregnancy, during a blood transfusion. With an erroneous transfusion of positive blood, the body will begin to produce antibodies, which in the future can affect the entire course of pregnancy, creating an Rh conflict. In 90% of cases, antibodies are produced after a blood transfusion.

If the sensitization process is running, then the antibodies will be constantly present in the blood. But the presence of antibodies in the blood is an optional prerequisite for the development of the Rhesus conflict. It is important to understand that the danger arises only in the case of contact of negative blood with positive, in the situations described above.

The Rhesus conflict that appears during the first pregnancy may not have a negative impact on the fetus: the mother's immune system is just starting to produce antibodies. Antibodies cannot pass through the thick wall of the placenta, because they are not yet sufficiently prepared and are only learning to “fight” with a foreign organism.

In subsequent pregnancies, immunity becomes stronger, more antibodies are produced, and they are much “more energetic”: they can easily penetrate the placental barrier and begin to destroy the baby’s red blood cells.

A decrease in red blood cells in the fetal body leads to the development of anemia and a decrease in hemoglobin levels.

Development mechanism

The developing organism of the child begins active work on the production of red blood cells in order to ensure a comfortable life. Therefore, the spleen, kidneys and liver increase in size. At this stage, there is a risk of developing hemolytic disease of the fetus.

In addition, the substance bilirubin begins to appear in the woman's blood, which in large quantities has a detrimental effect on the child's brain cells. It is because of the presence of bilirubin that the skin of some newborns acquires a yellowish tint in the first days of life. This is because the baby's liver processes bilirubin, which is a pigment in nature, very slowly. The body of a healthy baby can cope with the pigment on its own about a week after birth.

The sensitization process is not the same for everyone. In one case, it can manifest itself and pose a threat to the fetus, but in the other it does not. That is why early diagnosis is very important, which makes it possible to detect the presence of antibodies in a woman's body at various stages of pregnancy. In addition to the Rh conflict, there are cases when incompatibility can occur in other indicators, for example, blood type.

In this situation, the symptoms are easier - the newborn has a mild degree of jaundice, which is easy to cure in the first weeks of life without negative consequences and complications.

Symptoms

Tracking the symptoms of an Rhesus conflict is not easy. If, with most diseases, a woman immediately begins to feel painful symptoms that signal a problem, then in this situation, nothing threatens the mother’s body, her immunity can easily cope with foreign red blood cells.

However, there are cases when a pregnant woman begins to show clinical signs resembling the development of preeclampsia. At the same time, the child's body is forced to spend all its energy on creating new red blood cells.

The conflict of Rhesus mother and child is accompanied by the following symptoms, which can be tracked with the help of ultrasound and special tests:

The state of the organs of the fetus: the heart, liver, kidneys and spleen are enlarged in size.
Fetal swelling or accumulation of fluid in the abdominal and chest cavity.
The embryo assumes an atypical “Buddha pose”, which manifests itself in the form of limbs pushed aside (due to the enlarged abdomen and chest).
Edema of the placenta, which results in an increase in the umbilical cord and thickening of the placenta.
Edema of the soft tissues of the brain, leading to a bifurcation of the contour of the fetal head.

The danger of a Rh conflict for a child is that a developing hemolytic disease can lead to his death at a period of 20-30 weeks.

In a child born with mild cases of Rhesus conflict, as a rule, jaundice and anemia are detected. In more severe cases - swelling, damage to vital organs, as well as an increased body weight by 1.5-2 times, which can be dangerous for a newborn baby, up to death.

The very course of pregnancy in Rh-conflict can also have complications:

premature birth;
miscarriage;
anemia;
preeclampsia;
bleeding;
complications after pregnancy.

Diagnostics

Rhesus conflict occurs in less than 1% of cases. If a woman regularly visits a doctor and passes all the necessary tests, the Rh conflict is diagnosed already in the early stages.

A blood test to determine the Rh factor is carried out for both parents. The owner of a negative Rh will be assigned a blood test to determine the level of antibodies in the blood.

With an Rhesus conflict, there may be several options for development. In the first case, no sensitization process was detected in the pregnant woman, in the second, her blood was already in contact with a positive Rh. With the latter option, the woman will be required to testify to previous tests, information about blood transfusions (if any), data on pregnancies, miscarriages, and abortions.

It is believed that nothing threatens the fetus during the first pregnancy, but despite this, a woman should regularly donate blood for the amount of antibodies. The blood test is collected once every two months. Starting from the 32nd week of pregnancy, the analysis is carried out more often, since the number of antibodies can increase significantly in the third trimester and affect the health of the child.

The level or titer of antibodies in a woman's body can change during the entire course of pregnancy: periodically decrease or increase, while the amount of antibodies is not an indicator of the development of hemolytic disease of the fetus.

In addition to a laboratory blood test, a woman is prescribed an ultrasound scan to monitor the condition of the fetus. In the normal course of pregnancy, the examination is carried out 4 times. When symptoms of hemolytic disease begin to appear, a second ultrasound is prescribed to monitor the child's health. If fetal hemolytic disease is severe, an ultrasound scan is performed about once every five days.

