Rhesus conflict in parents. Rh-conflict during pregnancy: what should a woman with a negative Rh factor do to avoid consequences
Dear future parents!
Each of us in our lives met with such concepts as blood type and Rh factor, but not everyone appreciates the importance and necessity of determining these blood indicators during planning and carrying a desired pregnancy.
In order to sort out this issue we would like to introduce you necessary information and talk about the clinical events that are held in our center.
The Rh factor is a protein found on the surface of red blood cells (red blood cells that carry oxygen to tissues). If this protein is absent, then the Rh factor is considered negative. If the Rh protein is present in the blood, the Rh factor is considered positive. We all have either a negative or a positive Rh factor.
Future mom and dad, as you know, may have different blood Rh factors. If both parents are Rh-positive, then the child, as a rule (in 75% of cases), inherits a positive Rh factor. In the presence of Rh-negative blood in both parents, the situation is similar, the child in this case will be born with Rh-negative blood factor. If the mother is Rh-positive and the father is Rh-negative, there will be no complications during pregnancy.
Couples deserve great attention, where mom has rhesus negative-blood factor, and the future dad has a positive one. In this situation, there is a risk of developing a Rh conflict - incompatibility of the blood of the mother and fetus.
The mechanism of development of the Rhesus conflict, as a rule, is based on the work of our immune system. The body of a pregnant woman with Rhesus negative blood, begins to produce antibodies to red blood cells - the erythrocytes of the unborn child. But this situation occurs only if the Rh factor of the fetus is positive, inherited from the father. It is these antibodies, penetrating the placenta, that can destroy the erythrocytes of the unborn child, and as a result, cause a decrease in hemoglobin, intoxication and disruption of all vital organs and systems. The outcomes of the course of such a pregnancy, often unfavorable, are the threat of miscarriage, hemolytic disease of the fetus, high risks intrauterine death of the child, premature birth, etc.
In order to avoid adverse outcomes, the following rules should be followed:
- Future parents should determine their blood type and Rh factor before the planned conception.
- It must be remembered that abortions, miscarriages, blood transfusions, invasive procedures, can lead to an increase in sensitization (i.e., the appearance of immune antibodies) of the body Rh negative woman.
- If the Rh factor future mother turned out to be negative, and the father of the child is positive, it is necessary to determine the titer of anti-erythrocyte antibodies in the blood of a pregnant woman up to 20 weeks of pregnancy 1 time per month, then 1 time in 2 weeks. More frequent determination of antibody titer is carried out according to the doctor's prescription, depending on the indications.
- Upon reaching the gestational age of 28 weeks, in the absence of an antibody titer, it is necessary to administer 1 dose of anti-Rh-D-immunoglobulin. This drug prevents the formation of antibodies to the Rh factor, and therefore prevents the destruction of red blood cells in the fetus.
Due to the administration of the drug, specific antibodies may appear in the blood, therefore, after the administration of immunoglobulin, the determination of anti-erythrocyte antibodies is not carried out. The second dose of immunoglobulin is administered within the first 72 hours after delivery, provided that the baby's Rh factor is positive. It is also necessary to administer anti-Rhesus immunoglobulin within 72 hours during invasive procedures during pregnancy: chorion biopsy, placental biopsy, cordocenesis, amniocentesis, and for any adverse pregnancy outcome: abortion, miscarriage, ectopic pregnancy, hydatidiform skid.
Currently, the Medical Company "Life" has become possible definition fetal Rh factor using a modern, non-invasive technique for maternal blood. The reliability of this result is quite high, it is 99%. The test allows not only to determine the affiliation of the Rh factor of the future baby at an early stage of pregnancy, but also to identify the risk group of pregnant women for the development of the Rh conflict. This study makes it possible to predict the course of pregnancy in Rh-negative women, to perform in a timely manner preventive actions to prevent the development of Rh conflict and to identify the exact category of patients who need to study the titer of anti-erythrocyte antibodies throughout pregnancy and the introduction of anti-Rhesus immunoglobulin.
The time of bearing a child is one of the most beautiful in a woman's life. Every expectant mother wants to be calm for the health of the baby, enjoy the period of waiting for the addition. But every tenth lady, according to statistics, has Rh-negative blood, and this fact worries both the pregnant woman herself and the doctors who observe her.
What is the possibility of a Rh conflict between mother and baby, and what is the danger, we will tell in this article.
What it is?
When a woman and her future peanut have different blood counts, immunological incompatibility can begin, it is she who is called the Rh conflict. Representatives of mankind who have a Rh factor with a + sign have a specific protein D, which contains red blood cells. in a person with rhesus negative value this protein does not exist.
Scientists still don't know for sure why some people have a specific Rhesus macaque protein while others don't. But the fact remains - about 15% of the world's population have nothing in common with macaques, their Rh factor is negative.
Between the pregnant woman and the child there is a constant exchange through the uteroplacental blood flow. If the mother has a negative Rh factor, and the baby has a positive one, then the D protein that enters her body is nothing more than a foreign protein for the woman.
The mother's immune system reacts very quickly to uninvited guest, And when the protein concentration reaches high values, the Rh conflict begins. This is a merciless war that the pregnant woman's immune defense declares to the child as a source of a foreign antigen protein.
Immune cells begin to destroy the baby's red blood cells with the help of special antibodies that he produces.
