Rhesus conflict is a complication for the child. Consequences for a child of Rh conflict during pregnancy: consider all possible options

For many years, Rh incompatibility during pregnancy was a mystery to obstetricians and the cause of many, as it seemed at the time, inexplicable problems with pregnancy and hemolytic disease of the newborn (a condition when the red blood cells - oxygen-carrying red blood cells - are destroyed in the fetus). And only about 60 years ago, with the help of rhesus monkeys, scientists discovered a system of proteins in human erythrocytes (red blood cells), which were the main cause of incompatibility between mother and fetus. These antigen proteins are called the Rhesus system. Later it was proved that it is the incompatibility of the blood of the mother and fetus for these antigens that leads to hemolytic disease of the newborn.

To begin with, it is worth understanding what the Rh factor is, who has it, and under what conditions it becomes a problem for a developing baby.

What is the Rh factor?

This is a special protein that is located on the surface of red blood cells. It is found in almost all people - they are considered Rh-positive, and only 15% of the white population does not have it, this small group is Rh-negative. The Rh factor is indicated by two Latin letters - Rh - and plus and minus signs.

The presence of the Rh factor is not a disease, just like its absence, it is just one of the characteristics of blood. Just like we are all different.

Why does the Rhesus conflict occur?

Rh conflict occurs when an Rh-negative woman is pregnant with an Rh-positive fetus. In this case, in the late stages of pregnancy, fragments of the Rh-positive erythrocytes of the fetus enter the mother's bloodstream, are perceived as foreign and cause a protective reaction in her body, the essence of which is the formation of anti-Rh antibodies. Here they are, penetrating back to the baby through the placenta, and can cause the destruction of red blood cells in his blood. This process is called hemolysis. With the destruction of red blood cells in the blood of the fetus, bilirubin begins to form in large quantities. It has a toxic effect. The amount of bilirubin in the baby's blood helps determine the severity of the Rh conflict.

The destructive effect of Rh-positive erythrocytes of the fetus does not occur immediately. First, anti-Rhesus immunoglobulins M are formed in the blood of a Rh-negative woman, which means that she is pregnant with a Rh-positive child and the so-called acquaintance of two organisms has occurred, as a result of which the sensitivity of the cells and tissues of the mother's body increases (this process is called sensitization). So far, this is not a Rh-conflict, since immunoglobulins M are not able to cross the placenta due to their large size and, accordingly, cannot harm the growing fetus. Then after about 8–9 weeks, and in some women even after 6 months, immunoglobulins G appear. This means that sensitization has occurred and now a Rh conflict is possible, since these immunoglobulins are not so large and can already penetrate back from mother to baby through the placenta. After 28 weeks of pregnancy, the blood flow between the woman and the fetus increases, which leads to an increase in the amount of anti-Rhesus antibodies in the baby's body and an increase in their damaging effect. They cause the erythrocytes of the fetus to stick together, which, if not properly treated, can lead to such a serious complication as hemolytic disease of the newborn.

In the future, with a second pregnancy with a Rh-positive fetus, the mother's body immediately begins to produce immunoglobulin G, and this is the reason for the earlier onset of the Rh conflict and its stronger manifestation.

Risk factors for the development of Rh-conflict

If the expectant mother has a negative Rh factor, and the father of the child has a positive Rh factor, then the risk factors for the development of the Rh conflict will be:

• the second and subsequent pregnancies from this partner - both uterine and ectopic;
• miscarriages and abortions from this partner;
• arterial hypertension in the expectant mother;
• cesarean section performed in a previous pregnancy, and invasive gynecological manipulations related to pregnancy: abortion, ectopic pregnancies, miscarriages performed without the introduction of anti-Rhesus immunoglobulin.

Diagnostics

Diagnosis in Rhesus conflict is aimed not only at identifying this condition, but also at assessing the condition of the baby. What kind of research will the expectant mother need to undergo?

Determination of the Rh factor and. All pregnant women, when registering, regardless of what kind of pregnancy it is, are examined for blood group and Rh factor.

Determination of anti-Rhesus antibodies. This analysis is carried out at registration for all expectant mothers, Rh-negative women are given a second referral for this analysis for a period of 18–20 weeks, regardless of the Rh factor of the partner. If the partner has Rh-positive blood, the determination of anti-Rh antibodies is repeated monthly until 32 weeks of pregnancy (starting from 18–20 weeks), from 32 to 35 weeks of pregnancy, the analysis is carried out twice a month, from the 35th week of pregnancy - weekly to determine delivery strategy. The presence of these antibodies in large quantities (or, as doctors say, titre) and / or their rapid and massive increase indicate the presence of a Rh conflict. In such cases, the pregnant woman is observed together with the doctors of the perinatal center, where she is referred to the antenatal clinic.

Ultrasound examination of the fetus at 18–20 weeks of gestation. Rhesus conflict can be suspected by the following ultrasound signs:

• swelling and accumulation of fluid in the cavities of the fetus;
• unnatural posture of the fetus - the so-called Buddha posture, when, due to a large amount of fluid in the tummy, the baby is forced to spread his legs to the sides;
• double head contour;
• thickening of the placenta.

Subsequent ultrasound examinations of the fetus are usually carried out in dynamics to assess the condition of the baby at 24–26, 30–32 and 34–36 weeks.

Doppler and cardiotocography also allow you to understand how the baby feels and whether he needs active medical measures.

According to indications, invasive diagnostic methods are carried out:

Amniocentesis- this is a study when a small amount of amniotic fluid is taken through a puncture in the membranes for analysis to determine the level of bilirubin.

Cordocentesis- this is a study when a small amount of fetal blood is taken through a puncture of the umbilical cord to determine the amount of bilirubin.

Complications of Rhesus conflict

Why do doctors pay so much attention to the Rh factor of the expectant mother? The fact is that the Rhesus conflict can adversely affect the course of pregnancy and the condition of the fetus. It is dangerous with the following complications:

• miscarriage;
• the development of hemolytic disease of the newborn (HDN) is the most common complication of Rhesus conflict. The disease can occur in three different forms: edematous, icteric and anemic. The most dangerous form of HDN is edematous, since edema interferes with the normal functioning of the baby's organs. Such children often require resuscitation immediately after birth and long-term treatment. In second place in terms of danger is the icteric form, since a large amount of bilirubin damages the baby's organs - the brain, kidneys. And in third place is the anemic form, which is not so dangerous, but requires control and restoration of hemoglobin levels;
• intrauterine.

However, expectant mothers do not need to get upset and panic, because at present, thanks to the actions of physicians, in 90–97% of cases, complications of the Rh conflict can be avoided.

During the first pregnancy, the risk of developing a Rh conflict is approximately 10%, with repeated pregnancies, this risk remains the same if antibodies were not detected, or increases with each subsequent pregnancy if antibodies were produced. The increase in risk depends on how the pregnancy proceeded, what was the titer (amount) of antibodies and whether the vaccination was carried out. After an abortion or miscarriage in an Rh-negative woman pregnant with an Rh-positive fetus, the risk of developing an Rh conflict is approximately 3-5%.

Pregnancy management in Rh-conflict

The main goal of a gynecologist is to prevent the development of complications, since it is impossible to cure the Rh conflict itself.

Since the main cause of the baby's suffering in the Rhesus conflict is hypoxia, then most of the manipulations and drugs are aimed at eliminating it. The main task of a woman is to fulfill all the recommendations of her doctor as accurately as possible. After all, this is the only way to avoid serious consequences for this and, importantly, for subsequent pregnancies.

If anti-Rhesus antibodies are found in the blood of the expectant mother, then it is necessary to carry out treatment that will prevent an increase in their number. For this, non-specific and specific methods are used.

Non-specific include funds aimed at strengthening the vessels of the placenta, which helps to reduce the amount of antibodies penetrating through it to the fetus. These are vitamin therapy, oxygen therapy, UV irradiation sessions, plasmapheresis.

