How long can you determine the Rh conflict. Possible consequences for the fetus. Dangers and consequences

26.07.2019

Update: October 2018

Most women who are preparing to become mothers have heard about the "terrible and terrible" Rh-conflict during gestation. But this problem applies only to those of the fairer sex whose blood is Rh negative.

Rh-conflict during pregnancy threatens only those pregnant and planning pregnancy who have negative Rh blood, and even then, far from 100% of cases.

Understanding the Rh factor

It is known that human blood consists of red blood cells or erythrocytes, which are responsible for the transfer of oxygen, white blood cells - leukocytes that guard the health of the body, platelets, which are responsible for blood clotting and many other cells and systems.

The Rh factor is a D-protein that is an antigen and is localized on the surface of red blood cells. A significant part of people have the Rh factor, then their blood is called Rh-positive. For example:

among Europeans, there are 85% of Rh-positive people
while for Africans this figure rises to 93%
among Asians up to 99%

If D-protein is not detected, then such people are called Rh-negative. The Rh factor is genetically determined, just like hair or eye color, persists for life and does not change. The presence or absence of the Rh factor does not carry any benefit or harm, it is just a characteristic feature of each person.

And what is this - Rh-conflict?

Click to enlarge

It becomes clear that pregnancy with Rh-conflict occurs in situations where the mother's blood is Rh-negative, while the father's, on the contrary, is Rh-positive, and the unborn child inherits the Rh factor from him.

However, this situation occurs in no more than 60% of cases, and only 1.5% falls on the occurrence of Rh-conflict. The mechanism of the Rh-conflict during the period of waiting for the birth of a baby is that the red blood cells of the fetus, which carry the D-antigen, meet with the red blood cells of the Rh-negative pregnant woman and stick together, that is, agglutination occurs.

To prevent adhesion, the mother's immunity is turned on, the immune system begins to intensively synthesize antibodies that bind to the antigen - the Rh factor and prevent adhesion. These antibodies or immunoglobulins can be of two types, both IgM and IgG.

Rh-conflict in the first pregnancy

It almost never occurs, which is due to the production of type I immunoglobulins. IgM are very large and cannot cross the placenta to enter the fetal bloodstream. And in order for the erythrocytes of the unborn child and antibodies to meet, they need to "collide" in the gap between the uterine wall and the placenta. The first pregnancy almost completely excludes such a situation, which prevents the development of a Rh-conflict situation.

If a woman becomes pregnant again with a Rh-positive fetus

In this case, his erythrocytes, penetrating into the mother's vascular system, "trigger" an immune response, during which IgG is produced. The sizes of these antibodies are small, they easily overcome the placental barrier, enter the baby's bloodstream, where they begin to destroy his erythrocytes, that is, cause hemolysis.

In the process of destruction of the red blood cells of the fetus, bilirubin is formed from them, which in significant quantities is a poisonous substance for the child. Excessive formation of bilirubin and its action contributes to the development of such a formidable pathology as hemolytic disease of the fetus and newborn.

What leads to Rh-conflict?

For the development of Rh-conflict, two conditions are needed:

First, the fetus must have Rh-positive blood, and therefore inherit her Rh-positive father.
Secondly, the mother's blood must be sensitized, that is, have antibodies to the D-protein.

Most of the antibody production is due to previous pregnancies, no matter how they ended. The main thing is that there was a meeting of the maternal blood and the blood of the fetus, after which IgM antibodies were developed. It could be:

previous childbirth (in the process of expulsion of the fetus, contact with its blood cannot be avoided by a woman)
cesarean section
ectopic pregnancy
artificial termination of pregnancy (regardless of the method, and surgical, and)
spontaneous miscarriage
separation of the placenta by hand.

The production of antibodies is also possible after performing invasive procedures during the period of gestation, for example, after cordocentesis or amniocentesis. And such a reason is not excluded, although it is rather nonsense, like a transfusion of Rh-positive blood to a woman in the past who has an Rh-negative factor.

Of no small importance are the diseases of the woman who carries the baby. , diabetes mellitus, acute respiratory viral infections and flu damage the villi, and, consequently, the chorionic vessels and the blood of the mother and the unborn baby mix.

But you should know that hematopoiesis in the fetus begins to form from the 8th week of embryogenesis, which means that abortions performed up to 7 weeks are safe in terms of the development of a Rh-conflict situation in the future.

Manifestations of Rh-conflict

External, that is, visible manifestations of the Rh-conflict do not exist. The incompatibility of maternal and fetal blood does not in any way affect the condition of the pregnant woman. As described above, the Rh-conflict “matures” during the second pregnancy, and with each subsequent pregnancy the risk of this condition increases.

The incompatibility of the blood of the child and the expectant mother for the Rh factor has a very unfavorable effect on his condition and health in the future. To find out what devastating damage the Rh-conflict inflicted on the baby, an ultrasound scan of the fetus is performed. During an ultrasound examination, the following signs are well visualized:

the contour of the head becomes double, which indicates edema
the placenta and umbilical vein swell and increase in diameter
fluid accumulates in the abdomen, bursa, and chest
the size of the abdomen of the fetus exceeds the norm
splenohepatomegaly develops (an increase in the size of the liver and spleen), the fetal heart is larger than normal
the baby in the uterus takes a certain position in which the legs are divorced due to the large abdomen - this is called the "Buddha pose"

All of these ultrasound signs indicate the development of hemolytic disease of the fetus, and after birth it will be called hemolytic disease of the newborn. This pathology has three forms:

icteric
edematous
and anemic

The most unfavorable and severe form is edematous. The icteric form ranks second in severity. A child who has high levels of bilirubin in the bloodstream after birth is very lethargic, apathetic, has a poor appetite, constantly regurgitates (see), has reduced reflexes, he often has convulsions and vomiting.

