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At what time can a Rh conflict appear. What to do with a "conflict" pregnancy

Rhesus conflict- occurs as a result of incompatibility of the blood of the mother and fetus according to the Rh system. A conflict is also possible according to the AB0 system, i.e. by blood group (1 case per 250-300 births). This conflict develops when the mother has 0 (I) blood type, and the fetus has any other (II, III, IV). Although blood group incompatibility is quite common, as a rule, the resulting complications are much easier and do not require intensive care.

The reason for the development of Rh-conflict during pregnancy

Immunization (production of anti-Rhesus antibodies in the blood) of women with Rh (-) blood occurs during pregnancy with a fetus that inherited Rh (+) blood from the father, as a result disorders of the uteroplacental barrier(minor injuries of the villi and hemorrhages of the placenta, infectious diseases that increase its permeability). In physiological pregnancy, the possibility of penetration of fetal erythrocytes through the placenta into the mother's bloodstream increases with gestational age. So in the first trimester this happens in 3% of cases, in the second - in 15% of women, in the third - in 45%.

The mechanism of development of hemolytic disease of the fetus

When fetal Rh antigens enter the mother's bloodstream, antibodies (AT) are produced in her - immunization. Antibodies produced from the bloodstream of a pregnant woman penetrate to the fetus, reacting with erythrocyte antigens and forming an antigen-antibody complex. In this case, hemolysis (decay) of fetal erythrocytes occurs with the formation of indirect toxic bilirubin. The destruction of blood cells becomes the main cause of anemia in a child, and the accumulation of indirect bilirubin causes intrauterine jaundice. Since this bilirubin dissolves quite well in lipids (fats), it primarily affects the nuclei of the brain, causing encephalopathy and kernicterus. In severe forms of hemolytic disease, the fetus may develop dropsy up to anasarca (dropsy of the whole body).

Clinical picture

Information There are no specific symptoms characteristic of the Rhesus conflict in pregnant women. However, some doctors still describe the appearance of the so-called "mirror syndrome", as a result of which, in parallel with the increase in signs of "intrauterine catastrophe", a woman experiences symptoms resembling signs of preeclampsia.

Complications

The course of pregnancy in the presence of a conflict between the blood of the mother and the fetus is characterized by a large number of complications:

  • (13%);
  • (10%);
  • preeclampsia;
  • bleeding;
  • Purulent-septic complications in the postpartum period.

But the most formidable complication is the development hemolytic disease of the fetus and newborn (HFD and HDN).

Risk factors and risk factors for primary immunization in women

  • Artificial abortion - 5%;
  • Spontaneous abortion - 4%;
  • Ectopic pregnancy - 1%;
  • Full-term pregnancy (before childbirth) - 2%;
  • Invasive procedures (amniocentesis, cordocentesis) - 3%;
  • Transfusion of Rh (+) blood - 90-95%.

Diagnostics

Diagnosis of Rh sensitization in a woman is based on the results of anamnesis (blood transfusion, abortions, miscarriages, etc.) and determination of the titer of anti-Rhesus antibodies in the blood.

Diagnosis of GBP Based on ultrasound data

  • Fetometry;
  • Placentometry;
  • The amount of amniotic fluid;
  • Doppler study of cerebral blood flow and ultrasound signs of edema in the fetus.

Greater information about the condition of the fetus and the course of GBP can be provided by the study of amniotic fluid taken by. It is also possible to study fetal blood obtained during cordocentesis ( cord puncture). The only indication for these invasive interventions are data indicating the presence of anemia in the fetus, since only severe anemia in the fetus is an indication for intrauterine treatment. There are no other indications for amnio- and there are no, since they further increase the likelihood of sensitization.

Treatment activities

important To date, previously used methods to reduce the level of AT titer in the mother's blood (nonspecific desensitizing therapy, hemosorption, plasmapheresis, transplantation of a skin flap from her husband) have been recognized as ineffective.

GBP treatment(hemolytic disease of the fetus) is intrauterine blood transfusion(erythrocyte mass) to the fetus, in case of moderate and severe anemia. This procedure improves the blood counts of the fetus, reduces the risk of developing the edematous form of GBP and thereby prolongs the pregnancy. Intrauterine blood transfusion can be performed repeatedly up to 32-34 weeks of pregnancy. After that, the issue of early delivery is decided.

Management of pregnancy and childbirth

In pregnant women with Rh-negative blood, starting from 6-12 weeks of gestation, there is a need for a blood test for the presence of anti-Rh antibodies and determination of their titer in dynamics (approximately 1 time per month throughout the entire pregnancy).