The fetus suffers, the woman experiences sensitization, the consequences can be quite sad, up to the death of the baby in the mother's womb, the death of the crumbs after birth or the birth of a disabled child.
Rhesus conflict can occur in a pregnant woman with Rh (-) if the baby has inherited her father's blood characteristics, that is, Rh (+).
Much less often, incompatibility is formed according to such an indicator as a blood type, if the men and women have different groups. That is, a pregnant woman, whose own Rh factor has positive values, has nothing to worry about.
There is no reason to worry about families with the same negative Rh, but this coincidence does not happen often, because among the 15% of people with "negative" blood - the vast majority of the fair sex, men with such blood characteristics are only 3%.
Own hematopoiesis in peanuts in the womb begins around 8 weeks gestation. And from that moment on, in maternal blood tests, no a large number of fetal erythrocytes. It is from this period that the possibility of an Rhesus conflict arises.
Probability tables
From the point of view of genetics, the probability of inheriting the main characteristics of the blood - the group and the Rh factor from the father or mother is estimated equally at 50%.
There are tables that allow you to assess the risks of Rh conflict during pregnancy. And timely weighted risks give doctors time to try to minimize the consequences. Unfortunately, medicine cannot completely eliminate the conflict.
By Rh factor
By blood type
Dad's blood group | Mother's blood group | Child's blood type | Will there be conflict |
0 (first) | 0 (first) | 0 (first) | |
0 (first) | A (second) | 0 (first) or A (second) | |
0 (first) | B (third) | 0 (first) or B (third) | |
0 (first) | AB (fourth) | A (second) or B (third) | |
A (second) | 0 (first) | 0 (first) or A (second) | Chance of conflict - 50% |
A (second) | A (second) | A (second) or 0 (first) | |
A (second) | B (third) | Any (0, A, B, AB) | Chance of conflict - 25% |
A (second) | AB (fourth) | ||
B (third) | 0 (first) | 0 (first) or B (third) | Chance of conflict - 50% |
B (third) | A (second) | Any (0, A, B, AB) | Chance of conflict - 50% |
B (third) | B (third) | 0 (first) or B (third) | |
B (third) | AB (fourth) | 0 (first), A (second) or AB (fourth) | |
AB (fourth) | 0 (first) | A (second) or B (third) | Conflict probability - 100% |
AB (fourth) | A (second) | 0 (first), A (second) or AB (fourth) | Probability of conflict - 66% |
AB (fourth) | B (third) | 0 (first), B (third) or AB (fourth) | Probability of conflict - 66% |
AB (fourth) | AB (fourth) | A (second), B (third) or AB (fourth) |
Causes of the conflict
The likelihood of developing an Rhesus conflict is highly dependent on how and how the woman's first pregnancy ended.
Even a “negative” mother can quite safely give birth to a positive baby, because during the first pregnancy, the woman’s immunity does not yet have time to develop a killer amount of antibodies to the D protein. life saving situations.
If the first pregnancy ended in a miscarriage or abortion, then the likelihood of a Rh conflict during the second pregnancy increases significantly, since the woman's blood already has antibodies ready for attack at the earliest possible date.
In women who had a caesarean section during the first birth, the probability of conflict during the second pregnancy is 50% higher compared to women who gave birth to their first child naturally.
If the first birth was problematic, the placenta had to be separated manually, there was bleeding, then the likelihood of sensitization and conflict in a subsequent pregnancy also increases.
Danger for the mother-to-be negative Rh factor blood are also diseases during the period of bearing a baby. Influenza, SARS, preeclampsia, diabetes in history can provoke a violation of the structure chorionic villi, and mother's immunity will begin to produce antibodies that are detrimental to the baby.
After childbirth, the antibodies that were developed in the process of bearing the crumbs do not disappear anywhere. They represent the long-term memory of the immune system. After the second pregnancy and childbirth, the amount of antibodies becomes even greater, as after the third and subsequent ones.
Danger
The antibodies that maternal immunity produces are very small, they can easily cross the placenta into the bloodstream of the baby. Once in the blood of the child, the protective cells of the mother begin to inhibit the hematopoietic function of the fetus.
The child suffers, experiences an oxygen deficiency, since decaying red blood cells are the carriers of this vital gas.
In addition to hypoxia, fetal hemolytic disease may develop. and subsequently the newborn. It is accompanied by severe anemia. In the fetus, internal organs increase - the liver, spleen, brain, heart and kidneys. Central nervous system is affected by bilirubin, which is formed during the breakdown of red blood cells and is toxic.
If doctors do not start taking measures in time, then the baby may die in utero, be born dead, be born with severe damage to the liver, central nervous system, and kidneys. Sometimes these lesions are incompatible with life, sometimes they lead to deep lifelong disability.
Diagnosis and symptoms
The woman herself cannot feel the symptoms of the developing conflict of her immunity with the blood of the fetus. There are no symptoms by which the expectant mother could guess about the destructive process that takes place inside her. However laboratory diagnostics at any time can detect and track the dynamics of the conflict.
To do this, a pregnant woman with Rh-negative blood, regardless of which group and Rh factor of the father's blood, take a blood test from a vein for the content of antibodies in it. The analysis is done several times during pregnancy, the period from 20 to 31 weeks of pregnancy is considered especially dangerous.
About how severe the conflict is, says the resulting laboratory research, antibody titer. The doctor also takes into account the degree of maturity of the fetus, because the older the baby in the womb, the easier it is for him to resist the immune attack.