Bilirubin intoxication negatively affects the child even in utero, and is fraught with the development of mental and mental disability. With an anemic form, the fetus has a lack of red blood cells, which causes its oxygen starvation (hypoxia) and immature red blood cells (erythroblasts, reticulocytes) are present in large quantities in the blood.

Diagnostics and dynamic control

In the diagnosis of the described pathology, the early appearance of a woman in an antenatal clinic is of great importance, especially if the pregnancy is the second, third, and so on, and the pregnant woman has either been diagnosed with antibody sensitization in the past, or, which is much more unfavorable, a history of hemolytic disease of the fetus / newborn.

When registering for dispensary registration, all pregnant women, without exception, are determined by the blood group and Rh affiliation.
If the mother is diagnosed with Rh-negative blood, in this case, the definition of the group and the Rh factor in the father is shown.
If he has a positive Rh factor, a woman before 20 weeks of pregnancy is prescribed antibody titer tests every 28 days.
It is important to determine the type of immunoglobulins (IgM or IgG).
After the pregnancy has passed into the second half (after 20 weeks), the woman is sent to be monitored at a specialized center.
After 32 weeks, a blood test for antibody titer is performed every 14 days, and after 35 every 7 days.
The prognosis depends on the gestational age (see) in which antibodies were found. It is all the more unfavorable, the earlier immunoglobulins to the Rh factor were diagnosed.

If antibodies are detected, especially if the pregnancy is second and the chances of a Rh-conflict increase, the condition of the fetus is assessed, which is carried out both by non-invasive and invasive methods.

Non-invasive ways to determine the state of the unborn baby:

Ultrasound should be performed at gestation periods 18, 24 - 26, 30 - 32, 34 - 36 weeks and on the eve of childbirth. The position of the child, swelling of tissues, dilated umbilical veins are determined, as the baby grows and develops.

Dopplerometry

The blood flow velocity in the placental vessels and in the unborn child is assessed.

Cardiotocography (CTG)

It allows you to determine the state of the heart and vascular system in the fetus and diagnose the presence of a lack of oxygen (hypoxia).

Invasive methods:

Amniocentesis

During amniocentesis, amniotic fluid is taken by puncturing the fetal bladder and the content of bilirubin in them is determined. Amniocentesis is prescribed at an antibody titer of 1:16 or higher and is performed at 34 to 36 weeks. The negative aspects of this procedure should also be taken into account. Carrying out amniocentesis is fraught with infection, leakage of amniotic fluid, premature outpouring of water, bleeding and placental abruption.

Cordocentesis

The essence of the procedure is to puncture the umbilical vein and take blood from it. A highly informative method for diagnosing hemolytic disease, in addition, it allows intrauterine transfusion of blood to the fetus. Cordocentesis has the same negative aspects as amniocentesis, and it is also possible to form a hematoma at the puncture site or bleeding from it. This manipulation is carried out with an antibody titer of 1: 32 and in the case of hemolytic disease of the fetus / newborn in the previous child or his death.

Methods of confronting the Rh-conflict

Today, there is the only way to alleviate the condition of the fetus and improve its situation - this is intrauterine blood transfusion through cordocentesis. This method reduces the likelihood of premature birth and the development of severe hemolytic disease after birth. All other methods do not have a significant effect or are completely useless (desensitizing treatment, transplantation of the mother's husband's skin flap, and others).

A woman is delivered, as a rule, ahead of schedule. Preference is given to abdominal delivery, since in this case the risk of complications is reduced. But in some situations (absence of hypoxia, gestational age more than 36 weeks, not the first birth), independent childbirth is also possible.

To prevent Rh-conflict during the next pregnancy, a primiparous woman is injected with an anti-Rh immunoglobulin within 72 hours after the birth of a child, which will destroy the child's erythrocytes that have entered the mother's blood, which will prevent the formation of antibodies to them.

It is for the same purpose that a specific immunoglobulin is administered after artificial and spontaneous abortion. In addition, the introduction of immunoglobulin after an ectopic pregnancy and with bleeding during the current period of gestation is shown. For the purpose of prophylaxis, the administration of this immunoglobulin at 28 and 34 weeks is indicated.

Rhesus conflict and breastfeeding

There is no consensus on the issue of breastfeeding with Rh-conflict. Doctors assess the baby's condition and possible risks, and in some cases, immediately after childbirth, do not recommend breastfeeding for several days, sufficient to remove antibodies from the mother's body.

However, there is also the opposite opinion of doctors that such a restriction is not necessary. There is still no proper research in this area to confirm this or that position.

What does the Rh-conflict portend?

The consequences of pregnancy with Rh-conflict are very unfavorable. The presence of a huge amount of bilirubin in the child's blood affects the state of his internal organs and the brain (the damaging effect of bilirubin).

Hemolytic disease of the newborn often develops, the baby has a mental retardation, and his death is possible, both in the womb and after birth. In addition, the Rh-conflict is the cause of abortion and recurrent miscarriage.

Among all kinds of troubles that can happen during pregnancy, the Rh-conflict occupies a special place. It happens when a pregnant woman has a negative Rh, and the fetus has a positive one. What actions should be taken in this case?

Even from school, we know what an important role red blood cells - erythrocytes - play for humans. When red blood cells were studied in sufficient detail, it turned out that these red blood cells carry a huge amount of proteins on their surface. We are very familiar with some of these proteins - they determine the type of blood group. Let's get acquainted with one more - with the so-called Rh factor.