Specific treatment consists in the introduction of anti-Rhesus immunoglobulin. This drug prevents sensitization (increased sensitivity) of an Rh-negative woman by Rh-positive fetal red blood cells. It is administered twice - at the 28th week of pregnancy and after childbirth, provided that the child was born with a positive Rh factor. To achieve a protective effect, this must be done within 48, maximum 72 hours after childbirth. It is worth remembering that a low level of anti-Rhesus antibodies in the mother's blood is not a reason for refusing vaccination. After all, the introduction of anti-Rhesus immunoglobulin helps to significantly reduce the complications of the Rhesus conflict in subsequent pregnancies, but does not exclude the Rhesus conflict in principle. And in some cases, a second vaccination may be required. Also, a Rh-negative woman needs a vaccine for abortions, blood transfusions, obstetric invasive manipulations.

How to help a baby with an Rhesus conflict?

At the moment, there is only one method with proven therapeutic efficacy - intrauterine blood transfusion. It has been used since 1963 in severe forms of Rh conflict - fetal dropsy, severe hypoxia and the ineffectiveness of the above methods. At the moment, the technique of the procedure is fully developed, and the risk of complications has greatly decreased. Intrauterine blood transfusion is performed under ultrasound guidance through a small puncture in the mother's abdomen. An erythrocyte mass is injected into the umbilical cord, which allows you to remove intrauterine oxygen starvation of the fetus. Studies have shown that most babies who have had an intrauterine blood transfusion grow and develop normally.

Subsequent pregnancies after Rh conflict

Many women planning to become a mother for the second time are concerned about the question: if the first pregnancy proceeded with an Rhesus conflict, does this mean that the next time we should expect the same development of events? No, it's not. But in order for everything to be good, the following conditions are necessary:

• Of course, it would be ideal for an Rh negative woman to become pregnant with an Rh negative child. But, unfortunately, we cannot influence this factor.
• Timely administration of anti-Rhesus immunoglobulin in the first and current pregnancy - either at the 28th week of pregnancy or within 48-72 hours after.
• Refusal of abortions and blood transfusions without the use of anti-Rhesus immunoglobulin.
• Compliance with all prescriptions of your doctor.

Childbirth with Rhesus conflict

Childbirth is the main "treatment" of the Rhesus conflict. After the mother-fetus chain is broken, the woman’s body stops transmitting anti-Rhesus antibodies to the baby, which makes it possible for the baby’s body to recover. However, this does not happen immediately, as antibodies are present in the newborn's blood for several more days. Most births with Rhesus incompatibility take place naturally. But in some cases, a caesarean section is performed, since this delivery option is considered more gentle for the fetus when the baby suffers from a lack of oxygen and is weakened.

An indication for premature delivery in Rh-conflict is the deterioration of the fetus and the degree of maturity of its lungs.

Breastfeeding with Rh conflict

Of course, the question of whether it is possible to breastfeed a baby with an Rhesus conflict worries many mothers. However, experts still do not have a common opinion on this matter. According to the latest recommendations, breastfeeding is possible a few days after birth (usually 3-5 days), until most of the antibodies are removed from the mother's body, and before feeding, it is recommended to express milk to establish lactation.

Some experts believe that no restrictions are needed at all for breastfeeding. In fact, everything is individual and depends on the condition of both the mother and the baby after childbirth.

In conclusion, I would like to note that at the moment, thanks to the development of medicine and the control of doctors over the course of pregnancy accompanied by a Rhesus conflict, it is quite possible to endure and give birth to a healthy baby.

Is it possible to determine the Rh factor of the fetus?

Of course, it would be convenient to know what kind of Rh factor the future baby has - after all, it will immediately become clear whether the expectant mother should regularly donate blood for the presence of antibodies and whether there is a need to inject anti-Rhesus immunoglobulin. If an Rh-negative mother also has an Rh-negative blood factor, then all these precautions will not be needed. However, until quite recently it was impossible to determine this in a safe and generally accessible way for a developing child. But at the moment, expectant mothers have such an opportunity - it is possible to determine the Rh factor of a child by the mother's blood using the PCR method. The method is based on the fact that during pregnancy, the baby's DNA enters the mother's bloodstream, which makes it possible to determine the Rh DNA of the unborn baby. This examination can be carried out from the 12th week of pregnancy.

Modern science has learned to cope with many pathologies of pregnancy so that a woman can carry a healthy baby. A serious problem is the conflict between the Rh factors of the mother and fetus during pregnancy. A few decades ago, this was much more difficult, but today medicine comes to the aid of a woman and a baby. This article discusses the main signs and treatment of such a pathology.

What it is?

The Rh factor characterizes human blood, as well as its group. Rhesus (negative or positive) cannot be called "bad" or "good": it's like hair color, thigh length, foot size. It is also impossible to change the Rh factor of the blood, it is inherited from one of the parents and remains with the person for life. People pass on their genes that determine the Rh factor to their children.

The blood of different people differs in whether there is a special protein in red blood cells - cells that have a very narrow specialization (they deliver oxygen). If the protein is present there, a positive Rh factor is determined. If there is no protein, the Rh factor is negative.

It received its unusual name from experimental animals on which laboratory studies were carried out - rhesus monkeys. 85% of people have a positive Rh factor, 15% - vice versa.

Usually, a negative Rh factor does not manifest itself in any way, does not affect human health, well-being, or a tendency to certain pathologies. It does not provide any advantage in sports or intellectual pursuits. It (like the blood type) must be determined by passing a special analysis and remembered. In Soviet times, they even put a special stamp in the passport, and today there are stripes with blood type and Rhesus on the uniforms of military personnel, rescuers, firefighters, and so on.

A few years ago, a theory appeared that the blood type and Rh affect a person’s food preferences, as well as what foods he needs to eat and which ones should be avoided. So far, this theory has not been 100% confirmed.

However, information about these parameters is very important if there is a need for a blood transfusion. It is imperative that the blood be transfused from a donor with the same blood type and the same Rh factor.

Sometimes (but not always) these parameters affect the bearing and development of the child. If the baby got the “paternal” Rhesus, and the mother has a different one, such a pregnancy needs a more serious attitude. If you rely on fate and do nothing, the pregnancy may be terminated.

Of course, Rhesus conflict does not always occur. Thousands of babies born as a result of Rh-conflict pregnancy grow and develop normally. Nevertheless, with different Rhesus blood in parents, possible complications should be taken seriously. At a consultation about a pregnancy that a woman wants to keep, the doctor will definitely ask about the Rh factor. If future parents do not know anything about this, he will prescribe a blood type and Rh factor test.

It is known that a child inherits the Rh factor from one of their parents. From the point of view of genetics, this happens as follows. Human knowledge of genetics proves that an Rh-positive person can have a homozygous or heterozygous genotype.

Depending on the genotype of the spouses (even in a family where both parents have a positive blood Rh), the child may be negative.

Modern scholars believe that the formation of Rh-affiliation of the fetus begins at the 8th week of gestation. For a baby with a different Rh factor than the mother's, the prenatal period can be quite dangerous, because the woman's body "attacks" the fetus, perceiving it as a threat. Such a pregnancy is called Rh-conflict. Intrauterine mortality in this pathology reaches 6%.

However, this happens only when the pregnant woman did not receive adequate treatment or ignored the advice of specialists (for example, due to religious beliefs).

However, science has not only revealed the mechanism of the occurrence of the Rhesus conflict, but also developed effective methods for its prevention and treatment. A couple of decades ago, couples with different Rh blood factors were not recommended to have more than one child in order to avoid possible complications. Now families where the parents' blood Rh factors do not match can have two or even three children.

Approximately 99% of people belonging to the Mongoloid race have a positive Rh factor. Among Europeans, their share is less - 90%.

Causes

The Rh factor is determined by three pairs of genes. The main gene in each person is either dominant (it is designated D) or recessive (d). Homozygous genotype - when the child inherited the same Rh blood from the father and mother. The gene is denoted by the combination DD or dd. With a heterozygous genotype, the child receives two different genes - Dd.