Thus, titer 1:4 or 1:8 at 12 weeks of gestation - very alarming figure , and a similar antibody titer for a period of 32 weeks will not cause panic in the doctor.
When a titer is detected, the analysis is done more often to observe its dynamics. In a severe conflict, the title grows rapidly - 1: 8 can turn into 1: 16 or 1: 32 in a week or two.
A woman with antibody titers in the blood will have to visit the office more often ultrasound diagnostics. By ultrasound it will be possible to observe the development of the child, this research method gives enough detailed information about whether the child has hemolytic disease, and even about what form it has.
With the edematous form of fetal hemolytic disease in a child, an ultrasound will reveal an increase in size internal organs and brain, the placenta thickens, the amount amniotic fluid also increases and exceeds normal values.
If the estimated weight of the fetus is 2 times higher than the norm, this warning sign - dropsy of the fetus is not excluded, which can be fatal even in the mother's womb.
Hemolytic fetal disease associated with anemia cannot be seen on ultrasound, but can be diagnosed indirectly on CTG, since the number of fetal movements and their nature will indicate the presence of hypoxia.
Damage to the central nervous system will become known only after the birth of a child; this form of hemolytic disease of the fetus can lead to a developmental delay in the baby, to hearing loss.
Diagnosis doctors in antenatal clinic will be engaged from the very first day of registering a woman with a negative Rh factor. They will take into account how many pregnancies there were, how they ended, whether children with hemolytic disease were already born. All this will enable the doctor to assume possible probability conflict and predict its severity.
A woman will have to donate blood during the first pregnancy once every 2 months, during the second and subsequent - once a month. After 32 weeks of pregnancy, the analysis will be done every 2 weeks, and from 35 weeks - every week.
If an antibody titer appears, which can occur at any time after 8 weeks, may be prescribed additional methods research.
With a high titer that threatens the life of the child, a cordocentesis or amniocentesis procedure may be prescribed. The procedures are carried out under ultrasound guidance.
During amniocentesis, an injection is made with a special needle and a certain amount of amniotic fluid is taken for analysis.
During cordocentesis, blood is taken from the umbilical cord.
These tests allow you to judge which blood type and Rh factor the baby has inherited, how severely his red blood cells are affected, what is the level of bilirubin in the blood, hemoglobin, and determine the sex of the child with 100% probability.
These invasive procedures are voluntary, a woman is not forced to do them. Despite the current level of development of medical technology, interventions such as cordocentesis and amniocentesis can still cause miscarriage or premature birth and the death or infection of the child.
The obstetrician-gynecologist who leads her pregnancy will tell the woman about all the risks during the procedures or refusing them.
Possible consequences and forms
Rhesus conflict is dangerous both during the period of bearing a baby, and after it is born. The disease with which such children are born is called hemolytic disease of the newborn (HDN). Moreover, its severity will depend on the amount of antibodies attacked the blood cells of the crumbs during pregnancy.
This disease is considered severe, it is always accompanied by the breakdown of blood cells, which continues after birth, edema, jaundice skin, severe bilirubin intoxication.
edematous
The edematous form of HDN is considered the most severe. With her, the little one is born very pale, as if "bloated", edematous, with multiple internal edema. Such crumbs, unfortunately, in most cases are born already dead or die, despite all the efforts of resuscitators and neonatologists, die in as soon as possible from several hours to several days.
icteric
The icteric form of the disease is considered more favorable. Such babies, a couple of days after their birth, "acquire" saturated yellowish color skin, and such jaundice has nothing to do with common physiological jaundice newborns.
The baby has a slightly enlarged liver and spleen, blood tests show the presence of anemia. The level of bilirubin in the blood rises rapidly. If doctors fail to stop this process, the disease can turn into kernicterus.
Nuclear
The nuclear type of HDN is characterized by lesions of the central nervous system. The newborn may have seizures, he can involuntarily move his eyes. The tone of all muscles is reduced, the child is very weak.
When bilirubin is deposited in the kidneys, a so-called bilirubin infarction occurs. A greatly enlarged liver cannot normally perform the functions assigned to it by nature.
Forecast
In prognosis for HDN, doctors are always very careful, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the crumbs in the future.
Children are given detoxification injections in intensive care, very often there is a need for a replacement transfusion of blood or donor plasma. If on the 5-7th day the child does not die from paralysis of the respiratory center, then the forecasts change to more positive ones, however, they are rather conditional.
After hemolytic disease of newborns, children suckle poorly and sluggishly, their appetite is reduced, sleep is disturbed, and there are neurological abnormalities.
Quite often (but not always) in such children there is a significant lag in mental and intellectual development, they get sick more often, hearing and vision impairments can be observed. Cases of anemic hemolytic disease end most safely, after the level of hemoglobin in the blood of the crumbs can be raised, it develops quite normally.
The conflict, which developed not because of the difference in Rh factors, but because of the difference in blood types, proceeds more easily and usually does not have such devastating consequences. However, even with such incompatibility, there is a 2% chance that the baby will have enough problems after birth. serious violations central nervous system.
The consequences of the conflict for the mother are minimal. She will not be able to feel the presence of antibodies in any way, difficulties can arise only during the next pregnancy.
Treatment
If a pregnant woman has a positive antibody titer in the blood, this is not a reason for panic, but a reason for starting therapy and taking it seriously on the part of the pregnant woman.