It is the Rh factor that determines whether a person is Rh-positive or Rh-negative. What does this mean? It's simple: the fact is that not all people have the Rh factor, therefore, in cases where it is absent, they say that the blood is Rh-negative. Accordingly, when the Rh factor is present, the blood is Rh positive.

It is interesting!
The ratio of Rh-positive and Rh-negative people is strongly influenced by race. So, if among Europeans 85% of the population with Rh factor is noted, then among Africans this figure is 93%, and in Asian countries the share of the population with Rh-positive blood is close to 99%, i.e. for these regions the problem is not as urgent as, for example, for us.

What is the essence of the Rh-conflict?

It turns out that the Rh-conflict occurs solely through the fault of the immune system! Rh-conflict is nothing more than the "tricks" of our own immunity. What does not "suit" him?

Our body does not accept the penetration of foreign proteins. If this happens, antibodies are formed, the purpose of which is to destroy and expel the "raider" from the bowels of the body. Thanks to this vital function, we are able to resist various pathogenic pathogens and their toxins. However, in the case of Rh-conflict, such an activity of immunity can cause serious harm to the unborn child. After all, as we already know, the Rh factor is the same protein, and if it appears in a person with Rh negative blood, the immune system immediately begins its defensive actions, since such a protein is foreign to it. Unfortunately, this is exactly what happens when an Rh-positive fetus develops in a Rh-negative mother.

Dangerous consequences of the Rh conflict

The mother's antibodies begin a massive attack on the erythrocytes of the developing child, on the surface of which there is a protein "foreign" for the mother's body - the Rh factor. As a result, erythrocytes are destroyed (hemolyzed) and emitted into the blood a pigment substance - bilirubin, which stains the skin and mucous membranes yellow (hemolytic). As red blood cells are destroyed, their total number in the child's blood decreases sharply (i.e., anemia occurs), and the ability to carry oxygen is significantly impaired. As a result, various organs and tissues (including the brain) can experience severe oxygen deprivation, and their development can be disrupted even in the prenatal period, that is, during pregnancy.

In the most severe cases, due to severe damage to organs and tissues caused by oxygen deficiency, dropsy of the fetus is possible, when it forms throughout the body and in internal organs. Unfortunately, in this case, all measures to save the child's life are often useless. That is why the Rh-conflict is considered one of the most dangerous complications of pregnancy, and its possible development should in no case be left without medical supervision.

When and how is the Rh-conflict formed?

From all that has been said, we can now conclude that the Rh-conflict can only form when the mother has Rh-negative blood, and the father has Rh-positive blood. In this case, the probability of a Rh-positive fetus is 75%. At the same time, there will never be a Rh-conflict if a woman is Rh-positive or a man is Rh-negative.

But even if a married couple turned out to be "unfavorable" in terms of the Rh factor, one should not be afraid of pregnancy or even refuse it. Moreover, during the first pregnancy, the risk of developing Rh-conflict is negligible. Indeed, for the occurrence of the Rh-conflict, it is necessary that the child's erythrocytes get into the mother's blood vessels. However, nature has taken great care to ensure that mixing the blood of the mother with the blood of the fetus was impossible. A special barrier, which is called the hematoplacental barrier, successfully copes with the task of strictly differentiating the circulatory systems of the mother and the developing baby. It consists of tissues of the placenta and passes gaseous substances: oxygen from mother to child and carbon dioxide from child to mother, but does not allow blood cells to penetrate. Even if this barrier cracks due to various diseases of the placenta, the likelihood of Rh-conflict during the first pregnancy still remains very low. But the second and all subsequent pregnancies require maximum attention and increased medical supervision. Why?

During the first birth, the newborn's Rh-positive erythrocytes penetrate into the mother's Rh-negative blood: this cannot be avoided even with normal childbirth, let alone a caesarean section. And although the antibodies that are produced in response are no longer able to harm the child (since they appear after childbirth), the "immune memory" is preserved, due to which the woman becomes very susceptible to the Rh factor that is foreign to her. Therefore, during the second pregnancy "incompatible" in Rh, these antibodies begin to be produced very quickly and in large quantities sufficient for penetration into the fetus. The likelihood of such a development of events with each subsequent pregnancy becomes higher and higher.

How to prevent Rh-conflict?

Of course, from the point of view of preventing Rh-conflict, the ideal partner for a Rh-negative woman is an Rh-negative man. However, in practice, such married couples are not so common, and the choice of a life partner for the Rh factor is, to put it mildly, unreasonable. Therefore, we will proceed from a real situation. So, what preventive measures does modern medicine offer to avoid Rh-conflict?

First of all, the expectant mother herself must understand what responsibility lies with her, and strictly observe the terms of medical supervision. So, at least 1 time a month, it is necessary to donate blood to determine antibodies to the Rh factor. If there are no antibodies, then everything is going well and the Rh-conflict does not threaten the child. However, an increase in their level indicates that the activity of the immune system in relation to the Rh factor is increasing. In some cases, studies are supplemented by an analysis of amniotic fluid and umbilical cord blood. If all analyzes confirm the onset of the development of the Rh-conflict, it is necessary to go to a specialized perinatal center for conservation, where appropriate treatment will be carried out, and the mother and her unborn baby will be under continuous medical supervision.