The titer of AT during pregnancy can change: increase or decrease, remain unchanged or alternate between increased and decreased values. However, the absolute value of AT titer in the mother's blood is not an indicator of the severity of the fetal disease and is not of decisive importance for predicting the development of HDF and HDN. This means that the birth of children with Rh-negative blood is possible in women who have anti-Rh antibodies in their blood, left over from a previous pregnancy or abortion.

Highest value for the diagnosis of GBP has an ultrasound examination, which is advisable to appoint, starting from the 18th week. With a favorable course of pregnancy in sensitized women, it is advisable to conduct ultrasound at least once every 3-4 weeks, in severe forms of GBP - every 2-3 days.

The method of delivery of pregnant women with Rh conflict depends on the condition of the fetus, the duration of pregnancy and the preparedness of the birth canal. If all indicators are satisfactory, then childbirth is carried out naturally. If the condition of the fetus is regarded as severe, then preference is given.

Prognosis for mother and fetus

For mother

Additionally This conflict does not threaten the mother's life. All complications of pregnancy arising in this case disappear immediately after delivery. However, a woman is being immunized and the likelihood of a recurrence of the situation is quite high.

Women with Rh sensitization and a aggravated history (death of a newborn from hemolytic disease in a previous pregnancy) need to be aware that there is a possibility of pregnancy with a fetus with Rh-negative blood using the IVF method.

For the fetus

Depending on the severity of the clinical form of GBP and HDN, it is possible to make predictions:

  • Hemolytic anemia without jaundice and dropsy is the mildest form of the disease, the prognosis is favorable;
  • Hemolytic anemia with jaundice - without appropriate therapeutic measures, the disease develops, the prognosis is relatively favorable;
  • Hemolytic anemia with jaundice and dropsy is the most severe form of the disease, often such children die in utero, the prognosis is unfavorable.

Prevention

It is possible to solve the problem of Rh-conflict between mother and fetus in advance if preventive measures are taken in a timely manner:

  • Preservation of the first pregnancy in women with Rh-negative blood;
  • Carry out blood transfusion only taking into account the Rh-belonging of the woman and the donor;
  • Specific prophylaxis consists in the administration of human immunoglobulin anti-Rhesus to women who do not have anti-Rhesus antibodies in their blood after any termination of pregnancy (abortions, miscarriages, childbirth with a Rh-positive fetus);
  • In women with Rh-negative blood who do not have signs of sensitization, provided that the father of the child is Rh-positive, they should receive prophylactic human anti-Rhesus immunoglobulin, which is specially designed for intrauterine prevention of Rh conflict.

The term "Rh factor" is applied to one of the 36 blood group systems. It is a lipoprotein protein on the surface of red blood cells. If it is present on the shells of red cells, then the person is Rh-positive, if not, Rh-negative. When the Rh factors of the pregnant woman and the fetus do not match, hemolysis develops, leading to serious complications.

What role does the Rh factor play during pregnancy?

In itself, the presence of the Rh factor Rh does not affect human health, including pregnant women. This is just one of the immunological properties of blood.

With a positive Rh factor, it is considered stronger. Negative have only 15% of all people. In the embryo, the Rh factor appears at an early stage of pregnancy. Already at week 8, a small amount of fetal erythrocytes is determined in the mother's blood tests. The Rh factor of parents during pregnancy is important for predicting the further development of the child:

  • If the parents have the same Rh factor, then the conception and development of the baby will be favorable.
  • When the Rh factors of a woman and a man are different, an Rh conflict can develop. If the fetus inherits Rh from the father, then they will have incompatibility with the mother. This is very dangerous for a child. A miscarriage can occur at any stage of pregnancy.

The mechanism of the occurrence of Rhesus conflict

In the case of a Rh conflict, upon contact, the erythrocytes of the fetus and the woman stick together, which leads to complications. It is worth noting that Rh-positive blood tolerates this more easily. For this reason, a woman with Rh + does not have an Rh-conflict during pregnancy with a fetus with Rh-. The mother's blood does not react to the baby's Rh, so protective antibodies are not formed.

A dangerous condition is a negative Rh factor in a woman during pregnancy with an Rh-positive fetus. This is seen when a baby has inherited Rh from an Rh+ father.