With a positive blood test for the presence and increase in the number of antibodies, the pregnant woman can be sent for hospitalization for careful monitoring of the health of the fetus. Analyzes that are carried out at the risk of Rhesus conflict:

blood test with constant monitoring of antibody growth;
ultrasound examination of the fetus;
dopplerometry to assess the work of the heart and blood vessels of the fetus.

In addition to basic analyzes, invasive studies are also carried out to assess the condition of the embryo in more detail. They are considered more complex and require professionalism and special equipment from the medical worker:

Amniocentesis is a procedure in which the amniotic sac is punctured and the amniotic fluid is taken for analysis. Thanks to this diagnostic method, it is possible to establish the level of bilirubin and assess the condition of the child. Amniocentesis is prescribed to a woman when there is a tendency for the growth of antibodies and the child's condition worsens;
Cordocentesis is a diagnostic method in which blood is taken from the umbilical cord. Cordocentesis allows you to determine the exact amount of bilirubin in the blood, and also makes it possible to make a blood transfusion to the embryo if the symptoms of hemolytic disease increase and there is a threat of premature birth. With the help of cordocentesis, the severity of the Rhesus conflict is established.

Treatment

A pregnant woman with a negative Rhesus is prescribed courses of desensitizing therapy every trimester, which consists in the use of vitamin-mineral complexes, antihistamines, metabolic drugs and oxygen therapy.

If the formation of antibodies in the blood of a pregnant woman does not occur or their number does not exceed the permissible norms, then self-delivery is allowed.

In the case when the degree of Rh conflict is severe, and there is a real threat to the life of the child, a caesarean section is prescribed at 37-38 weeks. If a caesarean section is not possible for any reason, blood is transfused through the umbilical cord. Thanks to this procedure, the symptoms of anemia, hypoxia, and swelling are reduced, and the pregnancy is extended until the natural time - the moment of childbirth.

It is believed that blood transfusion is a very effective way to preserve the health of the fetus. But the procedure is a big risk, it must be performed by a qualified specialist under ultrasound control.

Previously, a popular method was plasmapherosis, as well as transplanting the skin of a man to a mother, but the effect of them was not so significant or was completely absent.

In a newborn, signs of hemolytic disease may not be found in the womb, but upon birth. Most often, the main manifestations are anemia and jaundice. When an infant develops symptoms of jaundice, treatment is reduced to placing the child in special photo lamps. If the degree of jaundice is small, then treatment is not prescribed at all, since over time its signs will pass by themselves.

Therapy of newborns with such symptoms is carried out under the strict supervision of a neonatologist, since an advanced degree of jaundice can lead to damage to the nervous system. A high level of bilirubin pigment is one of the factors that cause a child to lag behind in motor development.

There are a number of symptoms that can be managed in the first days of a baby's life in order to prevent the development of unpleasant consequences. But if treatment is not started in time, then pathological complications can be irreversible.

If a child was born with symptoms of hemolytic disease, then breastfeeding is postponed for several weeks so as not to provoke the development of new manifestations of the disease. If the newborn does not have a clinical picture of hemolytic disease after an injection of immunoglobulin, the mother can breastfeed. An anti-Rhesus injection is administered to a woman once, no later than three days, in order to prevent an Rhesus conflict during a subsequent pregnancy.

Currently, only early diagnosis and constant medical supervision will help, in the presence of a Rh conflict, to take timely measures and save the life of the fetus. Unfortunately, in practice there are cases when undetected antibodies begin to destroy the blood cells of the fetus, which leads to its intrauterine death or stillbirth.

Forecast

Summing up all that has been said, it can be noted that the Rhesus conflict is not a reason for terminating a pregnancy. Moreover, a woman may well endure a healthy child. The absence of the Rh factor is only an excuse for more careful control over the course of pregnancy.

This is not about the first pregnancy, but about the danger of the formation of antibodies during subsequent ones. But if you carefully monitor your health and perform all the necessary tests and injections on time, then repeated pregnancies will not cause complications.

When planning a child, you should not immediately predict the development of the Rhesus conflict, it is important to remember that this problem occurs only in 0.8% of women. Thanks to the active development in the field of immunology, it is real today to endure and give birth to a healthy baby.

Many women mistakenly believe that the "blood conflict" is the cause of the incompatibility of the mother and father, but this has absolutely nothing to do with the occurrence of the Rh conflict. The Rh factor is an inherited trait and is not at all associated with the relationship between the mother and father of the child.

There are situations in which a pregnant woman inspires herself with the idea that her body can reject a child for various psychological reasons: for example, "not ready for the birth of a baby." A clear understanding is needed that a negative emotional background will only harm the mother and baby, since a small developing person inside already perfectly identifies maternal feelings.

To restore the psycho-emotional state, it is necessary to seek help from a psychologist who, along with other specialists, will help a woman bear and give birth to a healthy child.

In a situation where the anamnesis is aggravated by the death of the fetus as a result of a hemolytic disease, and the woman does not want the problem to happen again, IVF pregnancy using Rh-negative blood can be used.