With the genotype DD or Dd, the Rh factor of a person is positive, with the genotype dd - vice versa. However, such details are clarified only at conception through the IVF procedure, when the couple is checked for various factors. Most people only know the blood type and Rh factor. It happens that these parameters are not defined. However, for the past 30 years, blood type and Rh factor tests have been taken at the maternity hospital.

This information is usually sufficient. Rhesus conflict during gestation can occur even if both spouses have a positive Rh.

The reason is always The Rh factor of the child does not match the maternal. In this case, the woman's immune system takes the fetus for an element that carries alien genes, and seeks to free the body from it. According to the same principle, human immunity fights viruses.

Incompatibility does not always appear. The probability of negative symptoms during the first pregnancy, according to some sources, does not exceed 5%, according to others - 10%. This is true if the woman is registered for pregnancy and takes into account appointments.

Usually, with each subsequent Rh-conflict pregnancy, the amount of antibodies in a woman's blood increases, so it becomes more and more difficult to bear a child.

However, there are cases when a conflict does not arise if the blood Rhesus does not match between the mother and the fetus. In this case, the hemolytic disease of the baby does not develop, the child is born healthy.

In addition, cases have been recorded in medicine when, with a high titer of antibodies in the mother's blood, hemolytic disease does not develop in the fetus. Experts have found that two types of antibodies can form in maternal blood. Some have a fairly large molecule. The placental barrier does not allow such antibodies to enter the child's circulatory system.

Compatibility table:

There is another type of conflict between the blood of a woman and a child - by blood type, when it is inherited from a man or does not match the group of both parents. Group incompatibility is much less common. For this, certain conditions are necessary: ​​the blood of the fetus has entered the maternal or vice versa, and at the same time, the child and mother have different groups. Normally, the placenta prevents blood from merging, but this can happen, for example, if it partially exfoliates.

The mechanism of this pathology is based on the fact that the erythrocytes of the first blood group do not contain antigens A and B, which are found in the blood of other groups. The first group is also distinguished by the presence of α and β antibodies, which, meeting with “foreign” antigens, begin to destroy the erythrocytes of the fetus. Cell breakdown is accompanied by the release of substances that adversely affect the development of the internal organs of the child - the liver, kidneys, brain. Bilirubin is the main toxin.

At what time?

If the future parents have different Rh factors, the doctor will refer the woman for an additional blood test - for the presence of antibodies. Even in the case of the first pregnancy, sensitization (acquisition by the body of increased sensitivity to foreign antibodies) can occur during a blood transfusion - or if a mother with a different Rh factor carries a child. In this case, the mother's blood already contains a small amount of antibodies.

Rh-affiliation of the fetus is determined after 8 weeks of gestation. At this time, the woman's body begins to react, producing more and more antibodies. Their concentration in the mother's blood becomes dangerous for the child in the second half of pregnancy.

To prevent Rh conflict at the 28th week of pregnancy, a woman is given a special drug that provides protection for the baby for 12-14 weeks - before the onset of childbirth.

However, during the next pregnancy, the antibody titer should be constantly monitored by conducting blood tests at least once a month.

Consequences

The result of an Rh-conflict pregnancy depends on whether the woman received adequate medical care during her course. In addition, during the first pregnancy, the onset of fetal-threatening consequences is less likely, since a sufficient amount of antibodies has not yet accumulated in the mother's blood to attack a child with a different Rh factor.

In the second and subsequent pregnancies, the likelihood of negative consequences for the child is much higher - especially if the necessary measures were not taken after the first birth. It should be remembered, for example, that within 48-72 hours, you need to enter anti-Rhesus immunoglobulin.

In most cases, without prevention, the Rh conflict affects the development of the fetus: the child develops hemolytic disease of the newborn. The severity of the course of this disease is influenced by various factors - including what kind of pregnancy the woman had. It is very important whether sensitization occurred before the onset of the first pregnancy, whether Rh-conflict immunoglobulin was used, whether additional procedures were performed, manipulations - plasmapheresis and intrauterine blood transfusion.

After the birth of a child, hemolytic disease is diagnosed when the newborn has jaundice.

Of course, the diagnosis must be confirmed by a bilirubin test. The child may also develop an anemic form of the disease. Its sign is pale skin in the first days of life. However, this is one of the milder forms of HDN.

Jaundice is considered a moderate variant of hemolytic disease of the newborn. Moreover, the condition of the baby after birth continues to deteriorate. The fact is that in the blood of the baby, the breakdown of the substance of bilirubin, which has accumulated during intrauterine development during Rh-conflict pregnancy, continues. The child at this time is lethargic, almost constantly sleeping, his muscle tone is reduced.

If treatment appropriate to the condition of the newborn is not prescribed, then the level of bilirubin continues to grow (up to 3-4 days), the baby's well-being worsens. Signs of the so-called nuclear jaundice are added to the symptoms - up to convulsions. Nuclear jaundice threatens to destroy the brain.

The most severe form of hemolytic disease is edematous. When conducting ultrasound screening in the third trimester, doctors often note its symptoms. The most obvious is the significant size of the internal organs of the child. After birth, the baby is in a serious condition, fluid accumulates in the chest and abdominal cavities, all tissues are edematous. Reveal a significant increase in the liver and spleen, signs of cardiac and pulmonary insufficiency.

As a rule, with this variant of the course of GBP, childbirth occurs earlier than the due date. If the condition of the fetus worsens, artificial labor induction is carried out or a caesarean section is performed.

After the birth of a child with hemolytic disease, doctors immediately begin treatment procedures. They are aimed at lowering the level of bilirubin, cleansing the child's blood from maternal antibodies, and increasing hemoglobin.

With a mild degree of HDN, which is manifested by mild jaundice, the child is prescribed phototherapy sessions. Under the influence of light, the level of bilirubin in the blood of a child decreases. The method of hyperbaric oxygenation is also very effective. The newborn is placed in a special pressure chamber, where he breathes pure oxygen. Usually, after several procedures, bilirubin becomes less.

If the child is in serious condition, the effect of such manipulations as exchange transfusion and hemosorption is used to quickly reduce the amount of bilirubin.

During the transfusion procedure, blood with a large amount of bilirubin is taken from the baby. Donated blood is then infused through the baby's umbilical vein. Sometimes up to 70% of the baby's blood volume is transfused. As a rule, in practice, the volume is calculated as 150 ml per kilogram of weight. This blood transfusion may be performed several times until the level of bilirubin drops to acceptable levels.

Hemosorption - the same plasmapheresis, when the child's blood is passed through an apparatus with special filters that trap bilirubin and antibodies.

Symptoms

In a pregnant woman, the Rh conflict is asymptomatic, she does not feel any special signs - except for the usual ailments for pregnancy. Sometimes a woman has symptoms similar to toxicosis.

Much harder Rh-conflict is reflected in the fetus. Often, in the absence of adequate medical care, a frozen pregnancy (or its spontaneous termination) is possible. If the indicator of the antibody titer in the woman's blood is at a high level, then the development of the Rhesus conflict begins quite early. This causes the death of the child between 20 and 30 weeks.

The only way to timely detect Rh conflict is a special blood test for antibodies. At a later date, signs of a Rh conflict become noticeable on ultrasound screening. The doctor notes the increased size of the internal organs of the child, obvious signs of anemia, swelling. Other signs are a thickened placenta, a large amount of amniotic fluid. The fetus assumes the characteristic pose of the Buddha, when the knees are separated due to the enlarged abdomen.

For more information about the condition of the fetus, procedures such as dopplerometry and CTG are prescribed. On dopplerometry, the doctor determines whether the circulatory system is normally developed and how it functions (between mother and child). This is an important indicator, since blood flow is often reduced during Rh-conflict pregnancy.

Fetal heart rate monitoring allows you to record the baby's heart rate. The result of cardiac monitoring is similar to an ECG tape. More frequent or rare heart contractions indicate that the child is not feeling well.

In recent years, invasive diagnostic methods have been used to obtain information about the condition of the fetus. This amniocentesis(puncture of the fetal bladder with the taking of amniotic fluid), cordocentesis- Cord blood sampling. In both cases, an analysis of amniotic fluid or cord blood is performed - for bilirubin.