In this case, the following processes take place:

  1. The meeting of the blood of the mother and fetus occurs in the space between the placenta and the uterus.
  2. An exchange is carried out there: nutrients and oxygen come to the baby, and the products of his life activity go to the mother.
  3. Against this background, part of the positive erythrocytes of the fetus enter the blood of the pregnant woman, and her negative red cells - into the blood of the child.
  4. In the same way, antibodies penetrate the baby, which are produced in response to genetically alien material - fetal erythrocytes.

Regardless of how many times a woman is pregnant, the entry of positive fetal red blood cells into the blood of an Rh-negative mother occurs in several other situations. Main cases:

  • Pregnancy, which is accompanied by preeclampsia, the threat of miscarriage or serious illnesses of a woman.
  • Premature detachment of the placenta or its manual separation.
  • Delivery by caesarean section.
  • Cordocentesis, chorion biopsy, amniocentesis are studies that are carried out during pregnancy.
  • Mother's transfusion of Rh-positive blood.
  • Miscarriage, induced abortion, or surgery for an ectopic pregnancy.

How to determine the Rh factor in a child

Families with Rh negative need not worry, although this is rare. Only 3% of men have Rh-. According to the laws of genetics, inheritance occurs from the father or mother. Rh transmission principles:

Symptoms

If there are no concomitant diseases, then the woman's well-being, even with a Rh conflict, does not change in any way. Externally, this deviation cannot be detected. To detect pathology, the following studies are used:

Consequences

During the first pregnancy, the likelihood of a Rh conflict is practically excluded. This is due to the fact that the produced IgM immunoglobulins are large, which is why they cannot cross the placenta and enter the blood of the fetus.

In subsequent pregnancies, the number of such antibodies increases. In addition, their size decreases, which increases the likelihood of an Rhesus conflict. If the fetus does not die at 20–30 weeks, then the following complications develop after birth:

  • hemolytic disease of the newborn;
  • muscle weakness;
  • regurgitation;
  • feeding difficulties;
  • cerebral palsy;
  • an increase in the abdomen;
  • pallor or yellowness of the skin, lip rims, conjunctiva of the eyes;
  • constant piercing crying, anxiety;
  • opisthotonus - arching with spasms of the muscles of the hands.

Treatment Methods

Rh conflict pregnancy requires special attention from doctors. If anti-Rhesus antibodies were found in the woman's blood or if specialists established signs of a hemolytic disease in a child, non-specific treatment is carried out. The treatment regimen in this case:

Treatment method

Description

Medical treatment
  • injections of ascorbic acid with a solution of 40% glucose;
  • B vitamins.

Physiotherapy
  • oxygen therapy;
  • UV sessions.

Undercooked liver or liver extracts must be introduced into the diet.

Diathermy of the perirenal region

This is a method of physical treatment in which the specified area is heated with high frequency currents. The procedure is prescribed at a high risk of spontaneous miscarriage.

Preterm birth

Shown with the inefficiency of previous methods. They are carried out in two ways:

  • naturally with a low titer of antibodies;
  • by caesarean section to reduce the time of contact of the mother's blood with the child.

There is also a specific treatment for Rhesus conflict. Unlike non-specific measures, it has slightly different indications. This treatment is prescribed to all women with a negative Rh in the following cases:

  • after childbirth, miscarriages, abortions;
  • after surgical treatment of ectopic pregnancy.

Specific therapy is the intramuscular administration of anti-Rhesus immunoglobulin immediately after childbirth or surgery. The injection should be made no later than 48-72 hours after medical manipulations. Otherwise, the drug will not bring the desired effect. Anti-rhesus immunoglobulin works like this:

  1. Destroys the fetal red blood cells in the woman's body, which managed to get into her blood during childbirth or surgery.
  2. As a result, antibodies do not have time to form.
  3. With the next pregnancy, the risk of Rh conflict is minimized.

Is it possible to prevent Rhesus conflict

Prevention of Rh conflict is necessary for all Rh-negative women, especially if their partner is Rh-positive. Vaccination with anti-Rhesus immunoglobulin helps to prevent this pathology. It is administered at 28 and 32 weeks of pregnancy. Other preventive measures:

  • blood transfusion only taking into account compatibility by group and Rhesus;
  • preservation of the first pregnancy in a woman with Rh–;
  • vaccination with anti-Rh immunoglobulin in Rh-negative women after childbirth, abortion, miscarriage, ectopic pregnancy.

Video

Alloimmune antibodies are formed in those women who have a conflict on the Rh factor with a child. However, many women, having received the test results in their hands, do not always understand what consequences this can lead to.