Prevention

Pregnancy planning is an important and responsible step. At this stage, a woman needs to get all possible advice from medical specialists.

The risk of Rh conflict and sensitization is not a contraindication for pregnancy. A positive component of the anamnesis is the preservation of the first pregnancy and the absence of medical abortions. If an Rh-negative mother had a miscarriage, ectopic pregnancy or abortion, then she should be given an injection of immunoglobulin within three days. This method of prevention is absolutely safe for both the mother and the fetus.

A pregnant woman at risk of Rhesus conflict is prescribed an injection at the 28th week of pregnancy, sometimes an additional injection of immunoglobulin is carried out at the 34th week. This procedure reduces the risk of symptoms of hemolytic disease in the fetus. If during pregnancy there was bleeding as a result of injuries or placental abruption, then the procedure is prescribed at the 7th month of pregnancy.

A contraindication to the introduction of immunoglobulin is the presence of antibodies in the mother's body at the current moment of pregnancy.

Good afternoon, dear readers!

Many of you have heard about the terrible Rh conflict, as a result of which a woman can remain childless, and the fetus will die in the womb.

Expectant mothers fear that they will not be overtaken by such a fate. What is the Rh-conflict during pregnancy, the consequences for the child from which can be so terrible?

Everyone has heard about the blood type, and many remember exactly what blood type they have. Each blood type can be Rh positive or Rh negative.

The Rh factor (you may have noticed in the specialized literature or in the test forms the designation Rh - this is exactly the Rh factor) is a lipoprotein that is located on the surface of red blood cells. It is present in 85% of all living people (+). 15% do not have this lipoprotein, so they are marked as Rh negative.

Rhesus conflict occurs when the bloodstream of an Rh-negative woman enters the bloodstream of an Rh-positive child. Incompatibility arises, the female body perceives the child as a foreign body and tries to get rid of it.

The Rh factor of the child is inherited as a dominant trait. So, let's see: mom + dad - what will happen? If the father is Rh positive, then the baby always inherits Rh (+). In this case, conflict is inevitable.

If there are several fetuses, one of the children becomes Rh negative, and then there is a chance that he will survive.

So, a Rh conflict is possible only if the mother has Rh negative, and the child has Rh positive. In other cases, there is no need to worry.

At the same time, during the first pregnancy, the risk of fetal rejection is much lower. This is due to the fact that the resulting antibodies are still present in a small concentration, almost do not penetrate the placenta and do not have a significant effect on the fetus.

With a second pregnancy, the risk of rejection increases significantly. In this regard, women with a negative Rh are not recommended to have their first abortions and be inattentive to their pregnancy, since the second one can end in failure.

Signs and effects

How to find out that the Rh conflict has come into action, and there is a danger for the child: quite obvious symptoms will tell about this:

preeclampsia (late toxicosis);
anemia;
the appearance of immature erythrocytes;
hypoxia of vital organs;
swelling;
thickening of the placenta;
increase in the volume of amniotic fluid;
weight gain in the newborn.

The last signs can only be noticed by a doctor on an ultrasound, so a woman with a negative Rh should be under the constant supervision of doctors.

The most dangerous form is edema. It affects not only the internal organs of the mother, but also the fetus itself. As a result, it develops, placental abruption begins, the child almost doubles in size.

The consequences of a conflict on Rhesus can be very deplorable. If the pregnant woman does not seek medical help, the child may die between 20 and 30 weeks. If the baby survives, there is a risk of having a baby with jaundice, anemia, or swelling.

Jaundice is especially dangerous, because the level of bilirubin in the blood rises. This is fraught with intoxication that affects the central nervous system. The child becomes lethargic, eats poorly, often burps, his reflexes are reduced. This can lead to mental and mental retardation and even hearing loss.

How to diagnose?

The first stage of diagnosis, my dear readers, begins from the moment when the doctor recommends that the pregnant woman donate blood for analysis to determine the group and Rh. If Rh is negative, the father's blood is taken for analysis. With a positive outcome, the woman is taken under special medical control.

The following factors are also taken into account:

previously, a woman received a blood transfusion, while Rh was not taken into account;
negative outcome of a previous pregnancy (miscarriage, abortion, intrauterine fetal death, birth of a child with abnormalities).

Also, a pregnant woman should undergo a complete examination:

analysis for the amount of antibodies in the blood;
to assess the condition of the fetus, placenta and internal organs;
electrocardiography;
phonocardiography;
cardiotocography;
amniocentesis (analysis of amniotic fluid);
cordocetesis (analysis of umbilical cord blood).

Amniocentesis is prescribed in the third trimester to determine antibodies in the amniotic fluid, the sex of the baby and the condition of his lungs, the presence of bilirubin.

Cordocentesis will help determine the level of hemoglobin, bilirubin, antibodies and other blood parameters.

Such a complete examination creates a complete picture of the course of pregnancy with Rh conflict, so that the doctor can prescribe treatment.

How to treat?