Since invasive diagnostic methods are not completely safe, they are carried out only with a high antibody titer. For amniocentesis, an important indicator is the antibody titer above 1: 16, for cordocentesis - 1: 32. Another argument for the appointment is the birth of children in the past who suffered from severe HDN.

Analyzes

An analysis of the blood of the expectant mother for antibodies is the main diagnostic method. In this case, an indicator such as antibody titer is determined.

The first analysis is carried out when a woman is registered for pregnancy to determine if sensitization has occurred before. If the mother has Rh negative blood, and the father is positive, then up to 28 weeks the analysis is repeated every 4 weeks, up to 36 weeks - every two weeks, and after - weekly. A value of 1: 2 is considered small. If the antibody titer reaches a value of 1: 4, this means that the woman has become sensitized, an immunological reaction has begun to develop.

An antibody titer of more than 1:16 means that the child needs to be further examined - for example, an amniocentesis may be prescribed. The risk of fetal death with an antibody titer of 1: 16 increases, but slightly (about 10%).

If the indicator in the third trimester increased to 1: 32, then the issue of artificial stimulation of labor is being decided. With this indicator, the child's condition worsens.

Of course, other factors are also taken into account - for example, the symptoms of a hemolytic disease in a baby, confirmed by ultrasound screening.

Treatment

Rh conflict occurs if the husband and wife have different Rh factors, and the baby inherits Rh from the father. During pregnancy, a woman's body produces antibodies that attack the fetus, mistaking it for a foreign element.

However, during the first pregnancy, the likelihood of complications is low. During the second pregnancy, antibodies begin to be produced again, and the antibody titer increases.

With each subsequent pregnancy, the mother's body attacks the fetus more and more, even if a miscarriage has occurred before.

To avoid complications (especially in the second and subsequent pregnancies), within 24–72 hours after childbirth, a woman is given anti-Rh immunoglobulin, the so-called vaccination against Rhesus conflict, in accordance with the clinical protocol, in accordance with the clinical protocol. This substance contains antibodies, anti-Rhesus, taken from donors. They will destroy the child's red blood cells that have entered the woman's blood, the production of antibodies will stop. The next pregnancy will proceed against the background of a lower amount of antibody titer in the mother's blood.

Then the children will be born healthy - or with minimal manifestations of HDN. Similar actions must be taken if a miscarriage occurs, after a medical abortion, or an ectopic pregnancy.

Usually an injection is given to a woman in other cases, when her blood could mix with the blood of the fetus. These are, for example, bleeding or manipulations such as amniocentesis or chorionic biopsy. Both of these procedures are invasive, involving penetration of the amniotic sac and placenta. They can lead to the appearance of an antibody titer in the woman’s blood, therefore, after such manipulations, anti-Rhesus immunoglobulin can be administered up to the 7th month of pregnancy.

If anti-Rhesus immunoglobulin was not administered after the first pregnancy, it can be used at 28 weeks of the next pregnancy. However, this method is not flawless, so the manipulation is carried out only for medical reasons and with the consent of the expectant mother.

However, the introduction of anti-Rhesus immunoglobulin is more of a prevention of Rhesus conflict.. Currently, the most effective way to treat this pathology, doctors call a blood transfusion to the fetus. It was first performed in 1963, but so far each such procedure is unique.

In February 2017, such a procedure was carried out by specialists from the Orenburg Regional Perinatal Center. Transfusion of donor blood to the fetus is carried out with mandatory control, using ultrasound. Blood is transfused through the umbilical cord.

This is a very effective procedure to prevent miscarriage or premature birth. However, manipulation is quite risky.

To combat the Rh conflict, doctors also tried to use membrane plasmapheresis - purification of blood plasma. This procedure is similar to the administration of drugs intravenously (through a drip). Only in this case, plasma is first taken from the vein (in small portions). It passes through a special filter and pours already cleaned.

This procedure usually lasts about an hour, the patient lies on the couch or sits in a comfortable position. In one session, you can clear from one to four liters of blood.

In an Rh-conflict pregnancy, a woman is transfused with donor plasma that does not have antibodies. This allows you to reduce the titer of antibodies in the blood of the expectant mother and improve the condition of the child. Judging by the reviews of mothers on pregnancy forums, it can be noted that the membrane plasmapheresis procedure does not help in all cases.

Most often, the blood of a pregnant woman is cleaned in small doses. Donor plasma is needed for one session a little. The expectant mother is prescribed one or two sessions a day and the level of antibody titer in the blood is monitored. If the effect of the procedure is noticeable, it is repeated up to 20-22 times.

Plasmapheresis is prescribed from 5 months. Most often, this procedure is carried out during the third trimester of pregnancy.

Plasma immunosorption is a procedure that is similar to plasmapheresis. In this case, the blood is passed through a carbon filter that traps harmful substances. Blood returns to the body of a woman in a purified form.

Plasmapheresis can also be done to a child in the first days of life. Maintenance therapy includes the administration of albumin preparations (for example, Epokrin), as well as glucose.

A more unusual treatment for Rh incompatibility during pregnancy is transplantation of the husband's skin flap onto the woman's thigh (for more than 12 weeks). Foreign skin "distracts" the attention of antibodies, which alleviates the condition of the fetus, but not for long. There is a known case when a woman had 10 such transplants, and this gave her the opportunity to carry a child. However, this method is found to be ineffective.

Methods for preventing complications

Since the Rh conflict manifests itself during pregnancy, if the Rh factors of the blood do not match in the future mother and father, it is better to check the antibody titer in a woman in advance. If sensitization has not yet occurred, the titer will be zero. This increases the chances of having a healthy baby.

If there is a suspicion that a mother with a negative Rh child has a positive one (for example, if the father is also Rh positive), then the doctor will definitely prescribe such an analysis. He will repeat it monthly to track the indicator over time.

Different Rhesus blood in a husband and wife is not a contraindication to pregnancy, but it is necessary to control the situation with the help of specialists.

Can I breastfeed?

Only a doctor can decide whether breastfeeding is indicated for a newborn. This decision is based on both individual performance and professional experience. If the test results show that the hemolytic disease of the newborn is severe, it is better to refrain from breastfeeding.

The fact is that at the age of up to 7 days there is still a high risk of maternal antibodies entering the baby's blood. This may cause his condition to worsen. This happens when there is a high titer of antibodies in the mother's blood. However refusal to breastfeed, even in the case of severe HDN, is a temporary measure.

During this period (its duration is also determined by the doctor), the baby is supplemented with special mixtures, donor, pasteurized, and also expressed milk. If the baby was born prematurely, then feeding through a tube is possible. In addition, if a phototherapy procedure is scheduled, additional fluid will be needed.

If the child receives less nutrients, then bilirubin is excreted from his body more slowly. As soon as the condition of the newborn improves, breastfeeding is prescribed. Mother's milk is the best of all possible nutritional options for the baby, because this way he receives everything necessary for development.

When the mother has a low antibody titer in the blood, there are no restrictions on breastfeeding. A woman begins to feed her baby almost immediately after birth: first with colostrum, then with milk.

Complete refusal of breastfeeding is a very rare and drastic measure. It is only suitable if the child is in serious condition. The same tactic is used in the conflict of blood types.

If a woman had pregnancies that ended in spontaneous or medical abortions, the birth of children with hemolytic disease of the newborn, then it is imperative to tell the doctor about this at the first appointment. Even if the pregnancy is the first, but the husband and wife have different Rhesus blood, this requires additional tests. The doctor should be aware of this feature.

For more information about the conflict between the Rh factors of the mother and fetus during pregnancy, see the following video.

Elena Zhabinskaya

I welcome you to my blog, Lena Zhabinskaya is with you today. Pregnancy is the time when I would like to relax, have fun and not be nervous over trifles. And, of course, we should strive for this.

However, the expectant mother should not forget that it is she who is responsible for the health and well-being of the crumbs. You should not rely solely on doctors, you yourself need to know the features and possible problems of the course of your pregnancy, know what to do, and make sure that the doctor controls the moments that may affect the health of the unborn child.