It is impossible to save a woman and her baby from such a phenomenon as incompatibility. But medicine can minimize the risks and consequences of the influence of maternal antibodies on the baby.
Three times during pregnancy, even if antibodies do not appear during gestation, the woman is prescribed courses of treatment. At 10-12 weeks, at 22-23 weeks and at 32 weeks, the expectant mother is recommended to take vitamins, iron supplements, calcium supplements, metabolic enhancers, and oxygen therapy.
If the titers are not detected before 36 weeks of gestational age, or they are low, and the development of the child does not cause concern to the doctor, then the woman is allowed to give birth naturally on her own.
If the titers are high, the child's condition is severe, then delivery can be carried out ahead of time by caesarean section. Doctors try to support the pregnant woman with medications until the 37th week of pregnancy so that the baby has the opportunity to “ripen”.
Unfortunately, this possibility is not always available. Sometimes you have to make a decision about an earlier caesarean section to save the little one's life.
In some cases, when the baby is clearly not yet ready to come into this world, but it is very dangerous for him to remain in the mother’s womb, an intrauterine blood transfusion is performed on the fetus. All these activities are controlled ultrasound scanner, every movement of the hematologist is verified so as not to harm the baby.
On early dates other methods of preventing complications may be used. So, there is a technique for sewing a piece of the skin of her husband to a pregnant woman. The skin flap is usually implanted on the lateral surface of the chest.
While the woman's immunity throws all its strength into rejecting a skin fragment that is foreign to itself (and this is several weeks), the immunological load on the child is somewhat reduced. Scientific disputes do not subside about the effectiveness of this method, but the reviews of women who have gone through such procedures are quite positive.
In the second half of pregnancy, with an established conflict, plasmapheresis sessions can be prescribed for the expectant mother, this will slightly reduce the number and concentration of antibodies in the mother's body, respectively, the negative load on the baby will also temporarily decrease.
Plasmapheresis should not frighten a pregnant woman, there are not so many contraindications to it. Firstly, it is SARS or another infection in the acute stage, and, secondly, the threat of miscarriage or premature birth.
There will be about 20 sessions. Approximately 4 liters of plasma are cleared in one procedure. Together with the infusion of donor plasma, protein preparations are administered, which are necessary for both mother and baby.
Babies who have had hemolytic disease are shown regular examinations by a neurologist, massage courses in the first months after birth to improve muscle tone, as well as courses of vitamin therapy.
Prevention
A pregnant woman at 28 and 32 weeks is given a kind of vaccination - injected anti-rhesus immunoglobulin. The same drug should without fail administered to a woman in labor after childbirth no later than 48-72 hours after the birth of the crumbs. This reduces the likelihood of conflict in subsequent pregnancies to 10-20%.
If the girl has a negative Rh factor, she should know about the consequences of an abortion during the first pregnancy. It is desirable for such representatives of the fair sex save the first pregnancy at all costs.
Blood transfusion without taking into account the Rh affiliation of the donor and the recipient is not permissible, especially if the recipient has his own Rh with a “-” sign. If such a transfusion takes place, anti-Rhesus immunoglobulin should be administered to the woman as soon as possible.
A complete guarantee that there will be no conflict can only be given by a Rh-negative man, moreover, preferably with the same blood type as his chosen one. But if this is not possible, you should not postpone pregnancy or abandon it just because a man and a woman have different blood. In such families, planning for a future pregnancy plays an important role.
A woman who wants to become a mother needs before the onset of " interesting position» take blood tests to detect antibodies to protein D. If antibodies are found, this does not mean that the pregnancy will have to be terminated or that you cannot become pregnant. modern medicine does not know how to eliminate the conflict, but knows very well how to minimize its consequences for the child.
The introduction of anti-Rhesus immunoglobulin is relevant for women whose blood does not yet have antibodies that are not sensitized. They need to do such an injection after an abortion, after even a slight bleeding during pregnancy, for example, with a slight detachment of the placenta, after surgery for an ectopic pregnancy. If antibodies are already present, then special effect don't expect to get vaccinated.
Common Questions
Is it possible to breastfeed a child?
If a Rh-negative woman has a child with positive Rh factor, and there is no hemolytic disease, then breast-feeding not contraindicated.
Babies who have experienced an immune attack and were born with hemolytic disease of the newborn are not recommended to eat within 2 weeks after the introduction of immunoglobulin to their mother mother's milk. In the future, the decision to breastfeed is made by neonatologists.
Breastfeeding is not recommended in severe hemolytic disease. To suppress lactation, a woman after childbirth is prescribed hormonal preparations, which suppress the production of milk to prevent mastopathy.
Is it possible to bear a second child without conflict if there was a conflict during the first pregnancy?
Can. Provided that the child inherits a negative Rh factor. In this case, there will be no conflict, but antibodies in the mother's blood can be detected throughout the entire gestation period, and in a fairly high concentration. They will not affect the baby with Rh (-) in any way, and you should not worry about their presence.
Before getting pregnant again, mom and dad should visit a geneticist who will give them comprehensive answers about the likelihood of their future children inheriting one or another blood characteristic.
Dad's rhesus unknown
When a future mother is registered in a antenatal clinic, immediately after her negative Rh is detected, the father of the future baby is also invited to the consultation for a blood test. Only in this way can the doctor be sure that he knows exactly the initial data of the mother and father.