Even in the absence of signs of Rh-conflict during pregnancy, an Rh-negative woman should immediately after childbirth examine the blood for the Rh factor in a newborn. If the blood turns out to be Rh-positive, then a special anti-Rh immunoglobulin is administered to the mother within 72 hours after childbirth. It destroys those red blood cells of the child that entered the mother's blood at birth. Moreover, it destroys very quickly, even before the immunity of the mother's body has time to develop antibodies. Thanks to this, the risk of Rh-conflict during the next pregnancy is reduced to naught.

The same immunoglobulin is administered to a Rh-negative woman no later than 72 hours after transfusion of Rh-positive blood, after an abortion and in some other cases. Today, as a preventive measure, it is recommended to be administered to all pregnant women with Rh negative blood - even in the absence of antibodies to the Rh factor - at the 28th and 34th weeks of pregnancy.

The risk of developing Rh-conflict in a Rh-negative woman is not higher than the risks of other complications of pregnancy. Therefore, it makes no sense to be too afraid of it, especially in the presence of a well-developed and effective prevention system. In addition, not every "Rh-conflict" couple has this complication even during the second and third pregnancies. Why, doctors still do not know. But it is quite possible that the disclosure of this riddle will give doctors new knowledge that will help turn this dangerous phenomenon into an easy incident.

Discussion

Much has been written about what threatens the first pregnancy with a positive child for a negative mother. I would like to know what the fifth threatens, if there was a conflict in the fourth before giving birth (about a week).

I have a negative Rh, my first husband was also negative, respectively, my daughter was also born with a negative one, and now my husband is positive, I wonder how high the likelihood of a Rh-conflict is in this case

And although this is hell, every day wake up and think that another day has passed and whether it is alive there .... donate many tubes of blood, often, and every time think how it is there .... give birth to one child and think there is whether another one has a chance or not to risk it ...

Although everything is so, but sometimes you get lucky.

Comment on the article "Rh-conflict during pregnancy"

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Throughout the pregnancy, I was afraid of rhesus - a conflict, and by the 32nd week I got out a conflict on the blood group. I have 1-, my husband has 2+, a girl, apparently 2-. Perhaps it was before, but the analyzes were not done, at least in the first piece of paper, which is pasted into the book ...

Discussion

Good afternoon. I am also from Vologda. I have my first pregnancy and already at the 23rd week of a very high titer for group antibodies. Please tell me which maternity hospital did you go to? What preventive measures did you take?

I, too, by the end of pregnancy, group titles began to be found. Moreover, the title was growing, it was already some rather significant. When she gave birth, they did a blood test, my son has 1-, like mine (my husband has 3+). She asked - how did they find antibodies to me, titers grew, they said - the laboratory was wrong.

With the second, they found antibodies to both A and B. They discussed that I knew for sure that they had not transfused and that the woman was not pregnant from another man (it’s hard not to notice :)). As a result, I went to the Hematological Research Center of the Russian Academy of Medical Sciences, passed the tests - they did not find anything (after 4 months I did a control test - nothing too). They said that group titers are very poorly determined in all non-specialized laboratories, they are often mistaken, in both directions.

Go there, the analysis is inexpensive [link-1]

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As a rule, during the first pregnancy, rhesus - the conflict rarely develops, since the mother's immune system first encounters foreign erythrocytes (red blood cells), and, therefore ...

Discussion

http: //www..aspx

Here is an excerpt from the article:
If you are expecting a baby (and you have a negative Rh factor), then get ready to donate blood from a vein often enough - this way doctors will be able to control whether you have antibodies, and if they are detected, how their number changes. Until the 32nd week of pregnancy, this analysis is performed once a month, from the 32nd to the 35th week - twice a month, and then until the birth - weekly. This procedure, of course, is not the most pleasant, but absolutely necessary.
Plus, it takes so little time that you won't have time to get upset. Based on the level of antibodies in your blood, the doctor can draw conclusions about the suspected Rh factor in the child and determine the possible onset of the Rh conflict.
Do not be afraid.

As a rule, during the first pregnancy, the Rh-conflict rarely develops, since the mother's immune system first encounters foreign erythrocytes (red blood cells), and, therefore, few antibodies destructive to the fetus are produced in the mother's blood. With subsequent pregnancies, the likelihood of problems increases. After all, protective antibodies ("memory cells" ;-) left over from a previous pregnancy still live in the blood of a woman giving birth. They break through the placental barrier and begin to destroy the red blood cells of the unborn baby. You already know what this can lead to.
In our time, the development of Rh-conflict can be prevented by introducing a special vaccine - anti-Rh immunoglobulin - immediately after the first birth or an interrupted pregnancy. This drug binds the aggressive antibodies formed in the mother's blood and removes them from the body. Now they will not be able to threaten the life of the unborn baby. If Rh antibodies were not administered prophylactically, this is also done during pregnancy. You should also be aware that it is now common practice to vaccinate every Rh negative woman shortly (up to 72 hours) after giving birth or miscarriage in the first pregnancy.
The article itself is completely at the link.

My husband and I have Rh - a conflict, that is, he has 1+, and I have 1-, and this is my second pregnancy (antibodies were not detected during the entire pregnancy). For a whole month I was "told" about compulsory vaccination, with rhesus - conflicts ...

Discussion

I have the same situation - my second pregnancy,
Also, there was no vaccine at the required time - therefore, it did not inject. while there was no conflict, then towards the end of pregnancy it is necessary to check more often, in the LCD they give directions once a month, but my doctor advised me once every 7-10 days and I myself went to invitro.
The bad news is that if you are planning another baby, it is advisable to inject it within 72 hours after giving birth (of course, if there are no titers).

are you talking about hyper ro? up to 32 weeks, it is introduced and immediately after giving birth to the mother if the child is born with the rez factor "+" but there are NO such vaccines in the RD, so your loved ones will have to run to find it. I also had this problem, but I was born "-". but if you don’t give birth anymore, then after giving birth you may not inject

Where can you read about Rh - conflict? I have a Rh factor "-", my husband has a "+". In Russia, in such cases, blood is often taken for antibodies. In England, in such cases, the drug is ALWAYS injected to prevent the appearance of antibodies. During pregnancy.