Just such nuances include the Rh-conflict during pregnancy, the table of which will be clearly presented by us and analyzed in detail below.

In the blood of each person there are cells - erythrocytes - special red blood cells. Each person has different cells. On the surface of red blood cells there are marker proteins that allow you to calculate the blood group and its Rh.

If a protein of a certain type is absent on the surface of red blood cells, the blood is considered Rh-negative, if present, it is Rh-positive.

This is neither good nor bad, it is an immunological property of the blood of an individual person. It is known that among the population of the Earth, people with Rh-positive blood predominate - about 86%, and with Rh-negative - approximately 16%.

Moreover, it so happened that among the peoples of European countries, the percentage of people with a negative Rh is about 20%, among the inhabitants of African states tends to 5%, and among Asian peoples less than 1.5%.

Rhesus conflict probability table

Which pregnant women may experience Rh incompatibility? Far from everyone. For clarity, we present a table of pregnant women at risk. To find out if there will be a Rh conflict, it is enough to know the Rh factors of the mother and father of the unborn child.

Thus, we see that not all pregnant women can have a Rh conflict with an unborn child. Moreover, not all pregnant women with a negative Rh factor have such a conflict.

For there to be a chance of an Rhesus conflict, several factors must coincide:

1. The pregnant woman is Rh negative.
2. The father of the child is Rh positive.
3. The unborn child is also Rh positive.
4. Entry of the child's red blood cells into the mother's bloodstream.

And even if all these factors coincide, even in this case the probability of a conflict is less than 1%. This I mean that it is completely superfluous to induce hysteria and panic around a negative Rhesus.

However, a woman is obliged to know possible problems, and demand from the doctor that this moment be controlled by him, and, if necessary, prevented (more on this below).

How does

To facilitate understanding of the mechanism itself, let's draw an analogy with viruses, especially since the mechanism of occurrence is extremely similar.

When a viral infection enters the body, the immune system begins to fight, antibodies are produced that neutralize the virus, and the person recovers.

Now imagine: a pregnant woman has, in fact, another person in her tummy. Yes, this is her baby, her blood, one whole, etc. But for the immune system it is a foreign organism.

And when the immune system of a pregnant woman, for some reason, detects this foreign organism (when fetal erythrocytes enter the blood of the expectant mother), her immunity turns on the defense system, producing antibodies that destroy fetal erythrocytes.

Causes of fetal blood entering the mother's bloodstream:

• various gynecological bleeding;
• abortions and;
• various surgical interventions during the period of bearing a baby (amniocentesis, manual separation of the placenta, chorionic villus sampling, laser coagulation of placental vessels, etc.);
• condition of ectopic pregnancy;
• directly .

What is dangerous for mother and child

Rhesus conflict is not dangerous for the mother herself, because it is caused by her antibodies, which fight against a foreign object - the fetus. Accordingly, the mother has no symptoms of conflict, and there are no such changes in her state of health, according to which the pregnant woman could suspect that something was wrong with the baby. For the future baby, everything is not so rosy, so it is important to know how the Rhesus conflict manifests itself in a child.

In the event of a conflict, the mother's antibodies penetrate the placenta and destroy the erythrocytes (special red blood cells that carry oxygen) of the fetus. As a result, the crumbs may begin a state of anemia (anemia), which can lead to hemolytic disease and consequences of varying severity.

Consequences of the Rhesus conflict for the child:

• The state of anemia (anemia).

The initial stage of hemolytic disease. It is characterized by a lack of oxygen in the fetus.

• and fetus.

Protective antibodies of the expectant mother destroy the fetal erythrocytes, as a result of the breakdown of which bilirubin is formed. The kidneys and liver of the crumbs are still immature and cannot adequately cope with the withdrawal of this substance.

The most dangerous form of this disease for the baby - kernicterus - is expressed in the accumulation of bilirubin in the cells of the nervous system and the brain of the child, which can lead to severe neurological pathologies and even death. The good news is that this is an extremely rare variant of the disease, and practically does not occur in the practice of modern gynecology.

• Dropsy of fetus and newborn.

As a result of poor supply of oxygen to the internal organs of the fetus, the liver and spleen increase in volume, the baby's tummy enlarges and swells because of this. On ultrasound in such cases, you can see that the baby is not in the fetal position with legs pressed to the chest, but in the Buddha position, when the legs are spread apart due to a swollen tummy.

There is also swelling in other parts of the body.

Diagnosis, prevention and treatment

When a woman registers for pregnancy in a antenatal clinic, she must take a blood test from a vein to determine her group, Rh factor and antibody titer (in Rh-negative pregnant women).

If your doctor has not prescribed this test for you, feel free to ask if he has forgotten about it and if he knows that this should be done.

If a pregnant woman has a positive Rh, then there can be no Rh conflict.

If the pregnant woman has a negative Rh, then the father of the child (if known) is sent for analysis of the blood type and Rh factor. If the future dad is Rh negative, there can be no conflict. If positive, such a probability appears, and the pregnant woman is taken under special supervision.

If the expectant mother is Rh negative and anti-Rhesus antibodies are not detected, then she is planned to be given an anti-Rh immunoglobulin, as well as monitoring their appearance throughout pregnancy.

If antibodies are found in a pregnant woman with a negative Rh, then their level is regularly monitored.

The main goal of all pregnancy management in a future mother with a negative Rh factor and the likelihood of a Rh conflict is to prevent the mother's immune system from developing protective antibodies against fetal erythrocytes.

Accordingly, such women are contraindicated (without the most extreme need) for any surgical manipulations: chorionic villus sampling, cordocentesis, amniocentesis.

What is important is not the very fact of detecting protective antibodies, but how long they were detected and the dynamics of their growth. A good indicator is when, even if they are formed and found in some quantity, it does not change much for several weeks.

It is quite another matter when the amount of antibodies increases sharply in a few days. And, of course, the later they are discovered, the better, since their absence will give the child more time for normal development. As a result, when a conflict arises, the baby may already be ready to be born into the world, albeit ahead of schedule, but with less harm to health.

It is considered normal if the antibody titer is up to 1:4. In this case, as in the case if they are not found in a future mother with a negative Rh, at a period of 28 weeks the woman is given the first dose of anti-Rh immunoglobulin.

A titer of 1:8 for Kell and 1:32 for D-antibodies is considered a dangerous amount. In this case, the risk of severe forms of fetal hemolytic disease is recognized as critical.

If protective antibodies are detected, their number is monitored every 1-2 weeks (a blood test is taken). In addition, the condition of the fetus is closely monitored by ultrasound every 1-2 weeks.

If the child's condition worsens, intrauterine blood transfusion of the fetus is performed. Unfortunately, all other methods, except for this, are recognized as ineffective.

If there is no possibility to transfuse the blood of the fetus, the issue of early planned birth is being decided. In any case, there is nothing to expect in such a situation, and this can lead to serious health problems for the child and even his death.

If a Rh-negative mother had a pregnancy without a Rh conflict and no antibodies were formed, then after childbirth, a blood test is taken from the newborn and her Rh factor is determined.

If Rh is positive, then mothers are given a special vaccine - anti-Rhesus immunoglobulin, which is designed to prevent the formation of protective antibodies and exclude the possibility of developing an Rh conflict during the second and subsequent pregnancies in this woman.

This procedure is important to carry out within three days (72 hours) after childbirth - in this case, the effect will be maximum. If this did not work out, then this injection can be given within 28 days from the date of delivery, but in this case the effectiveness will be much lower.

If protective antibodies were found in a Rh-negative woman during pregnancy, albeit in a small amount, it does not make sense to administer anti-Rh immunoglobulin after childbirth, and in this case the procedure is not performed.

I suggest you watch a video in which the doctor briefly and clearly explains all the main points on the topic of our today's article.

Is Rh conflict possible during the first pregnancy

In order for an Rh conflict to occur, it is necessary that the baby's red blood cells enter the mother's bloodstream and be noticed by her immune system.