Fortunately, today medicine offers many methods that can contain the mother's immunological response to the Rhesus conflict. To this end, for 2 weeks in each trimester, a course of therapy is carried out, including:

calcium and iron preparations;
oxygen therapy;
vitamins;
means to improve metabolism;
antihistamine medicines.

If the woman's condition is severe, a caesarean section is performed for a period of 36-38 weeks with ultrasound control and intrauterine blood transfusion.

If a baby is born with signs of hemolytic disease, breastfeeding is not allowed within 2 weeks after birth.

As a preventive measure for Rh-conflict, doctors advise mothers with a negative Rh not to terminate their first pregnancy, not to transfuse blood if necessary without considering Rh.

A good prevention is the introduction of anti-Rhesus immunoglobulin, which is prescribed both after surgery and in early pregnancy. It destroys positive red blood cells in the mother's bloodstream and prevents an immunological response from forming.

The formation of an immunological conflict between the organisms of the expectant mother and the child in her womb leads to serious diseases. Moreover, it can cause death for the baby. Therefore, such a pathology is given great attention by doctors. Pregnancy of an Rh-negative mother with a "positive" child requires careful monitoring by the supervising obstetrician-gynecologist. This will help to take the necessary measures to save the life of the child, to provide all possible assistance for the normal course of gestation.

Rhesus conflict during pregnancy: when and how it happens, and what to do next

Rhesus conflict is a pathological phenomenon, which is based on the incompatibility of the mother and fetus, which occurs at the immunological level. For a conflict to develop, the expectant mother must have a negative Rh, and the baby in the womb must have a positive one. But mother sensitization does not always develop, since some additional factors are necessary for this. This pathology is quite dangerous, because it can cause the child to develop serious illnesses or even die.

What is Rh conflict between fetus and mother

An immunological conflict as a result of Rhesus incompatibility between a future mother and a child develops either in the process of bearing a child, or during his birth. The Rh factor itself is a lipoprotein, otherwise called D-agglutinogen, and is attached to red blood cells. In people with this agglutinogen, Rh is read positive, and in its absence, it is negative. Incompatibility develops as a result of the fact that the fetus inherits a positive factor from the father. When during pregnancy, for any reason, the red blood cells of the baby and the mother begin to interact, their agglutination occurs, which is also called clumping.

Causes of Rh conflict manifestation: risk factors

The occurrence of incompatibility is possible for various reasons, which will depend on certain characteristics of pregnancy.

First pregnancy

During the first bearing of a baby, a conflict rarely appears, and some situations from the life of a future mother can provoke it:

Carrying out a blood transfusion when Rhesus compatibility is not paid attention to.
Previous artificial termination of pregnancy according to the indications or at the request of the woman.
Spontaneous abortions in the past.

Also, sensitization can occur in such cases:

Severe preeclampsia, with violation of the integrity of the structures of the vascular bed of the placenta.
Carrying out amniocentesis, cordocentesis or taking a biopsy of chorion tissue to diagnose the condition of the fetus.
Development of early placental abruption

Without such phenomena, sensitization can only occur during the interaction of the blood of the child and the mother during childbirth, which will be reflected in the next gestation.

Repeated gestation

During the second and subsequent pregnancies, the baby's red blood cells penetrate the wall of the mother's vessels, which activates the response coming from the immune system and the production of type G immunoglobulin. Such immunoglobulins are small, they simply penetrate the placental barrier into the fetal bloodstream. As a result of this phenomenon, the structure of fetal erythrocytes is disturbed and hemolysis is formed. This process leads to the formation of bilirubin (a toxic substance) and the further development of hemolytic disease.

Multiple pregnancy

The conflict between Rhesus in multiple pregnancies often occurs only if this conception is not the first. If twins or triplets accompany the first pregnancy, then during gestation without complications and timely prevention, the expectant mother may not worry.

When the mother's blood type is the first "-"

If the expectant mother has the first blood group with a negative factor, then the conflict can be if the baby inherits from the father not only a positive Rh, but also a certain blood type:

First or second when my father had a second.
First or third, when dad has a third.
The second or third, when a man has a fourth.

Blood Rp inheritance table: incompatible groups and the likelihood of conflict formation

Genetic studies have made it possible to understand that it is possible to assess how great the threat of an Rhesus conflict during gestation is. These risks are analyzed by doctors so that they can minimize the possible complications of such a condition.

There are two main tables:

Rhesus risk.
blood type risk.

If we evaluate the presence or absence of agglutinogen:

If the focus is on the blood group, then the table takes on a different form:

Father	Mother	Child	chances of conflict
0	0	0	—
0	A	0 or A	—
0	V	0 or B	—
0	AB	A or B	—
A	0	0 or A	50%
A	A	0 or A	—
A	V	Any option is possible	25%
A	AB	0, A or AB	—
V	0	0 or B	50%
V	A	Any option is possible	50%
V	V	0 or B	—
V	AB	0, A or AB	—
AB	0	A or B	100%
AB	A	0, A or AB	66%
AB	V	0, V or AB	66%
AB	AB	A, B, AB	—

To navigate the table, it must be taken into account that 0 is the first blood group, A is the second, B is the third, AB is the fourth.