If the father's Rh is unknown, and for some reason it is impossible to invite him to donate blood if the pregnancy came from IVF donor sperm, That a woman will have a blood test for antibodies a little more often than other pregnant women with the same blood. This is done in order not to miss the moment of the beginning of the conflict, if it takes place.
And the doctor's proposal to invite her husband to donate blood for antibodies is a reason to change the doctor to a more competent specialist. There are no antibodies in the blood of men, since they do not become pregnant and do not have any physical contact with the fetus during the wife's pregnancy.
Is there a fertility effect?
Such a connection does not exist. The presence of a negative Rh does not mean that it will be difficult for a woman to get pregnant.
Fertility levels are affected by completely different factors - bad habits, caffeine abuse, excess weight and diseases of the genitourinary system, burdened history, including a large number of abortions in the past.
Are medical or vacuum abortions dangerous for terminating a first pregnancy in an Rh-negative woman?
This is a common misconception. And, unfortunately, often such a statement can be heard even from medical workers. The technique of carrying out an abortion does not matter. Whatever it is, the baby's red blood cells still enter the mother's bloodstream and cause the formation of antibodies.
If the first pregnancy ended in an abortion or miscarriage, how high are the risks of conflict in the second pregnancy?
In fact, the magnitude of such risks is a rather relative concept. No one can say with an accuracy of a percentage whether there will be a conflict or not. However, doctors have certain statistics that estimate (approximately) the likelihood of sensitization of the female body after an unsuccessful first pregnancy:
- miscarriage on short term- +3% to possible future conflict;
- artificial termination of pregnancy (abortion) - + 7% to the likely future conflict;
- ectopic pregnancy and surgery to eliminate it - + 1%;
- delivery at term with a live fetus - + 15-20%;
- delivery by caesarean section - + 35-50% to a possible conflict during the next pregnancy.
Thus, if a woman's first pregnancy ended in an abortion, the second - in a miscarriage, then during the gestation of the third, the risks are estimated at about 10-11%.
If the same woman decides to give birth to another baby, provided that the first birth went well naturally, then the probability of a problem will be more than 30%, and if the first birth ended in a caesarean section, then more than 60%.
Accordingly, any woman with a negative Rh factor who has conceived in Once again become a mother.
Does the presence of antibodies always indicate that the child will be born sick?
No, this is not always the case. The child is protected by special filters that are in the placenta, they partially restrain aggressive maternal antibodies.
A small amount of antibodies will not cause much harm to the child. But if the placenta ages prematurely, if the amount of water is small, if a woman falls ill with an infectious disease (even a common ARVI), if she takes medications without supervision by the attending physician, then the likelihood of a decrease in the protective functions of the placental filters increases significantly, and the risk of giving birth to a sick baby will increase. .
It should be borne in mind that during the first pregnancy, antibodies, if they appear, have a fairly large molecular structure, it can be difficult for them to “break through” the protection, but when repeated pregnancy antibodies are smaller, more mobile, fast and "evil", so an immunological attack becomes more likely.
Everything related to genetics has not yet been studied well enough, and any “surprise” can be obtained from nature.
There are several cases in history when a mother with Rh (-) and a father with a similar Rh had a child born with positive blood and hemolytic disease. The situation requires careful study.
For more information about the likelihood of a Rh conflict during pregnancy, see the following video.
All cells human body have antigens, or in other words "labels". Labels are special proteins on the surface of cells. There are usually not one or two such antigens, but many, up to 50. The Rh factor is the presence of these proteins on the outer membrane of red blood cells. If these proteins are present, then the person is Rh positive; if they are not - Rh negative. The ratio of Rh in the world is approximately as follows: 1-2 people out of ten are owners of Rh-negative blood.
Rhesus conflict as it is
If an Rh-negative mother carries an Rh-positive baby (and vice versa) from, respectively, an Rh-positive father, then she gradually develops a serious condition, called “Rh-conflict” among doctors. With it, the woman's body begins to react to the fetus as to a foreign body, hostile in nature. In the mother's blood, antibodies to the baby's blood proteins begin to be produced. The production of antibodies is essentially the destruction foreign body. In 99% of cases, it leads to miscarriage or death of the fetus inside the mother's body, but this happens under certain circumstances.
Why is this happening
Rhesus conflict triggers in the mother's body a process such as agglutination. This word literally refers to blood clotting: red blood cells stick together due to exposure to foreign proteins, and the blood coagulates like spoiled milk leading to the death of a woman. To prevent this from happening human body worked out defense mechanism- production of antibodies that destroy fetal red blood cells with the opposite Rh. This process of protection is called sensitization.
What does this mean for mother and baby?
If the pregnancy is the first, the Rh conflict will not occur - attention! - in the event that even microscopic particles of the child's blood did not enter the maternal bloodstream. The placenta is a kind of barrier between the blood of the fetus and the pregnant woman. She protects female body from the penetration of the child's red blood cells. But if children's red blood cells enter the mother's blood, the mechanism of sensitization, or the production of antibodies, immediately starts.
When it might happen:
After the usual first birth;
after an abortion or miscarriage;
as a result of the first ectopic pregnancy;
because of uterine bleeding in a pregnant woman;
as a result of taking a sample of amniotic fluid, which is done with an analysis such as amniocentesis;
with a number of other examinations, which are necessarily carried out in the first trimester to identify serious pathologies baby development.