This is only possible if a woman had an ectopic pregnancy, miscarriages or abortions in the past, that is, situations where the erythrocytes of the previous fetus could enter her bloodstream and in those situations she was not injected with anti-Rhesus immunoglobulin.

If a woman did not have these problems in the past, and the real pregnancy is the first, then the Rhesus conflict is practically excluded. The thing is that if a certain amount of fetal erythrocytes enters the mother's bloodstream, her immune system will initially produce a very small amount of protective antibodies that will not be able to cause any harm to the health of the crumbs, in particular, cause hemolytic disease.

blood group conflict

This is an even rarer situation than the Rhesus conflict. Its essence lies in the fact that the immune system of the future mother reacts to the protein of the blood group of the unborn child, and not to the protein-marker of the Rh factor.

For clarity, we present the data of this conflict in the table by blood groups.

Thus, we see that most often a conflict in blood type during pregnancy can occur if the following factors coincide:

1. a pregnant woman has the first (0) blood group;
2. the father of the child has a second (A) or third (B) blood group.

And even if these factors coincide, then less than 1% chance that there will be hemolytic disease of the fetus and newborn.

Other cases of blood type conflict are also possible, but these cases are even rarer.

Pregnancy is a golden time when you need to tune in to the best and be less nervous. Even for mothers-to-be with Rh negative. But all this must be done together with a competent gynecologist and not forgetting to regularly take a blood test for antibody titer, because it is you who are responsible for health and a small life that is gaining strength in your tummy. Take care of yourself, Lena Zhabinskaya was with you.

Isoserological incompatibility of the blood of the mother and fetus is a condition in which there is a conflict in the Rh or ABO system. A special case of this pathology is the Rhesus conflict. In the absence of adequate therapy and timely assistance, this condition threatens with spontaneous abortion, fetal death in the later stages, or the development of hemolytic disease. Serious consequences await the child even after birth. What should a woman know about this dangerous pathology?

Rhesus: general concepts

In the body of each person there are specific antibodies that determine the Rh affiliation of his blood. Rhesus is a set of 50 specific antibodies - proteins located on red blood cells. In practical medicine, group D antibodies are of the greatest importance. It is these proteins that determine the Rh of each person.

The Rh factor is set at the time of conception and does not change throughout life. 85% of people have protein D and are considered Rh-positive (Rh+). The remaining 15% of the world's population lack a specific protein and are considered Rh-negative (Rh-).

In ordinary life, the Rh factor does not matter. Both Rh-positive and Rh-negative people are equally likely to suffer from various diseases. Rh does not affect the conception of a child. Problems occur only in Rh-negative women during pregnancy. It has been proven that the absence of an important protein can be fatal to the development of the fetus under certain circumstances.

Excursion to genetics

The rhesus of the embryo is laid at the time of conception and is determined by the rhesus of its parents:

Based on these data, several conclusions can be drawn:

1. In an Rh-positive woman, the conflict never develops, and the Rh of the fetus does not matter.
2. An Rh-negative woman can have an Rh+ or Rh- baby.
3. If an Rh-mother bears an Rh-child, there will be no conflict.

Rh conflict occurs in one single case: when an Rh-negative woman is pregnant with an Rh-positive fetus.

Causes of Rh conflict

The essence of the problem lies in the fact that there are no specific antibodies in the blood of an Rh-woman, while they are present on the erythrocytes of an Rh+ embryo. During gestation, the blood of mother and child inevitably mixes. Fetal antibodies enter the mother's bloodstream. Here they are perceived as a kind of alien object. The immune system of a woman tries to protect the body from the introduction of a stranger, and does everything to get rid of the problem. This explains all the clinical manifestations of the Rh conflict during pregnancy.

Rh antibodies that enter the woman's bloodstream are very aggressive. They are absolutely not dangerous for the mother, but pose a real threat to the health and life of the fetus. In this case, the first pregnancy for an Rh-woman usually ends happily. The likelihood of developing an Rhesus conflict occurs mainly in the second and subsequent pregnancies.

Why is the risk of Rh conflict minimal during the first pregnancy? The thing is that during gestation, the fetus is reliably protected from direct contact with the mother's blood. During the first pregnancy, antibodies of class M (YgM) are produced, which are not able to pass through the hematoplacental barrier and reach the fetus. In the future, with repeated contact (second pregnancy), class G antibodies (YgG) are formed, which easily pass through the placenta, enter the fetal bloodstream and have their negative effect.

The entry of Rh-positive antibodies into the woman's bloodstream occurs in the following situations:

• during childbirth;
• with abortions, miscarriages;
• with an ectopic pregnancy (at the time of its interruption).

The risk of developing antibodies increases in such situations:

• in case of bleeding during pregnancy;
• with invasive manipulations during pregnancy (amniocentesis, cordocentesis, chorionic biopsy);
• with traumatic childbirth;
• with manual separation of the placenta;
• during a caesarean section.

In all these situations, a large number of fetal erythrocytes carrying Rh + antibodies enter the maternal circulation. It is also possible the formation of antibodies during the transfusion of Rh-positive (incompatible) blood to a woman. This phenomenon is called Rh sensitization.

In most cases, a woman's immunization occurs in her first birth. At the same time, the child is born healthy, but Rh antibodies penetrate the mother's body. Once they appear, they remain in the bloodstream forever. It is impossible to get rid of Rh antibodies. In a second pregnancy, these antibodies will quickly recognize the Rh+ fetus and signal the immune system. That is why repeated pregnancy with an Rh+ fetus leads to the development of serious complications up to its termination. With each subsequent pregnancy, the severity of the possible consequences increases.

Symptoms in women

There are no specific manifestations of the Rhesus conflict. The expectant mother does not notice any changes in her condition. The woman's well-being is not disturbed. Without laboratory diagnostics and ultrasound, it is impossible to determine the pathology on the basis of clinical symptoms alone.

Some experts talk about the existence of a "mirror syndrome". It is believed that with an increase in antibodies in the blood, a woman develops characteristic symptoms of preeclampsia as a sign of a violation of the body's adaptation to pregnancy. The appearance of edema, increased blood pressure, deterioration of the general condition is noted. Currently, the connection of these signs with the Rhesus conflict has not been proven, so you should not focus on them.

Consequences for the fetus

Rhesus conflict poses a certain threat to the child. The growth of aggressive antibodies leads to a violation of the vital functions of the fetus and threatens the development of the following complications:

• spontaneous miscarriage;
• premature birth (after 22 weeks);
• HBP, fetal hemolytic disease;
• HDN is hemolytic disease of the newborn.

The first two complications should be considered as manifestations of HDN, but it is not always possible to find out the exact cause of abortion.

Hemolytic disease of the fetus and newborn

Passing through the hematoplacental barrier and penetrating the fetal circulation, Rh + antibodies enter into a specific reaction with the fetal antigens located on erythrocytes. As a result of all these actions, hemolysis develops - the destruction of red blood cells, and a chain of pathological reactions is launched:

• Massive hemolysis leads to a decrease in the number of red blood cells and the development of anemia.
• Anemia provokes fetal hypoxia.
• The constant death of red blood cells causes the liver and spleen of the fetus to work in an enhanced mode, as a result of which these organs increase in size.
• The load on the kidneys increases, which leads to their insufficiency up to the complete cessation of their function.
• There is damage to the brain cells of the fetus.

Hemolytic disease makes itself felt in the second half of pregnancy. Pathology is detected during ultrasound. The progression of the disease leads to the formation of severe pathologies in the fetus and the birth of a sick child. If the liver, kidneys and other internal organs cannot cope with the load, fetal death occurs at any stage of pregnancy.

Quite often, the Rh-conflict manifests itself after the birth of a child. This condition is called hemolytic disease of the newborn (HDN). The symptomatology is similar to GBP, since the initial symptoms of the pathology are noted even in the period of intrauterine development.

Forms of hemolytic disease (HD):

anemic form

The easiest version of the course of GB. This form says:

• a decrease in the level of red blood cells with the development of anemia and concomitant fetal hypoxia;
• slight enlargement of the liver and spleen.