The danger of incompatibility for the fetus and mother: the influence of a negative factor

Rhesus incompatibility between a future mother and her child is a dangerous condition. It threatens the woman herself only psychologically, because of the experiences associated with such a situation. But for the fetus, the consequences of the pathology are much more serious.

First trimester

The most serious violation associated with the first period of bearing a baby is the possibility of abortion. The conflict of the mother's immune system with the fetus that has just begun to form can lead to impaired development and attachment of the zygote.

Since this period is associated with the active laying and formation of the main systems, the immunological conflict negatively affects them. There are disturbances in the structure of the central nervous system, after intoxication the liver and kidneys are exposed.

In the second trimester

The middle of a woman carrying a baby with a conflict between Rhesus is associated with such possible complications:

Development of nuclear jaundice.
Disturbances in the structure of the brain, leading to mental retardation.
Enlargement of the spleen and liver, which are unable to function normally.

In the third trimester

For the final stage of gestation, the immunological incompatibility of the expectant mother and her child can become the basis for a number of situations:

early childbirth.
Anemia in a child.
Jaundice.
Hemolytic disease.
developmental delays in the future.

How is the diagnosis carried out

Diagnostic measures to detect immunological incompatibility are quite simple. With their timely implementation, the doctor will be able to easily interpret the results, choosing the appropriate tactics for further action.

How long is it diagnosed

If a Rh-negative pregnant woman is determined that her baby will be Rh-positive, she needs monitoring:

If she is pregnant for the first time and is not sensitized, the examination is repeated every 2 months.
If a woman is sensitized, then the analysis is performed every 30 days until 32 weeks, then every half a month from 32 to 35 weeks of gestation and every 7 days from 35 weeks of gestation.

What tests are given

The main method of diagnosis is the delivery of blood by a woman to determine the titer of anti-Rhesus antibodies.

A high antibody titer does not indicate the conflict itself, but indicates its possibility and the need for preventive measures.

Some diagnostic methods are also used to track the condition of the child:

Ultrasound, it is carried out 4 times for 20-36 weeks and before the birth of the baby.
Electrocardiography.
Phonocardiography.
Cardiotocography.

The last three methods are primarily aimed at analyzing the severity of hypoxia in a baby, for a quick start of therapy.

In addition to the above measures, amniocentesis is allowed from 34 to 36 weeks. This helps to identify not only the level of antibody titer in the aqueous membrane of the fetus, but also the degree of maturity of its lungs, the density of bilirubin.

Treatment

Therapeutic measures to help expectant mothers and their children at risk of developing Rhesus incompatibility include non-specific desensitization methods: vitamin therapy, metabolites, calcium and iron, antiallergic drugs, oxygen therapy. But the main way to prevent incompatibility is to vaccinate the expectant mother with immunoglobulin.

If the conflict caused a serious condition of the child, then by the 37-38th week a caesarean section is performed.

What is anti-rh immunoglobulin or vaccine for rh-negative women

Anti-Rh immunoglobulin is a medicine with a high level of antibodies, the purpose of which is to strengthen the immune system. It contains a protein fraction with immunological activity, which is obtained from human plasma or donor serum. Before creating a vaccine, the source material is examined to confirm the absence of antibodies to the immunodeficiency virus, hepatitis C and B.

When is anti-D immunoglobulin given?

Immunoglobulin of the Anti-D group is prescribed to women during the gestation period with a high risk of developing an Rhesus conflict. In some cases, it is a drug with a therapeutic effect, but it can also have a preventive function.

How often is the introduction of anti-Rhesus immunoglobulin during pregnancy

Serum is administered intramuscularly for the first time at 28 weeks of gestation, then another dose is administered immediately after the birth of the child.

Is it necessary to introduce immunoglobulin during the second gestation

If, in the results of the examination, the antibody titer is within the normal range, the doctor will recommend the introduction of immunoglobulin, but this procedure may not be carried out at the discretion of the woman.

How Rh conflict can affect a child: pathologies and consequences for the fetus

Immunological incompatibility is extremely dangerous for an unborn baby, it can cause:

Jaundice of newborns.
Dropsy of the brain.
Severe malformations of the brain and heart.
Stillbirths.
Premature birth.

What immunoglobulin injections are used: a list of popular remedies

The most relevant immunoglobulin preparations:

Immunoglobulin G anti-rhesus Rh0 (D).
HyperROU S/D.
Immunoro Kedrion.
Partobulin SDF.
BayRow-Dee.
Human immunoglobulin antirhesus Rh0 (D).
Resonator.

All of these tools are analog, but not 100% equivalent. The choice of the drug is carried out by a specialist who supervises the woman throughout her bearing of the baby. He focuses on the individual characteristics of her body, choosing the most profitable and effective remedy. Also, the doctor selects the most suitable dosage for the patient.

Is it possible to avoid Rh conflict without resorting to medication

It is not possible to independently avoid incompatibility with a child according to the Rh factor, without using medications.