Thus, any situation where the blood of the mother and fetus with different Rh factors is mixed, triggers the Rh conflict. The result of such activity of the maternal organism is miscarriage, miscarriage. Even if the first pregnancy went without problems, the second one will definitely have an Rhesus conflict, which will lead to the death of the child. But there is no reason to despair. Modern medicine has developed a number of measures that prevent the loss of a baby and allow you to calmly report a second pregnancy.
What does this mean for the child
Rhesus conflict - very severe and dangerous state, which is fraught not only with miscarriage. Even if the second pregnancy could be reported without appropriate treatment, sensitization will lead to severe malformations of the child:
Hemolytic disease with the development of subsequent anemia;
damage to internal organs (liver, heart, etc.);
brain damage with subsequent development of dementia and other abnormalities.
If a woman was not properly observed by a doctor during her 2nd pregnancy and has a healthy first child, her second baby will be born seriously ill (if born at all) with almost 100% guarantee. For this reason, all pregnant women and women planning to conceive should definitely do a blood test and, if there is a threat, be especially carefully observed by a doctor throughout the entire gestation period.
When characteristic features Rhesus conflict, the baby may need a blood transfusion while still in the womb. To prevent problems in the future, the mother after the first birth (or abortion) is injected with Rh immunoglobulin serum. This procedure must be repeated in the second, third and all other pregnancies, because the immunoglobulin is only valid for 12 weeks. With all these problems and difficulties, it is possible to give birth with a difference in the Rhesus of the parents, but this process should be treated with particular care, keeping in mind the existing threats.
The Rh factor is a protein found on the surface of red blood cells. In total, there are about fifty types of these proteins. If at least one of them is present in the body of the expectant mother, then it means that she has a positive Rh factor, and if it is absent, then it is negative. At the same time, only the D antigen affects the occurrence of the Rh conflict.
The fact that a protein is present or, conversely, absent in the human body does not at all mean that it has some kind of disease or pathology. It's just a genetic trait, just like eye color, hair color, or blood type.
According to honey. statistics, rhesus negative is not frequent occurrence, it occurs in only 15% of people in the world. And yet, if a woman is Rh-, you need to be especially careful when planning a pregnancy, since each unsuccessful attempt may lead to serious Negative consequences for the opportunity to become a mother.
How does it affect conception and fetus in the future?
The Rh factor itself does not affect the likelihood and ease of conceiving a child, but the different Rh factor of the spouses will affect how the pregnancy will later proceed. So, the most favorable case is when both potential parents have the same Rhesus, but this is not always the case. Conception will not happen faster just because of the coincidence of the couple's Rh, since this process is influenced by a lot of factors, but pregnancy will be easier when the future father and mother are both Rh-positive.
Rh-negative husband and wife also significantly reduce the risk of problems in the future.. When a child inherits a positive Rh from the father, with a negative mother's blood type, the development of an Rh-conflict disease is possible.
We offer you to watch a video about the effect of the Rh factor on the course of pregnancy:
Does the absence of the D antigen in the mother affect the bearing of the child?
The immune system protects a person from infectious diseases and this happens due to the fact that the body's antibodies destroy foreign proteins and antigens that have entered it.
If the mother's blood is Rh-negative, then, as her future baby is Rh-positive, the woman's body perceives the fetus as something alien and hostile, which is why it starts an immune attack against it. At the same time, erythrocytes in the blood of the unborn baby, which are literally destroyed, are at particular risk. This phenomenon is called Rhesus conflict and, if nothing is done, this phenomenon can lead to very unpleasant consequences.
It should be understood that Rh negative mother is not an indicator that Rh conflict is inevitable.
In the event that the woman and the future crumbs are Rh negative, these problems simply will not arise. Yes, and if the rhesus of the mother and child do not match, it also does not always occur.
Is it possible to get pregnant with different or identical values?
With a positive in a woman and a man
This combination is considered the most optimal. Most often, with it, pregnancy occurs quickly and there are no conflicts during conception.
When mom and dad are negative
As a rule, there are no problems with the possibility of conception in this case either. If there is infertility, then it is not associated with a negative Rh in both partners, but with some other reasons.
If the spouses are different
In this case, everything is not so clear. Most often when different rhesus with partners, a woman manages to get pregnant, although she bears and gives birth healthy child however, it does not always work. In particular, the pregnancy of an Rh-negative mother with an Rh-positive child can lead to gestation problems, and if the situation is the opposite, then problems should not arise. The body of an Rh-positive mother will not react negatively to an Rh-negative fetus.
What is Rhesus conflict in obstetrics, and why does it occur?
Rh-conflict pregnancy - what is it?
Under this concept in obstetrics understand any pregnancy, accompanied by the production of antibodies directed against fetal cells. The Rhesus conflict itself develops according to the type, like any other immunological reaction. It occurs due to the fact that a mother with a negative Rh factor and an unborn child who has a positive Rh exchange blood.
Wherein the immune system The mother regards the presence of the fetus in her body as an alien threat and begins to develop antibodies against it. In order for this to happen, it is enough that 35-50 ml of erythrocytes of the blood of her future crumbs enter the woman's body. However, even if there is an incompatibility of the blood of the mother and child according to the Rh factor, the Rh conflict itself does not always occur.