Discussion

I have 1 (-) my husband has 1 (+)
after the first birth, an anti-rhesus immunoglobulin was injected to prevent a problem in the 2nd pregnancy. I honestly hope that it will act, since I have not heard of any drugs that can still prevent the conflict.

girls, thank you!

Rh - a conflict can arise during pregnancy of a Rh-negative woman with a Rh-positive fetus (Rh factor from the father). When fetal erythrocytes enter the mother's bloodstream, anti-Rh antibodies are formed against the Rh factor.

Discussion

My husband and I also have different rhesus (I have negative), the first two B. donated blood for rhesus conflict about every month, there was no conflict, this B. passed it once, and during the last visit to the LCD I was told that this test now paid ... I was a little taken aback ... and somehow I didn't hand it over)))

not yet except to take monthly for antibodies. major problems after 32 weeks may appear. so my doctor told me I also had a Rh-conflict with my husband.

Different rhesus is, as a rule, always a conflict, only more or less pronounced. I, for example, have never detected antibodies and rhesus during pregnancy - they did not pose a conflict.

Discussion

Today, the approach to Rh-conflict pregnancies and the treatment of newborns with hypertension has not changed much and remains largely traditional. And not because our medicine has not advanced in these matters, but because of the same poverty of our clinics, lack of equipment, drugs of not the best quality (expensive clinics are not meant). What is not a problem for any European clinic is often impossible with us. Therefore, we still have quite strict restrictions and prohibitions, in particular - not to breastfeed in the first few days. This is a normal precaution. And if somewhere in prosperous Europe it is allowed to feed, then in our country it is not worth fighting with doctors, defending feeding. Therefore, if you are planning to give birth in Russia, and not abroad, then all the same, I would advise you to focus not on Western medicine, but on the possibilities of that clinic, maternity hospital, in which you will find yourself. In Moscow, maternity hospitals are now very well equipped, even those in which give birth free of charge. Surely there is some one specialized in Rh-conflict pregnancies, they can tell about this in the LCD.

This berth froze at 9 weeks, and there was still a mini-abortion before it. In 2004. we started planning the baby, having previously been treated (there were a lot of sores), and in 2005 my son was born! She gave birth at the Center for CPSIR in Sevastopol (caesarean). The baby is Rh-positive like a dad, he had hemolytic disease, icteric form, mild course. Now he is 1.7 years old and he is an ordinary child, but I was treated all the time without stopping. There were injections and droppers, pills and candles. For those who are interested in the details, write or call 89162472886 Tatiana, but now I rarely go on the Internet.

My Rh factor is negative, my husband and daughter are positive. After the birth, I was NOT given an injection of immunoglobulin, the birth was 6 years ago. I advise you to be sure to get tested for the presence of antibodies in the blood before planning.
To my great regret, I passed. Twice already. My blood antibody titers are too high. I was treated with stirrups of immunologists - for insurance and at the Planning Center on Sevastopolskaya. They said with one voice:
- the best development of events - on the preservation of several months + intrauterine blood transfusion during pregnancy (it may be needed more than once).
- either miscarriage, the entire pregnancy to go under a miscarriage
- or a long treatment (I did not remember the details) again without guarantees.

My husband and I decided to abandon the second bio child in favor of adoption. The possible, but very tangible risk of not bearing my child stops me.

Rhesus is a conflict during pregnancy. Unfortunately, this is exactly what happens when there is a Rh-negative mother in the body. In this case, the probability of conceiving an Rh-positive fetus is 75%.

Discussion

I also have a denial. Rh factor (and 4 group), my husband - it seems to put it down. (he doesn’t know for sure, but since autumn I’ve been kicking him to go clarify - nifiga doesn’t kick!)
We take the first one. (which I did not even suspect before the miscarriage) turned out from unity. times. The miscarriage was why - I don't know: a week before that I froze my legs well - maybe because of this, maybe because of a lack of progesterone. Now we can only guess). And that was at the beginning of 97.
Now we take it. does not come - why, it is also unknown, but I have so far been unscrewed from the examination in the hospital (until the fall, but now I go to the gynecologist every month).

Ia nikogda takogo ne slyshala.hot "i interesovalas" voprosom .. u menia rezus otricatel "nyi.
hm .. ne znau. zdes "voobshe rezus otric. za probleu ne schitaut. prosto ukol delaut posle rodov, chtob ne bylo problem so sl. beremennostiu ..

Knowledge about the Rh factor can be safely called one of the most valuable knowledge acquired by a person in the entire history of medicine. It allows you to avoid a huge number of serious relationships during blood transfusion, as well as during pregnancy and childbirth, in particular, in cases where the so-called Rh-conflict occurs in the child and the mother. So, what is the Rh factor, and what does it mean for expectant mothers?

Rhesus conflict: essence and mechanism

The Rh factor is a specific protein that is found on the surface of red blood cells in approximately 85% of the world's population. That is, those who have such a protein are called people Rh positive, and those who do not have it - Rh negative. The Rh factor does not affect the mother's health and the course of pregnancy, however, if a "negative" woman is pregnant from a "positive" man, in this case there is a possibility of the so-called Rh-conflict.