A woman must understand that the means offered by traditional medicine are not effective, and only timely assistance received by her in a medical institution will be the key to the birth of a healthy baby.

It is also possible to refuse to administer the drug if the expectant mother has contraindications, for example:

Hypersensitivity.
Hyperthymia.
Dyspepsia.
Any type of diabetes.
Already identified sensitization.

Immunological incompatibility is not dangerous for the expectant mother, but it has an extremely adverse effect on the fetus and can even cause its death. In accordance with this, such a phenomenon requires not only careful monitoring of the course of gestation by the doctor, but also following all the recommendations from the mother.

Useful video

Many people know about the importance of the Rh factor in blood transfusion. But not everyone correctly evaluates its significance for a baby if it is negative for a woman and positive for a man. But in these circumstances, the baby may face a serious illness and even death before birth. Signs of Rh conflict during pregnancy in the early stages will let you know about the danger. They are easily identified by specialists if a woman registers on time. Then the chances of having a healthy baby increase.

Read in this article

Briefly about the Rhesus conflict

Part of the blood is erythrocytes and plasma. When mixed, the former make it possible to replenish, if necessary, its volume in the body with the help of a transfusion. And during gestation, the woman's blood serves as a source of nutrition for the embryo. Red blood cells contain substances that sometimes make a person's biological fluid unacceptable to another due to a lack of compatibility. These are agglutinins and Rh factor. But not everyone has the latter. Blood containing these particles is Rh-positive. Their absence makes it negative.

When the mother is a carrier of just such blood, and the father has Rh particles, the fetus can inherit the properties of its biological fluid. That is, there is incompatibility between the woman and the embryo. Her blood counteracts this mismatch by producing anti-Rh agglutinins. Substances enter the placenta, blind red blood cells, making the existence of the fetus problematic. By these actions, the mother's body is protected from foreign blood particles of the embryo, pushing it to death.

Detection of signs of Rh conflict during pregnancy in the early stages makes it possible to neutralize it so much that the danger to the existence and health of the future little person is minimized.

Signs of Rh incompatibility in a future mother

Both parents should know their own blood type and Rh status at the stage of pregnancy planning. With special care, this should be treated by mothers with a negative indicator. But for women who have Rh particles in their blood, there is a possibility that after conception a similar conflict will arise.

If the pregnancy is the first, the woman's blood produces a minimal amount of anti-Rh agglutinins. In this case, the risk to the fetus is small. Therefore, for women with Rh-negative blood, the preservation of the first pregnancy is fundamentally important. This is the best way to give birth to a healthy child, since with each subsequent attempt, with blood incompatibility, the body produces more and more protective particles that are dangerous for the fetus.

The difficulty is also hidden in the fact that the Rhesus conflict during early pregnancy, the symptoms in the mother clinically almost do not betray their presence. That is, she often does not feel anything special that would indicate this serious problem. Frequent, but optional accompaniment of the Rhesus conflict is. Then a woman can observe in herself:

Increased heaviness and pain in the abdomen. They are also felt in the lower back;
General weakness;
Difficulty breathing due to an elevated diaphragm;
High blood pressure;
in the absence of physical activity;
Swelling of the legs;
Characteristic gurgling sounds inside the abdomen;
Stretch marks appearing on the skin;
Abdominal size inappropriate for the gestational age.

But suspicious persons may feel the same, and self-confident ones do not attach importance to these symptoms. In addition, polyhydramnios is caused by other reasons, and not just by the incompatibility of the elements of the blood of the mother and the baby. Therefore, at an early stage of pregnancy, more reliable ones are needed.

How is the diagnosis

Rhesus conflict is determined by examining the mother's blood. It is required first when registering a pregnant woman. First, in fact, the blood type and Rhesus are established, that is, the very possibility of a problem is being studied. If the risk is determined, anti-Rhesus agglutinins can already be detected in the biological fluid from the 8-10th week.

A pregnant woman more than once donates blood for analysis for antibodies. A special protein is placed in the biological fluid, which is cleaved in the presence of anti-Rh agglutinins in it. This reaction is clearly visible to the specialist, moreover, it is even possible to determine the amount of such substances. The blood is diluted with protein until it stops reacting. Thus, the volume of anti-Rhesus particles and the level of danger to the embryo are revealed.

If the blood test of the expectant mother gave a positive result, it is repeated as the pregnancy develops, and is studied in other ways to track the situation and save it.

The first signs in the fetus

It is possible to reliably recognize the Rh conflict by the indicators of the fetus, which are determined using hardware studies. And the faster they are carried out, the more likely a successful outcome for the baby.

Symptoms of Rh conflict during pregnancy at an early stage are as follows:

Incorrect position of the fetus in the uterus. The usual posture for the unborn child is with arms folded on the chest and legs pulled up to the stomach. The embryo appears to be curled up into a ball. With Rhesus conflict, his stomach is enlarged due to swelling, and the limbs are spread apart. Physicians call the position the posture of the Buddha;
Double outlines of the head on ultrasound. It is also caused by fluid retention in soft tissues;
Enlarged placenta and umbilical vein. Occur due to impaired blood flow caused by the Rhesus conflict. There are more blood vessels in the placenta than normal and they become thicker;
Enlargement of the liver and spleen. This is also due to impaired hematopoiesis, hypoxia.