For example, it happens that during such a pregnancy antibodies may not be produced at all, or there are so few of them that they cannot cause serious harm to the health of the unborn baby.
There are a number of factors that increase the occurrence of Rh conflict during gestation. And not all of these reasons are associated with the ingestion of the blood of her unborn child into the body of a woman.
The more "bloody" the obstetric intervention was, the greater the risk of immunization. The same thing happens if there was no bleeding, but the placental barrier.
- With a caesarean section, this risk increases by 52.5%.
- With manual separation of the placenta - by 40.3%.
- Prenatal bleeding increases it by 30%.
- And with eclampsia, when the placental barrier is broken, the risk is 32.7%.
We offer you to watch a video about what is Rh-conflict during pregnancy:
Probability when expecting a first baby
The first pregnancy is considered relatively safe in terms of Rh conflict.. The fact is that usually the placenta reliably protects the fetus from the effects of antibodies, and they themselves either do not have time to form, or, if they are produced, then in very small quantities. To put it simply, the mother's body does not seem to notice developing fetus, and therefore the production of antibodies does not occur until the child's blood begins to mix with the woman's blood.
At normal course pregnancy, this happens, as a rule, already during childbirth.
The likelihood of a baby coming into contact with antibodies produced by the body of his Rh-negative mother is extremely small, although it is possible. In general, the occurrence of Rh conflict during the first pregnancy is not frequent and is approximately 10%.
The probability of carrying a fetus a second time
During the second and subsequent pregnancies, the likelihood of an Rhesus conflict increases significantly. This is due to the fact that an Rh-negative woman has already developed an immune memory, which leads to an increased formation of antibodies to the D antigen contained in the blood of her Rh-positive baby.
The second and any of the subsequent pregnancies, regardless of how they proceeded and how they ended, become a catalyst that triggers the production of antibodies in the mother's body.
However, this does not mean at all that a woman who has given birth to one child can no longer become pregnant, since this will certainly lead to an Rhesus conflict. It's just that a woman needs to be more careful and responsible in controlling antibodies.
And the first thing that is required is not to refuse the injection of anti-Rh immunoglobulin when prescribed by the attending obstetrician-genecologist, if you plan to endure and give birth to a second baby healthy. This will bind foreign Rh-positive antigens and prevent the development of antibodies in the mother's body, which significantly reduces the risk of complications during a subsequent pregnancy.
If during the first pregnancy antibodies were not produced, and the immunoglobulin serum was administered on time, then when carrying a second baby, the probability of an Rhesus conflict will be equal to the same initial 10%.
What is the danger in the development of conflict?
Rhesus conflict can be very dangerous during pregnancy, as antibodies seriously attack the fetus and destroy its red blood cells. With Rhesus conflict, massive destruction of red blood cells is observed, because of which a large amount of bilirubin, which has pronounced toxic properties, is released into the blood.
As a result, all organs and tissues of the fetus are damaged, but the nervous system of the baby suffers especially strongly, for example, the tissues of his brain soften, which can lead to mental retardation. The spleen and liver, the main purpose of which is precisely to rid the body of bilirubin, do not cope with their function. And the mass death of red blood cells itself leads to the fact that anemia and hypoxia develop in the crumbs.
All these three factors, running together, lead to a serious complication - hemolytic disease of the fetus.
The consequences of complications - hemolytic disease of the fetus can be:
As for the Rh-negative mother, who has become the unwitting culprit of all these troubles, then the Rh-conflict in itself, most likely, will not affect her health, even if the developing fetus has any serious pathologies.
Sometimes, but not always, with a Rh conflict, a future mother may develop preeclampsia, which is a truly serious complication.
We offer you to watch a video about the dangers of Rhesus conflict:
Why can't you have an abortion?
Why is it impossible to terminate the pregnancy with a negative Rh in the mother?
Doctors do not recommend that Rh-negative women have abortions, except for medical indications, but even in this case, it is advised to think carefully before making such a decision. With each subsequent pregnancy, antibodies in a woman's body are produced at an increasing rate and in increasing quantities. And the possibility of successful bearing of the fetus at times decreases with each termination of pregnancy.
Parental Blood Type Compatibility Chart
What to do for prevention?
Even at the planning stage of pregnancy, a woman needs to do a blood test in order to determine her group (if this has not been done before) and Rh affiliation. In the event that the potential mother turns out to be negative, it will be necessary to find out the Rh affiliation of the future father. This should be done before pregnancy in order to keep the formation of antibodies under control from the very beginning.
It is advisable to get expert advice at the planning stage regarding the possible risks of Rhesus conflict during gestation and its possible outcome.
It is important in this situation to treat family planning methods with all possible responsibility.
That is, do not have abortions and try to keep the first pregnancy as much as possible. And from the very beginning, from about 7-8 weeks, it is recommended to register and be observed by a doctor so that in case of complications associated with a negative Rh factor, the necessary assistance was provided to the expectant mother in a timely manner.
Receive all the necessary appointments from the observing obstetrician-gynecologist, including mandatory vaccination with human immunoglobulin anti-Rhesus rho (d).
Summing up, I would like to say that the negative Rh factor itself is far from being as scary as it might seem.. It is not always the cause of the Rh conflict, but it is advisable to take care of its prevention as early as possible - preferably, even at the stage of pregnancy planning. Only in this case it will be possible to reduce the likelihood of complications to a minimum.