Alloimmune antibodies

To begin with, it is worth understanding the terminology. Such antibodies are formed when there is a conflict with the rhesus of red blood cells. In particular, they may bother a woman who has a negative Rp but is pregnant with a positive one. In this case, a miscarriage may occur, and if the pregnancy is maintained, the baby may acquire

Knowing that she is a carrier of a negative Rh, a woman must be observed by a doctor and regularly be tested for antibodies.

Throughout pregnancy, girls should be more attentive to their health: drink vitamins, strengthen their immunity. Otherwise, there is a risk of catching any virus or infection. This can damage the placenta, which is a kind of conductor from mother to baby. In this case, the child's red blood cells will enter the woman's circulatory system, and this will inevitably lead to an Rhesus conflict.

When can conflict occur?

Rp children will inherit from their parents. If both are positive, then the child is likely to be the same. However, there are exceptions. If mom and dad have both positive, then the baby can take one or the other factor.

If both are negative, then in this case there is nothing to worry about. The child will absolutely take a negative Rh, which means that there will be no conflict.

At what point can it happen?

  • Childbirth. When bleeding, as a rule, the newborn's blood enters the mother's, and this leads to the formation of antibodies. Fortunately, if the pregnancy is the first, it will not affect either one or the other in any way. But when repeated, they can affect the child.
  • placenta injury. Detachment or damage to its integrity will cause the two circulatory systems to mix, and this will cause the appearance of antibodies.
  • An abortion or ectopic pregnancy with an Rh-positive fetus also results in the release of red blood cells into the mother's bloodstream, where conflict will occur.
  • Forced transfusion. There are situations when a woman is mistakenly “dripped” with the wrong Rhesus blood. By the time of pregnancy, there will already be antibodies in her body.

First pregnancy

The womb is the first place of residence of the baby. She protects him from various injuries and helps to develop until the moment of birth. But even being in it, the child can feel the consequences of the Rhesus conflict. This requires the following condition: the mother has a negative Rp, the fetus has a positive one.

The first pregnancy is the safest, even if both have different Rh. If it proceeds without problems, then the risk of antibody formation is very low. Only after childbirth, when the two types of blood mix, can they enter the mother's blood.

There are several factors that affect the fetus during the first pregnancy.

  • Abortions for medical (and not only) indications.
  • Infectious diseases that caused a violation of the integrity of the placenta.
  • Injuries that lead to maternal blood loss.

Analysis for Rh conflict

It is carried out for all girls who have a negative Rh. As soon as a woman learns about her situation, she needs to report her problem to the doctor. He will give a direction for an analysis that determines alloimmune

In the first weeks, the conflict can manifest itself, causing an involuntary miscarriage. Some do not even have time to find out that they are pregnant, as the body rejects a fetus with a different Rh. It is necessary to carefully consider this issue and register with a gynecologist as soon as possible.

Starting from the twentieth week, the woman will be tested for alloimmune antibodies once a month. By the onset of the last trimester, the frequency will be increased to two times. But closer to childbirth, at 35 weeks, you will have to take samples every week.

If the situation is complicated by a high amount of antibodies, the expectant mother will be transferred to a hospital for more careful monitoring.

In order to determine the presence of a conflict, a woman donates blood from a vein, which is tested using special reagents. In the most severe cases, cordocentesis is performed. To do this, the umbilical cord is pierced, from which blood is taken. However, this method is very dangerous for the baby. It is resorted to in exceptional cases, when there is a suspicion of a hemolytic disease of the child.

When will there be no conflict?

The mother's womb is a barrier to the entry of various viruses and infections during the development of the baby until he is born. In it, the fetus feels completely safe. But, unfortunately, she can not always protect him from the Rhesus conflict. You should not worry about it if both mother and child have a negative Rp. This means that the baby has inherited the maternal Rh, and their blood will no longer “conflict”.

There is no reason to worry for those mothers who have a positive Rp. The majority of such people in the world - 85%. Even if the child took the father's negative Rh, there will be no conflict.

If the presence of antibodies is determined in time and regularly examined by a doctor, then in this case there will be no problems. Alloimmune antibodies can only affect the second and subsequent pregnancies. But by this time, the mother will already be prepared and will inform the doctor in advance about her negative Rh.

Consequences

What to do if there is an Rhesus conflict during pregnancy? The consequences for the child may be different.