During the first week of a baby's life, pallor of the skin is noted. The general condition of the baby is not disturbed. Anemia responds well enough to correction. In the future, this form of GB practically does not affect the development of the child.

icteric form

Main symptoms:

• anemia;
• early jaundice of the newborn (before the 2nd day of life);
• enlargement of the liver and spleen.

In utero, this form of pathology is practically not expressed in any way. All major changes occur after the birth of a child. Jaundice indicates the rapid breakdown of hemoglobin and an increase in the blood of its destruction product - bilirubin. The baby's condition worsens, neurological symptoms are noted. Treatment is carried out in a specialized department or in intensive care.

edematous form

The most severe variant of the course of GB. The first symptoms are noted even in the period of intrauterine development. Massive hemolysis of erythrocytes leads not only to anemia, but is also accompanied by edema of all tissues. The child is born in an extremely serious condition with impaired function of vital organs. The prognosis is unfavorable, but under certain conditions it is possible to save the life of a child. Often, the edematous form leads to early termination of pregnancy.

Diagnostic methods

To detect pathology, the following methods are used:

Laboratory research

All women who register for pregnancy donate blood three times to determine the blood type and Rh affiliation:

• at the first appearance;
• for a period of 30 weeks;
• before childbirth.

In case of detection of Rh-analysis is carried out every month. Be sure to determine the titer of antibodies in dynamics. The absolute value of the titer does not matter much. The doctor pays attention to the growth rate of antibodies. Too rapid growth or an abrupt change in antibody titer may indicate the development of complications. Regular monitoring of the level of antibodies helps to notice the onset of the Rhesus conflict in time and prevent the development of undesirable consequences.

ultrasound

The condition of the fetus is assessed during an ultrasound. The first signs of GBP can be detected at 18-21 weeks, during the second ultrasound screening. Further tactics will depend on various factors:

1. In the absence of Rh sensitization (according to a blood test, i.e., in the absence of antibodies in the mother's blood), a second ultrasound is performed at a period of 32-34 weeks (III screening).
2. In the case of Rh-sensitization and a satisfactory condition of the fetus, ultrasound control is indicated every 2 weeks.
3. If GBP is detected, ultrasound is performed every 3-7 days (according to indications - daily).

Ultrasound signs of GBP:

• an increase in the thickness of the placenta by 0.5 cm or more (in relation to the norm at a given stage of pregnancy);
• an increase in the size of the liver and spleen;
• polyhydramnios;
• expansion of the umbilical vein more than 10 mm (additional sign).

An accurate diagnosis can only be made with the edematous form of GBP. In this case, there is a pronounced increase in the liver and spleen, ascites, a significant thickness of the placenta (up to 6-8 cm). There is an increase in the size of the heart. An effusion in the pleural cavity, swelling of the intestinal walls, subcutaneous tissue of the head, and limbs of the fetus are diagnosed.

Of great importance is the determination of the velocity of blood flow in the middle cerebral artery with dopplerometry. An increase in this indicator by more than 1.5 MoM for a particular gestational age indicates severe anemia. In this case, additional invasive diagnostics is indicated.

Invasive procedures

To assess the condition of the fetus is shown:

• amniocentesis - amniotic fluid sampling (from 16 weeks);
• cordocentesis - cord blood sampling (from 18 weeks).

Cordocentesis is an accurate method for diagnosing GBP. It is also used to assess the severity of pathology. The only indication for this procedure is severe anemia detected by ultrasound. In this case, cordocentesis serves not only for diagnosis, but also for treatment (intrauterine blood transfusion). In other situations, cordocentesis is not indicated, since such an intervention in itself increases the risk of sensitization and the growth of antibodies.

During cordocentesis, the received portion of blood is examined, the level of hemoglobin, hematocrit, and bilirubin is determined. The data obtained are compared with the norm for each period of pregnancy.

Non-invasive diagnostics

Determination of the Rh factor of the fetus by the mother's blood is a modern procedure used in many progressive clinics. A woman donates blood for analysis, and fetal erythrocytes are detected in the material received. The laboratory determines the blood type and Rh factor of the fetus. Establishing Rh- blood of the fetus in the early stages of pregnancy allows you to avoid the appointment of dangerous invasive procedures and thereby significantly reduce the risk of possible complications.

Principles of therapy

Specific therapy for Rhesus conflict has not been developed. Until recently, methods such as plasmapheresis and hemosorption were practiced, but they were found to be ineffective. There are no drugs that can change the level of antibodies in the mother's blood or reduce the likelihood of developing HDD.

The only method to compensate for severe anemia in the fetus is intrauterine blood transfusion. Manipulation is carried out during cordocentesis. After receiving the material, the necessary laboratory tests are carried out, the volume of erythrocyte mass for transfusion is determined. Red blood cells of the 0 (I) blood group Rh- are introduced. After completion of the blood transfusion, a control blood sampling is carried out and the necessary indicators are re-determined.

If necessary, the procedure is repeated up to the 34th week of pregnancy. Next, the question of a possible delivery is decided.

Childbirth with Rhesus conflict

Since the operation increases the risk of further sensitization and massive entry of fetal erythrocytes into the mother's bloodstream, they try to give birth through the natural birth canal. Indications for a caesarean section may include:

• severe condition of the fetus with GBP;
• immature cervix;
• the presence of extragenital pathology or other factors.

Prevention

Specific prevention of Rhesus conflict involves the timely administration of anti-Rhesus immunoglobulin in certain situations:

1. When pregnant Rh + fetus for a period of 28 weeks.
2. In natural or operative childbirth (the maximum period is 72 hours after delivery).
3. After a spontaneous miscarriage, induced abortion, interrupted ectopic pregnancy within 72 hours.
4. When carrying out any invasive manipulations during gestation.

Anti-Rhesus immunoglobulin is administered intramuscularly once (dosage 300 mg). It is recommended to carry out prophylaxis during the first hours after childbirth, abortion, etc. The maximum possible period for the administration of the drug is 72 hours.

Non-specific prophylaxis:

1. Preservation of the first pregnancy in an Rh woman.
2. Competent contraception.
3. Rejection of abortion.
4. Blood transfusion taking into account the Rh factor.

Why is it so important to keep the first pregnancy? In most cases, immunization does not occur during the first pregnancy, and a woman can give birth to a healthy baby without problems. In the second and subsequent pregnancies, the risk of developing GBP increases significantly (without specific prophylaxis). In the event that a woman has an abortion in her first pregnancy and does not inject anti-Rhesus immunoglobulin, she has every chance of being left without children in the future.

Currently, an IVF program has been developed that allows you to give birth to a healthy child, even in severe cases. IVF is indicated for Rh-sensitization and previous death of the fetus or newborn. In this case, embryos with Rh-blood are pre-selected, and they are implanted in the uterus. In this scenario, there is no Rh conflict, and a woman can safely endure pregnancy.

How many different factors affect the course of pregnancy, and all of them simply need to be taken into account. Many women have heard something about such a sad phenomenon as Rhesus conflict during pregnancy. However, not all of them understand what it is and what this phenomenon is connected with. And misunderstanding quite naturally gives rise to fear, and even panic.

Therefore, it is very important to know what is the conflict of Rh factors during pregnancy, and what is the Rh factor in general.

What is the Rh factor?

Of course, it is worth starting with the very concept of the Rh factor. This word refers to a special protein that is located on the surface of red blood cells. This protein is present in almost all people, only 15% are absent. Accordingly, the first are considered Rh-positive, and the second - Rh-negative.

In fact, the Rh factor is just one of the immunological properties of blood, and does not affect human health in any way. Blood with a positive Rh factor is considered stronger.

This property of blood was discovered by two scientists: Landsteiner and Wiener in 1940 when studying rhesus monkeys, which gave the name to this phenomenon. The Rh factor is indicated by two Latin letters: Rp and plus and minus signs.

What is Rh-conflict of mother and child? When positive and negative red blood cells come into contact, they stick together, which does not lead to anything good. However, stronger Rh-positive blood easily tolerates such an intervention. Therefore, in women with a positive Rh factor, no conflict on this basis can arise.