Its essence lies in the fact that the erythrocytes of the mother and the child, which have different signs, meet each other, as a result of which a specific reaction begins in the woman's body, reminiscent of an allergy. Antibodies produced by the immune system begin to destroy the child's red blood cells, which leads to the most dire consequences.

It should be noted that such complications are especially likely due to the so-called sensitization: conditions when the blood of a child enters the blood of a pregnant woman, due to which the production of antibodies begins in her body... This happens in cases where the mother has a history of abortions, miscarriages, ectopic pregnancies, uterine bleeding and other complications during the period of gestation. In addition, sensitization can occur with any damage to the placenta due to infections, gestosis, detachment, as well as some medical manipulations (amniocentesis).

If there have not been such situations in the past, and the woman's pregnancy is the first, then serious problems usually do not arise: the doctor carefully monitors the patient's condition, and the birth most often goes well. However, during the second and subsequent pregnancies, the mother will need special treatment, which can exclude the occurrence of serious complications. In addition, in order to protect the baby, every woman needs to know about the possible risk of a rhesus conflict in each case.

Possibility of Rh-conflict depending on Rhesus of parents

To determine the possibility of Rh-conflict, one should recall the laws of genetics, according to which certain blood groups are inherited, as well as Rhesus from parents. In particular, in at risk are families where the expectant mother has a negative Rh, and the father is positive.

The following table can be used to determine this risk.

Rh factor inheritance

Inheritance of blood groups

Father	Mother	Fetus	The likelihood of conflict
Group I (0)	Group I (0)	I group	0
Group I	II group (A)	I / II group	0
Group I	Group III (B)	I / III group	0
Group I	IV group (AB)	II / III group	0
II group (A)	I group	I / II group	probability 50%
II group	II group	I / II group	0
II group	III group	All 4 groups	probability 25%
II group	IV group	I / II / IV group	0
Group III (B)	I group	I / III group	probability 50%
III group	II group	All 4 groups	probability 50%
III group	III group	I / III group	0
III group	IV group	I / III / IV group	0
IV group (AB)	I group	II / III group	100% chance
IV group	II group	I / II / IV group	probability 66%
IV group	III group	I / III / IV group	probability 66%
IV group	IV group	II / III / IV group	0

It must be remembered that it is impossible to determine the likelihood of a conflict with complete certainty using such tables; this will require blood tests from the father and mother, as well as a doctor's consultation.

Diagnosis and symptoms

The danger of a rhesus conflict lies in the fact that he usually does not give any clinical manifestations that can alert a pregnant woman. In some cases, she may feel symptoms similar to the manifestations of gestosis, but it can be very difficult to clearly define a hemolytic disorder.

That's why all women at risk should be closely monitored gynecologists throughout pregnancy, and regularly undergo an ultrasound procedure... Symptoms of Rh factor conflict in a fetus include the following:

severe swelling;
accumulation of fluid in the body cavities (abdominal, chest), as well as in the area of the pericardial sac;
an increase in the size of the abdomen;
the so-called "Buddha pose": a large belly and limbs taken away from it;
enlargement of the spleen, liver and heart;
"Double contour" (soft tissue edema) of the head;
thickening of the veins of the umbilical cord and placenta.

In order to diagnose Rh-conflict and prevent symptoms, it is very important to determine the group and Rh in both the expectant mother and the future father, regularly conduct an antibody test, and, if necessary, prescribe adequate treatment.

Possible consequences

In the event of a conflict of rhesus, the woman's antibodies begin to attack the "foreign" erythrocytes of the fetus, gradually destroying them, as a result of which bilirubin is released into the blood, which stains the skin yellow. In addition, the number of red blood cells in the child's blood quickly drops, which leads to a deterioration in the ability to carry oxygen. Tissues and organs, including the brain, begin to experience severe oxygen deprivation, which disrupts their development and leads to a variety of diseases.

In the most difficult cases, due to severe tissue damage, the fetus develops dropsy; unfortunately, in such cases, saving the child's life is often impossible.

As for the mother, he does not carry a direct danger to her condition, however, if the first pregnancy was interrupted or proceeded with complications (for example, with uterine bleeding), then the second and subsequent ones require special attention. This is due to the so-called immune memory: the mother's body produces specific antibodies to the baby's erythrocytes, that is, the risk of problems and complications increases significantly. That is why so-called "negative" women are especially advised not to have abortions..

How to prevent complications from developing

To completely eliminate the risk of complications due to the Rh-conflict, it is necessary even before conception, that is, at the stage of pregnancy planning, or at least at the earliest stages undergo a rhesus analysis... If Rh is negative, it will be necessary to conduct another study on the type of antibodies and their concentration (titer) in the woman's blood, which will be able to answer the question of how much their amount is dangerous for the child. You need to take such an analysis up to 18-20 weeks, and if a pregnant woman has had cases in the past rhesus conflicts, then the determination of the concentration of antibodies is carried out earlier.

It is considered normal titer less than 1: 4. In this case, the woman only needs regular monitoring of the fetus, and a re-analysis is performed at the 28th week (if no abnormalities are found in the fetus).
If the amount of antibodies remains at this time at level 1: 4 and mless, the pregnant woman receives a dose of a special vaccine (anti-rhesus immunoglobulin), which can prevent possible complications.
At title more than 1: 4, the analysis for antibodies should be carried out approximately once every one to two weeks, carefully monitoring their dynamics.