  1. Firstly, in such a situation, the mother's body perceives the fetus as a foreign body. Red blood cells in the blood begin to produce special antibodies that can lead to the destruction of the embryo. In response to this reaction, the child's body actively increases bilirubin. This hormone affects the functioning of the liver, spleen and other internal organs. It can also negatively affect the baby's brain, leading to various kinds of disorders.
  2. The conflict of Rhesus leads to a decrease in the level of fetal hemoglobin. The child begins oxygen starvation, which is very dangerous and can lead to pregnancy fading.
  3. A large amount of bilirubin is the cause of jaundice in a newborn.
  4. For the mother herself, who was not examined in time for the presence of antibodies, this can end in failure. Rhesus conflict can lead to premature birth.

Conclusion

Fortunately, there are not many women who have a negative Rp. On the whole planet, there are no more than 15%. Expectant mothers have a huge responsibility - to endure and give birth to a healthy baby, if, nevertheless, there was a Rh conflict during pregnancy. The consequences for the child can be very severe. For this reason, a woman should be carefully examined, and if necessary, go to the hospital for careful observation.

Humanity is made up of men and women, blonds and brunettes, tall and short, and also those who have a protein called the Rh antigen in their red blood cells and those who don't. Everything would be fine - the owners of positive and negative Rhesus live very amicably and often form pairs, but some combinations of Rhesus parents during pregnancy can lead to an Rhesus conflict between mother and baby.

What it is? How dangerous? Is it possible to prevent Rh conflict and how to treat its consequences? Is breastfeeding allowed? Elena TELINA, obstetrician-gynecologist, deputy chief physician for obstetrics and gynecology, AVICENNA Medical Center of the Mother and Child Group of Companies, tells.

What is Rhesus conflict?

First, let's figure out what the Rh factor is. This is a special protein - the Rh antigen, which is located (or not located) on the surface of erythrocytes - red blood cells. If this protein is present in the blood, then Rh is considered positive, and if it is not - negative. In 1940, doctors K. Landsteiner and A. Wiener helped to detect the Rh antigen by rhesus monkeys - this protein was first isolated from their erythrocytes. In honor of these monkeys, the Rh factor got its name.

About 85% of the European population of the planet has a positive Rh factor, about 15% have a negative Rh factor. The highest percentage of people with a negative Rh factor is found among the Basques. Interestingly, in Asians, Africans and the indigenous population of North America, negative Rh is extremely rare - in about 1% of cases, so Rh conflict is very rare for them.

” A negative Rh factor does not affect a person’s life in any way; you cannot determine such a difference by eye. However, during pregnancy, the mismatch between the Rh factors of the mother and the baby can cause a rather serious complication - the Rh conflict.

"Rh-positive" and "Rh-negative" blood are incompatible. The entry of the Rh antigen into the blood with a negative Rh causes a strong immune response - the body perceives a protein that is foreign to it as a serious illness that must be destroyed. A whole army of antibodies is being urgently produced that attack and destroy the "positive" antigens.

What happens if a source of such “foreign” antigens appears inside the body and firmly settles there for 9 months? The concentration of antibodies will constantly increase, they will increasingly attack proteins that are unsafe for them, trying to completely destroy their source. This is what happens when the mother has a negative Rh factor, and the baby has a positive one. Mom's body defends itself by attacking unfamiliar antigens. This condition is called Rhesus conflict.

” The risk of developing an Rh conflict exists if the mother has a negative Rh, and the father has a positive one. Other combinations will not provoke such a conflict.

Expert comment

Rhesus conflict is the incompatibility of the blood of the mother and fetus according to the Rh factor. This condition can develop only in a pregnant Rh-negative patient with an Rh-positive fetus (while the father's Rh is positive).

Rhesus conflict and first pregnancy

As a rule, during the first pregnancy, the concentration of antibodies in the mother's blood is relatively low, and the fetus develops calmly, practically without experiencing their harmful effects. However, each subsequent pregnancy with this combination causes more and more active formation of antibodies, increasing the risks.

Expert comment

The risk of developing a Rh conflict during the first pregnancy is not common (namely, the 1st pregnancy, not childbirth, because all pregnancies that are interrupted for a short period may not produce laboratory markers, but antibodies will accumulate with each subsequent pregnancy).

Analysis for Rh factor and antibodies

You can find out if there is a risk of Rh conflict for a given pregnancy using blood tests. At the beginning of pregnancy, a woman takes an analysis to determine the blood type and Rh factor.

If Rh is negative, then the doctor prescribes the next test - to determine the level of antibodies to a positive Rh factor. In the future, this analysis is recommended to be taken monthly - this is the only reliable way to track possible sensitization in time and prevent the occurrence of serious complications.