Over time, the features of the signs of Rh conflict during early pregnancy become clearer:

Anemia. Antibodies produced by the woman's blood reach the placenta, where they interact with the erythrocytes of the embryo. The latter are destroyed, which makes it difficult to supply the tissues of the unborn baby with oxygen;
Reticulocytosis. Instead of mature erythrocytes, particles are formed in excessive quantities that are devoid of a nucleus. This is due to an acute lack of oxygen;
Erythroblastosis. The formation of another early form of erythrocytes, also non-nuclear and unable to support the normal formation of the fetus;
Elevated bilirubin. It occurs due to a violation of the liver of the unborn baby.

Methods for detecting signs of blood incompatibility in terms of the embryo

What are the symptoms of Rh conflict during early pregnancy, are detected using:

ultrasound. The screen shows areas of swelling of the internal organs of the fetus, which in these circumstances are enlarged;
Doppler. This method will reveal increased blood viscosity. It happens in the embryo due to the destruction of red blood cells, which makes the blood flow slow;
Cardiotocography. The study is aimed at establishing the deficiencies in the formation of the cardiovascular system, which, in case of Rhesus conflict, makes these organs enlarged due to edema.

Identified signs of Rh conflict during pregnancy in the early stages - this is the chance of a healthy baby. Modern medicine is able to neutralize the factors interfering with its prenatal development in a later period. But for this, methods of detection and therapy are used, which themselves can cause placental abruption, the introduction of infections into the body of the embryo, leakage of amniotic fluid, premature birth and many other complications.

Pregnancy is an extremely important stage in the life of every woman. The future of the child, the state of his health and immunity directly depends on its course. It is necessary to foresee the most likely dangers, to exclude all risk factors, which include Rh-conflict during pregnancy. When a future woman in labor is registered with a antenatal clinic (LC), a referral for many tests and studies will be issued. They are necessary to identify possible diseases and risks of bearing a child.

Each time, not only the blood type is determined, but also the Rh factor, it is considered a fundamental indicator. It is present in approximately 85% of humanity, they are considered Rh-positive. Those 15% of the population in which this protein is not found are Rh-negative. In everyday life, it is absolutely not important which Rh factor is inherent in an individual.

This indicator becomes important after conception, in particular when registering. When does Rh conflict occur during pregnancy? Mostly this happens with a negative Rh in the mother and positive in the father. This is the case when the unborn child inherits the Rhesus of the biological father. Therefore, there is a discrepancy between the Rh blood of the mother and the fetus. And here they diagnose Rh conflict. According to various estimates, the risk of this conflict reaches 75%. If a woman has Rh positive, and her father is negative, there is no conflict, and pregnancy (especially the first one in a woman) will pass without complications.

The likelihood of Rh conflict

Reasons for development

Rhesus conflict occurs if the blood of a fetus with Rhesus "+" enters the mother's system with a negative status. More often, pathology is diagnosed during the second and each subsequent pregnancy, extremely rarely during the first, if there was a blood transfusion with components or whole blood without determining Rhesus. An imbalance occurs when the baby's blood becomes foreign to the mother's body, antibodies are synthesized. Positive and negative red blood cells at the time of the "meeting" are soldered - agglutination. To prevent this, the immune system synthesizes antibodies - immunoglobulin. This substance is of 2 types, it tries to destroy them, hemolysis occurs.

As pregnancy progresses, there is a constant exchange of oxygen and nutrients between mother and baby. The woman receives the waste products of the child. In the same way, mother and baby exchange red blood cells, the baby's blood is filled with antibodies. Rhesus conflict during the first pregnancy is a rare case. It produces antibodies of the LgM type. They have a large diameter, penetrate the fetus in a limited volume, without causing any special problems. With each subsequent conception, starting from the second, the likelihood of an Rhesus conflict increases, since the mother's body is already producing other antibodies - LgG. They are much smaller, more of them enter, bypassing the placenta, into the circulatory system of the fetus.

Table of Rh conflicts during pregnancy

There is a process of hemolysis, bilirubin toxin begins to accumulate. Antibodies were isolated in previous pregnancies, how they ended does not matter.

"Provocateurs" of the conflict are considered:

previous natural childbirth;
caesarean section operation;
abortions and abortions;
miscarriage;
placental abruption prematurely and separation by hand.

Symptoms and signs

The well-being of a woman in such a conflict is practically not disturbed, the symptoms are not clearly expressed. There may be a slight anemia, problems in the liver, more pronounced toxicosis. However, there is a real danger to the child. In the event that a Rh conflict occurs during pregnancy, the risk to the fetus is very serious. Diagnosed with hemolytic disease, it often provokes premature or complicated birth, death in the womb. Pregnant women need to undergo an ultrasound examination to identify possible pathologies.