In any case, if even a minimal amount of antibodies is detected, the woman needs regular examinations (ultrasound, Doppler ultrasound, etc.). If the condition of the fetus worsens, it is necessary to carry out an intrauterine blood transfusion, which will make up for the lack of red blood cells in the fetus's blood. In situations where such a solution is impossible, the question of urgent delivery is raised, since any delay can threaten the death of the fetus.

Anti-Rh immunoglobulin: prevention of Rh-conflict

The Rh-conflict vaccine is a drug that able to prevent sensitization, that is, the production of specific antibodies in a woman's body... The mechanism of action of anti-rhesus immunoglobulin is as follows: it destroys "positive" red blood cells, preventing the mother's immune system from starting a defense reaction.

It is believed that about 20 mcg of the drug neutralizes 1 ml of erythrocytes, therefore, about 300 mcg of the vaccine is needed to “neutralize” the “foreign” erythrocytes of the child that accidentally entered the mother's blood.

The first dose of the drug is usually administered to a woman in the period from 28 to 34 weeks (preferably at 28 weeks) in the event that there are no antibodies in her blood and the blood type of the fetus is unknown. The second dose must be administered within 3 days after delivery (if the child has a positive Rh).

Also, the introduction of anti-rhesus immunoglobulin is strongly recommended to all "negative" women after abortion, ectopic pregnancies or miscarriages: this can protect them from serious problems in the future.

It should be noted that in most cases anti-rhesus immunoglobulin is well tolerated by women, however, like any other medical drug, it can cause various allergic reactions, including anaphylactic shock. Therefore, after the introduction of the vaccine, the pregnant woman should at least 30 minutes. be under the supervision of doctors.

Usually, anti-rhesus immunoglobulin is available in domestic perinatal institutions, but it can only be purchased with a prescription. The average cost is 5 thousand rubles. The vaccine is a colorless or light yellow solution (a small precipitate is allowed) for intramuscular administration. Before the introduction of the ampoule, it should be kept for about two hours at room temperature, and after opening the drug should be used immediately as directed. The shelf life of anti-rhesus immunoglobulin is three years.

Many people know about the importance of the Rh factor in blood transfusion. But not everyone correctly evaluates its value 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 early pregnancy 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 Rh-conflict

Part of the blood is red blood cells and plasma. When mixed, the former make it possible to replenish, if necessary, its volume in the body with the help of transfusion. And when carrying, 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 for 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 the carrier of just such blood, and the father has Rh particles, the fetus can inherit the properties of his biological fluid. That is, there is an incompatibility between the woman and the embryo. Her blood counteracts this mismatch by producing anti-Rhesus agglutinins. Substances enter the placenta, blind erythrocytes, making the existence of the fetus problematic. By these actions, the mother's body is protected from foreign particles of the embryo's blood, pushing it towards death.

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

Signs of Rh incompatibility in the expectant mother

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

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

The complexity is also hidden in the fact that the Rh conflict in early pregnancy, the symptoms in the mother clinically almost in no way give out its presence. That is, she often does not feel anything special, which would indicate this serious problem. A frequent but optional accompaniment of the Rh-conflict is. Then a woman can observe in herself:

Increased heaviness and soreness in the abdomen. They are felt in the lower back;
General weakness;
Difficulty breathing due to a raised diaphragm
High blood pressure readings;
in the absence of physical activity;
Swelling of the legs;
Distinctive gurgling sounds inside the abdomen;
Stretch marks that appear on the skin;
Belly size inappropriate for pregnancy.

But suspicious persons may feel the same, and self-confident people may not attach importance to these symptoms. In addition, polyhydramnios is caused by other reasons, and not only 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

Rh-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 studied. If the risk is determined, from the 8-10th week, anti-rhesus-agglutinins can already be detected in the biological fluid.

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

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

The first signs of the fetus

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

Symptoms of Rh conflict during early pregnancy are as follows:

Incorrect position of the embryo in the uterus. The usual posture for an unborn child is with arms folded on the chest and legs pulled up to the stomach. The embryo looks curled up into a ball. With Rh-conflict, his abdomen is enlarged due to swelling, and the limbs are pulled apart. Doctors call the position the Buddha pose;
Double outlines of the head on ultrasound. It is also caused by fluid retention in soft tissues;
Increased size of the placenta and umbilical vein. They arise due to impaired blood flow caused by Rh-conflict. The placenta has more blood vessels than normal and they become thicker;
Expansion of the liver and spleen. This is also due to a violation of hematopoiesis, hypoxia.

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

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

Methods for detecting signs of blood incompatibility according to the parameters of the embryo

What symptoms of Rh conflict during early pregnancy are, are identified with the help of:

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

The revealed signs of Rh conflict during early pregnancy are the chances of a healthy baby. Modern medicine is able to neutralize factors that interfere 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.

Maria Sokolova

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The presence of a negative Rh factor in the expectant mother can become a serious problem if the future dad is Rh positive: the child can inherit the father's Rh factor, and the possible result of such an inheritance is the Rh conflict, which is potentially dangerous for the baby and mother. The production of antibodies begins in the mother's body by the middle of the 1st trimester, it is during this period that the manifestation of the Rh-conflict is possible.

How are Rh-negative mothers diagnosed, and is it possible to treat Rh-conflict in the process of carrying a baby?

Diagnostics of the Rh-conflict during pregnancy - when and how are tests for titers and classes of antibodies taken?

The doctor learns about the amount of antibodies in mother's blood using tests called "titers." The test indicators demonstrate whether there have been “meetings” of the mother’s body with “foreign bodies”, for which the body of the Rh-negative mother also accepts the Rh-positive fetus.

Also, this test is necessary to assess the severity of the development of hemolytic disease of the fetus, if it occurs.