Recently, Rh-negative pregnant women have another opportunity - a non-invasive determination of the Rh factor of the fetus by the mother's blood. The disadvantages of this analysis are that it is not widespread in Novosibirsk and is expensive.

Examples of the cost of such an analysis in Novosibirsk clinics:

    "Ultrasound-studio": Determination of the Rh factor of the fetus by the mother's blood using the PRENETIX method, the cost is - 12 000 rubles.

    "Avicenna": Non-invasive determination of the Rh factor of the fetus. price - 7 800 rubles.

Expert comment

The penetration of fetal Rh antibodies into the mother's blood and, accordingly, the emergence of a conflict, is possible from the 9th week of pregnancy, when the uteroplacental blood flow begins to work actively (during physiological pregnancy, fetal erythrocytes penetrate the placenta in 3% of women in the 1st trimester, in 15% in the 2nd , and 45% in the 3rd trimester). From the 9th week of pregnancy, we can use a special laboratory test to determine the blood type and Rh factor of the child from the mother's blood. The test has high specificity and gives the correct result. In the future, knowing about the negative Rh of the baby, you can no longer control the presence of Rh antibodies during pregnancy - they cannot be, but if we get a Rh-positive blood type of the child, the control of Rh antibodies should be 1 time per month Rh antibodies).

With a Rh-positive group of a baby, a conflict may not arise in the first pregnancy, but trace “conflict”, “alert” cells will always remain, which can manifest themselves more actively in subsequent pregnancies with a Rh-positive baby and cause clinical manifestations already in the baby in development of hemolytic disease.

Anti-rhesus immunoglobulin

It is possible to prevent the development of a Rh conflict - or a sensitization reaction with an injection of anti-Rhesus immunoglobulin. In fact, it is a dose of ready-made antibodies that bind to the antigens of the baby that have entered the mother's bloodstream. Thus, "foreign elements" are neutralized and the mother's body does not need to develop its own army of antibodies.

” Anti-Rhesus immunoglobulin is administered to women with a negative Rh, a pregnant "positive" fetus for a period of 28-32 weeks and within 72 hours after childbirth.

Rh conflict, that is, a rare increase in the concentration of antibodies to the Rh antigen, is triggered when Rh-positive red blood cells enter the bloodstream of an Rh-negative mother. Therefore, all situations associated with bleeding during a potentially "conflict" pregnancy and delivery also require the immediate administration of anti-Rhesus immunoglobulin.

Factors that increase the risk of Rh conflict:
. artificial termination of pregnancy;
. miscarriage;
. ectopic pregnancy;
. childbirth and caesarean section;
. preeclampsia;
. bleeding during pregnancy;
. invasive procedures during pregnancy: cordocentesis, amniocentesis, chorionic villus sampling;
. abdominal trauma during pregnancy;
. history of blood transfusion without taking into account the Rh factor.

It is important to understand that sensitization can occur without injury - the penetration of fetal erythrocytes through the placenta into the mother's bloodstream is also possible during the physiological course of pregnancy.

Expert comment

Today, in the world and in our country, a special anti-Rhesus immunoglobulin is used, which prevents the development of a Rh conflict. This drug is administered intramuscularly at 28-32 weeks of gestation and within 72 hours after delivery if the newborn has a laboratory confirmed Rh positive blood type. At the birth of a Rh-negative child, repeated administration of anti-Rhesus immunoglobulin is not advisable. The introduction of antirhesus globulin is also indicated in patients with an interrupted pregnancy (abortion, miscarriage, ectopic). the volume of fetal blood in the mother's bloodstream increases with increasing gestational age and reaches about 30-40 ml with any termination of pregnancy, with the accumulation of Rh antibodies in a woman.


Risks and consequences of Rhesus conflict

The concentration of antibodies dangerous to the fetus in most cases increases with each "conflict" pregnancy. These antibodies can freely enter the fetal circulation and begin to damage positive red blood cells and hematopoietic organs more and more. As a result, the baby develops hemolytic disease, which, if left untreated, can lead to very serious consequences.

Risks of pregnancy with Rh conflict:

  • premature birth, miscarriage;
  • hemolytic disease of the fetus;
  • hemolytic jaundice.

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 a protein on the membrane) and negative (with its absence on the cell membrane) blood particles, namely erythrocytes, as a result of which their agglutination (gluing) occurs, accompanied by a violation of normal blood parameters.

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, in about 10-15% of cases, antibodies are produced. 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 thoughts 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.