Rh-conflict during pregnancy: what should a woman with a negative Rh factor do to avoid consequences
Rhesus conflict during pregnancy occurs as a result of blood incompatibility according to the Rh (rhesus) system. According to statistics, this type of incompatibility occurs in 13% couples, but immunization during pregnancy occurs in 1 in 10-25 women.
Pregnancy of a woman with a negative Rh factor, in which the fetus has a positive Rh factor, leads to the production of antibodies by the mother's immune system to the child's red blood cells.
As a result of this, the fetal red blood cells "stick together" and are destroyed. This is a humoral immune response to the presence of a Rh factor protein foreign to the mother's body.
- Rh factor - what is it
- The likelihood of developing a Rh conflict during pregnancy: table
- Causes
- Feto-maternal transfusion
- Rhesus conflict during pregnancy: the mechanism of occurrence
- Consequences for the child
- Risks
- Diagnosis, symptoms and signs of Rh conflict during pregnancy
- Treatment
- Plasmapheresis in Rh-conflict pregnancy
- Cordocentesis
- Immunoglobulin for Rh negative
- Can the Rh factor change during pregnancy?
What is the Rh factor
To understand what a Rh conflict is during pregnancy, you need to dwell on such a concept as the Rh factor.
Rh (+) is a special protein - agglutinogen - a substance that can stick together red blood cells and damage them when they encounter an unfamiliar immune agent.
The Rh factor was first discovered in 1940. There are about 50 varieties of antigens of the Rhesus system. The most mutagenic dominant is the D antigen, which is found in the blood of 85% of people.
Antigen C is found in 70% of people, and antigen E is found in 30% of people on the planet. The presence of any of these proteins on the erythrocyte membrane makes it Rh positive Rh (+), the absence - Rh negative Rh (-).
The presence of agglutinogen D has ethnicity:
- people of Slavic nationality have 13% of Rh-negative people;
- among Asians 8%;
- in people of the Negroid race, there are practically no people with a Rh-negative blood factor.
IN Lately Increasingly, there are women with negative Rh factor blood, according to the literature, this is associated with mixed marriages. Consequently, the frequency of Rh conflict during pregnancy in the population increases.
System D antigen inheritance
Types of inheritance of any traits are divided into homozygous and heterozygous. For example:
- DD, homozygous;
- Dd, heterozygous;
- dd is homozygous.
Where D is the dominant gene and d is the recessive.
Rhesus conflict during pregnancy - table
If the mother is Rh positive and the father is Rh negative, then one out of three children will be born Rh negative with a heterozygous type of inheritance.
If both parents are Rh-negative, then their children will be 100% Rh-negative.
Table 1. Rhesus conflict during pregnancy
| Man | Woman | Child | The likelihood of Rh conflict during pregnancy | |
| + | + | 75% (+) | 25% (-) | No |
| + | — | 50% (+) | 50% (-) | 50% |
| — | + | 50% (+) | 50% (-) | No |
| — | — | 100% (-) | No | |
Causes
The cause of the Rh conflict during pregnancy is:
- transfusion of incompatible blood through the AB0 system is extremely rare;
- feto-maternal transfusion.
What is a feto-maternal transfusion?
Normally, in any pregnancy (physiological or pathological), a small amount of fetal blood cells enters the mother's bloodstream.
A negative Rh factor during pregnancy in a woman definitely carries a danger for a baby with a positive Rh factor. Rhesus conflict develops, as well as any immunological reaction. At the same time, the first pregnancy can proceed without complications, but subsequent (second and third) ones lead to Rh conflict and severe symptoms of hemolytic disease of the fetus and newborn.
Mechanism of immunization (development of Rh conflict)
An Rh-negative mother and an Rh-positive fetus exchange blood cells, the mother's immune system perceives the baby's red blood cells as foreign proteins and begins to produce antibodies against it. For the development of a primary immune response, it is enough for 35-50 ml of fetal erythrocytes to enter the mother's bloodstream.
The volume of blood that comes from the baby's bloodstream to the mother increases with obstetric invasive procedures, caesarean section, childbirth, and other obstetric manipulations.
The first immune response begins with the appearance of immunoglobulins M - these are large pentagram molecules (polymers) that hardly penetrate the placental barrier and do not destroy the erythrocytes of the fetus, thus they cannot harm it. Therefore, the first pregnancy most often proceeds without consequences.
Secondary fetoplacental transfusion entails consequences for the child. It occurs during repeated (second, third, fourth) pregnancy.
Cellular memory works in the body of a pregnant woman and, as a result of repeated contact with the Rh factor protein, protective antibodies are produced - immunoglobulins G - a Rh conflict develops. Immunoglobulin G molecules are small monomers that can penetrate the placental barrier and cause hemolysis - the destruction of fetal and newborn erythrocytes.
What contributes to the development of Rh sensitization?
The first pregnancy in an Rh-negative mother with an Rh-positive fetus in most cases ends successfully and ends with the birth of the fetus. Any subsequent pregnancy, regardless of outcome (early miscarriage, abortion, spontaneous interruption) in a Rh-negative woman becomes an impulse for the development of a secondary immune response and the appearance of immunoglobulins that destroy the baby's red blood cells in utero.
The cause of the Rh conflict during pregnancy in an Rh-negative mother can be:
- In the first trimester:
- medical abortion (surgical or medical), provided that these complications arose for a period of 7-8 weeks.