Determination of titers is carried out through a blood test, which is taken without any special preparation of a woman, on an empty stomach.

Also, the diagnostics may include the following methods:

... Or the intake of amniotic fluid, carried out directly from the fetal bladder, with mandatory ultrasound control. With the help of the procedure, the blood group of the future baby, the density of the waters, as well as the titer of the mother's antibodies to Rh are determined. The high optical density of the investigated waters may indicate the breakdown of the baby's erythrocytes, and in this case, experts decide how exactly to continue the pregnancy.
Cordocentesis ... The procedure involves taking blood from the umbilical cord vein while monitoring an ultrasound probe. The diagnostic method allows you to determine the titer of antibodies to Rh, the presence of anemia in the fetus, Rh and blood group of the future baby, as well as the level of bilirubin. If the result of the study confirms the fact of negative rhesus in the fetus, then the mother is freed from further observation "in dynamics" (with negative rhesus, the baby never has a rhesus conflict).
... This procedure evaluates the size of the baby's organs, the presence of puffiness and / or free fluid in the cavities, as well as the thickness of the placenta and umbilical vein. In accordance with the condition of the expectant mother, ultrasound can be performed as often as the situation requires - up to the daily routine.
Dopplerometry ... This method allows you to assess the performance of the heart, the level of blood flow rate in the umbilical cord and blood vessels of the baby, and so on.
Cardiotocography ... Using the method, it is determined whether there is fetal hypoxia, and the reactivity of the baby's cardiovascular system is also assessed.

It is worth noting that procedures such as cordocentesis and amniocentesis by themselves can lead to an increase in antibody titers.

When is antibody testing done?

In the 1st pregnancy and in the absence of miscarriages / abortions: once a month from the 18th to the 30th week, twice a month from the 30th to the 36th week, and then once a week until the very birth.
In the 2nd pregnancy: from the 7-8th week of pregnancy. When titers are detected no more than 1 to 4, this analysis is repeated once a month, and when the titer increases, it is 2-3 times more often.

Experts consider the norm in "conflict" pregnancy titer up to 1: 4.

The critical indicators include credits 1:64 and up.

Treatment

If, before the 28th week, antibodies were not detected in the mother's body at all, or in a value not exceeding 1: 4, then the risk of developing a Rh conflict does not disappear - antibodies can manifest themselves later, and in rather large quantities.

Therefore, even with a minimal risk of Rh-conflict, specialists are reinsured and, for preventive purposes, inject the expectant mother at the 28th week of pregnancy anti-rhesus immunoglobulin D so that the female body stops producing antibodies that can destroy the baby's blood cells.

The vaccine is considered safe and harmless to mom and baby.

Re-injection is done after childbirth in order to avoid complications in subsequent pregnancies.

If the blood flow velocity exceeds 80-100, doctors prescribe an emergency caesarean section to avoid the death of the baby.
With an increase in the number of antibodies and the development of hemolytic disease, treatment is carried out, which consists in intrauterine blood transfusion. In the absence of such an opportunity, the issue of pre-term birth is resolved: the formed lungs of the fetus allow the stimulation of labor.
Purification of maternal blood from antibodies (plasmapheresis). The method is used in the 2nd half of pregnancy.
Hemisorption. An option in which, with the help of a special apparatus, mother's blood is passed through filters to remove toxic substances from it and purify, and then return (purified) back to the vascular bed.
After the 24th week of pregnancy, doctors may prescribe a series of injections to help the baby's lungs mature faster for spontaneous breathing after an emergency delivery.
After childbirth, the baby is prescribed a blood transfusion, phototherapy or plasmapheresis in accordance with his condition.

Usually, Rh-negative mothers from a high risk group (approx. - with high antibodies, if a titer is detected at an early stage, in the presence of the first pregnancy with Rh-conflict) are observed in the JK only until the 20th week, after which they are sent to the hospital for treatment.

Despite the abundance of modern methods of protecting the fetus from mother's antibodies, delivery remains the most effective.

As for intrauterine blood transfusion, it is carried out in 2 ways:

The introduction of blood under the control of ultrasound into the abdomen of the fetus, followed by its absorption into the bloodstream of the child.
Injection of blood through a puncture with a long needle into the umbilical vein.

Prevention of Rh-conflict between mother and fetus - how to avoid Rh-conflict?

Nowadays, anti-Rh immunoglobulin D is used for the prevention of Rh-conflict, which exists under various names and is known for its effectiveness.

Preventive actions are carried out for a period of 28 weeks in the absence of antibodies in mother's blood, given that the risk of contact of her antibodies with the baby's erythrocytes increases during this period.

In case of bleeding during pregnancy, using methods such as cordo- or amniocentesis, the administration of immunoglobulin is repeated to avoid Rh-sensitization during subsequent pregnancy.

Prevention by this method is carried out, regardless of the outcome of pregnancy. Moreover, the dose of the drug is calculated in accordance with the blood loss.

Important:

A blood transfusion for an expectant mother is possible only from a donor with the same rhesus.
Rh-negative women should choose the most reliable methods of contraception: any method of terminating a pregnancy is the risk of antibodies in the blood.
After childbirth, it is imperative to determine the baby's rhesus. In the presence of a positive rhesus, the introduction of anti-rhesus immunoglobulin is indicated, if the mother has low antibodies.
The introduction of immunoglobulin to the mother is indicated within 72 hours from the moment of delivery.

The site warns: this article will in no way replace the relationship between doctor and patient. It is for informational purposes only and is not intended as a guide for self-medication or diagnosis.