Symptoms of intrauterine Rh conflict:

increased swelling, especially in the abdominal cavity, in the pericardial sac;
spleen, liver, heart may increase in volume;
the soft tissues of the head swell, a double contour appears;
due to the enlarged tummy, the limbs of the child look to the sides;
the placenta thickens, the diameter of the umbilical vein increases.

Dangers for the baby

The resolution of red blood cells affects the functioning of the child's body. The culprit for this is bilirubin, a by-product of decay. The functioning of the nervous system, heart, kidneys and liver is most severely disrupted. The accumulation of fluid in the tissues of the body can lead to intrauterine death of a baby. There is a high risk of miscarriage and premature birth.

What is the danger of this conflict for the born child? The following stages of hemolytic disease are possible:

Anemic. The child has a reduced number of erythrocytes in the blood, pale skin, lethargy, inhibition of sucking reflexes. The baby's heart beats faster, its tones are muffled.
Icteric - the most common variant of the disease. Signs of a Rh conflict are determined by an increase in the concentration of bilirubin in a child in the blood, which occurred after the destruction of red blood cells. The liver and spleen increase in size. The skin usually has a pronounced yellow color. With a more severe course, the nervous system can be affected, bilirubin encephalopathy is diagnosed. At the same time, muscle tone changes, reflexes are weakened, and intracranial pressure increases. Perhaps the appearance of seizures.
The most serious form is edematous. It occurs if antibodies began to be produced early enough, in the second trimester. In this case, the integrity of the vascular wall is violated, fluid and proteins come out of the tissues. This caused the appearance of edema in the internal organs.

Prevention

To prevent hemolytic disease, a woman may be offered a vaccination, a vaccine based on anti-Rhesus immunoglobulin is used. The first injection is given at week 28, since more often at this time the risk of an Rhesus conflict is maximum. The second injection is indicated in the first three days after delivery.

To minimize potential complications in subsequent pregnancies, be sure to inject serum immunoglobulin in the first 3 days after birth. It destroys the Rh-positive components that have entered the circulatory system of the woman in labor from the fetus. At the same time, the risk of such pathologies during subsequent pregnancy is significantly reduced.

Diagnostics

Usually, after determining the conflict in the mother, a similar study is carried out for the father of the child. When determining the father's Rh-positive status, it is necessary to do an analysis to determine the concentration of antibodies. All patients with Rh-negative status are assigned a second test in the middle of the pregnancy. From the thirty-second week it is carried out twice a month, and from the thirty-fifth - weekly. It is important not to miss a sharp increase in the number of antibodies. Already from 18-20 weeks it is necessary to do an ultrasound. Repeated examinations are carried out at least three more times. If necessary, a woman is assigned dopplerometry and cardiotocography, they are necessary to assess the well-being and development of the fetus.

If necessary, the doctor may prescribe invasive methods of analysis:

Amniocentesis. During this examination, a small amount of amniotic fluid is taken, the level of bilirubin in it is determined.
Cordocentesis. For research, a small volume of the baby's blood is extracted by puncturing the umbilical cord, and the concentration of bilirubin is also determined.

Treatment Methods

Now, in fact, only intrauterine blood transfusion can be considered an effective treatment for such a pathology. The procedure is prescribed only if the child suffers from anemia, which affects his growth and development. This method of treatment is carried out in a hospital, with its help it is possible to achieve significant stabilization of the baby's condition, reduce the risk of early delivery, the occurrence of serious pathologies after childbirth.

Most often, such treatment is intended for those women who are diagnosed with an excess of the permissible norm of antibodies in the first half of the 1st trimester, as well as for patients who carried a previous pregnancy with an Rhesus conflict. These patients are sent for observation and treatment in a hospital (usually a hospital). Methods of purification of blood (plasma) from antibodies, for example, plasmapheresis, hemosorption, and techniques to increase the activity of the immune system are recognized as ineffective, today they are almost not used.

Delivery in Rh conflict

Quite often, delivery is carried out ahead of time, since in the last weeks the concentration of antibodies increases sharply. The permission option is determined by the condition of the pregnant woman and the baby. It is generally accepted that with a caesarean section, the risks for the baby are minimized; in certain cases, only this operation is performed. If the baby is in a satisfactory condition, the gestational age exceeds 36 weeks, natural childbirth is already allowed. They must be carried out by highly qualified personnel, it is necessary to carefully monitor the condition of the woman and the fetus, and to carry out methods for the prevention of hypoxia.

Some doctors suggest that antibodies can get into breast milk, this fact has not been confirmed. Most often, obstetricians recommend briefly abstaining from breastfeeding. This is necessary for potentially harmful substances to leave the woman's body. Some doctors are sure that there are no risks here and you can feed immediately after delivery. You can and should almost always keep breastfeeding. It is very useful for a baby, especially weakened by such a difficult pregnancy.

With an established Rhesus conflict, parents should be extremely attentive to the state of health, begin to take care of the unborn child at the stage of planning the conception of a child. Be sure to take tests in a timely manner and visit your doctor. This will avoid many dangers and problems.