However, Rh-negative women are more likely to have normal pregnancies. If the father of the child is also Rh negative, then there is no ground for conflict. When does Rhesus conflict occur? When a positive Rh factor is detected in a husband, the child's blood will also have Rp + with some degree of probability. In this case, an Rhesus conflict may arise.

It is possible to determine the Rp of a child without an intervention dangerous to his health only approximately based on the indicators of the parents. This is clearly shown in the table. Rhesus conflict during pregnancy occurs extremely rarely, only 0.8%. However, this phenomenon is fraught with very serious consequences, which is why so much attention is paid to it.

What are the causes of Rhesus conflict? The positive blood of a baby for a mother with a negative Rp is a serious threat, and in order to cope with it, the woman's body begins to produce antibodies, respectively, they react with the fetal red blood cells and destroy them. This process is called hemolysis.

Maternal and fetal blood occurs between the uterus and the placenta. It is in this place that the exchange takes place: oxygen and nutrients enter the baby’s blood, and the waste products of the fetus enter the mother’s blood. At the same time, part of the erythrocytes, as it were, change places. So the positive cells of the fetus are in the blood of the mother, and her red blood cells in the blood of the fetus.

In the same way, antibodies enter the blood of the baby. By the way, obstetricians have long noticed that Rhesus conflict during the first pregnancy is much less common.

What is it connected with? Everything is quite simple: at the first “meeting” of the blood of the mother and fetus, IgM type antibodies. The size of these antibodies is very large. Rarely and in very small quantities, they enter the blood of the child, and therefore do not cause problems.

Rp inheritance table

Father	Mother	Child	Probability of blood type conflict
0 (1)	0 (1)	0 (1)	No
0 (1)	A (2)	0 (1) or (2)	No
0 (1)	AT 3)	0 (1) or B(3)	No
0 (1)	AB (4)	A (2) or B (3)	No
A (2)	0 (1)	0 (1) or A(2)	50/50
A (2)	A (2)	0 (1) or A(2)	No
A (2)	AT 3)		50/50
A (2)	AB (4)	B(3) or A(2) or AB(4)	No
AT 3)	0 (1)	0(1) or B(3)	50/50
AT 3)	A (2)	Any (0(1) or A(2) or B(3) or AB(4))	50/50
AT 3)	AT 3)	0(1) or B(3)	No
AT 3)	AB (4)	0 (1) or B(3) or AB(4)	No
AB (4)	0 (1)	A(2) or B(3)	Yes
AB (4)	A (2)	B(3) or A(2) or AB(4)	50/50
AB (4)	AT 3)	A(2) or B(3) or AB(4)	50/50
AB (4)	AB (4)	A(2) or B(3) or AB(4)	No

Rh conflict during the second pregnancy is much more likely, since upon repeated contact with Rh-negative blood cells, the woman's body produces antibodies of another type - IgG. The size allows them to freely enter the baby through the placenta. As a result, the process of hemolysis continues in his body, the toxin bilirubin, a product of the breakdown of hemoglobin, accumulates in the body.

What is dangerous Rhesus conflict? Liquid accumulates in the organs and cavities of the baby. This condition leads to disruption of the development of almost all body systems. And the saddest thing is that after the birth of a child, antibodies from the mother's blood continue to function in his body for some time, therefore, hemolysis continues, the condition worsens. It is called hemolytic disease of the newborn, abbreviated as HDN.

In acute cases, a miscarriage is possible due to an Rhesus conflict. In a number of cases, this phenomenon becomes the cause of miscarriage. That is why women with negative Rp need to be very careful about their condition and not miss scheduled visits to the gynecologist, tests and other studies.

Symptoms of Rh conflict

How does the Rhesus conflict manifest itself? Unfortunately, there are no external manifestations visible to the naked eye. For the mother, all the processes that take place in her body and are associated with the Rhesus conflict are not dangerous at all, and do not have any symptoms.

Symptoms of Rhesus conflict can be seen in the fetus with ultrasound. In this case, you can see the accumulation of fluid in the cavities of the fetus, swelling; the fetus, as a rule, is in an unnatural position: the so-called pose of the Buddha. Due to the accumulation of fluid, the abdomen increases, and the baby is forced to spread the legs to the sides. In addition, there is a double contour of the head, this is also due to the development of edema. The size of the placenta and the diameter of the vein in the umbilical cord also change.

Rh-conflict of newborns can result in one of three types of disease: icteric, edematous and anemic. edematous the form is considered the most severe and most dangerous for the child. After birth, these babies often require resuscitation or a stay in an intensive care unit.

The second most difficult form icteric. The degree of complexity of the flow in this case is determined by the amount of bilirubin in the amniotic fluid. anemic the form of the disease is the easiest, although the severity also largely depends on the degree of anemia.

Antibody test during pregnancy

One of the ways to determine the very presence of a Rh conflict is an antibody test. This analysis is carried out for all women with suspected Rhesus conflict. To determine the risk group at the beginning of pregnancy, everyone is tested for the Rh factor, and the father of the child must also undergo the same procedure. If the combination of Rh factors in a particular case is dangerous, a woman will be tested once a month for a Rh conflict, that is, for the amount of antibodies.

Starting from the 20th week, if the situation is threatening, a woman from the antenatal clinic will be transferred for observation to a specialized center. Starting from week 32, a woman will be tested for antibodies 2 times a month, and after 35 weeks - once a week until the onset of labor.

Much depends on how long the Rh conflict is detected. The earlier this happened, the more problems such a pregnancy portends, since the effect of the Rhesus conflict has the ability to accumulate. After 28 weeks, the blood exchange between mother and child increases, and, consequently, the amount of antibodies in the baby's body increases. Starting from this period, the woman is given special attention.

Studies to determine the degree of damage to the fetus

It is possible to determine the condition of the fetus using a number of studies, including invasive ones, that is, associated with a certain risk to the health of the fetus. From the 18th week, they begin to regularly examine the child with the help of ultrasound. The factors that doctors pay attention to are the position in which the fetus is located, the condition of the tissues, placenta, veins, and so on.

The first study is scheduled in the region of 18-20 weeks, the next - at 24-26, then at 30-32, one more at 34-36 weeks and the last one immediately before childbirth. However, if the condition of the fetus is assessed as severe, mothers may prescribe additional ultrasound examinations.

Another method of research that allows you to assess the condition of the baby is dopplerometry. It allows you to evaluate the work of the heart and the speed of blood flow in the blood vessels of the fetus and placenta.

CTG is also invaluable in assessing the condition of the child. It allows you to determine the reactivity of the cardiovascular system and suggest the presence of hypoxia.

Worth mentioning separately invasive evaluation methods fetal condition. There are only 2 of them. The first - amniocentesis- puncture of the fetal bladder and sampling of amniotic fluid for analysis. This analysis allows you to determine the amount of bilirubin. In turn, this allows you to very accurately determine the condition of the child.

However, puncture of the amniotic bladder is a really dangerous procedure, and in some cases it entails infection in the amniotic fluid, can cause amniotic fluid leakage, bleeding, placental abruption and several other serious pathologies.

The indication for amniocentesis is the antibody titer in Rhesus conflict 1:16, as well as the presence of children born in a woman with a severe form of HDN.

The second research method is cordocentosis. In this study, the umbilical cord is pierced and a blood sample is taken. This method even more accurately determines the content of bilirubin, in addition, it is with these methods that a blood transfusion is performed for a child.

Cordocentosis is also very dangerous and leads to the same complications as the previous research method, in addition, there is a risk of developing a hematoma on the umbilical cord, which will interfere with the metabolism between mother and fetus. Indications for this procedure are antibody titer 1:32, the presence of previously born children with severe HDN or children who died due to Rh conflict.

Treatment of Rh conflict during pregnancy

Unfortunately, the only really effective way to treat Rh conflict during pregnancy is a blood transfusion to the fetus. This is a very risky operation, but it provides a significant improvement in the condition of the fetus. Accordingly, it helps to prevent premature birth.

Previously, other methods of treatment were widely used, such as plasmapherosis during pregnancy, skin grafting of a husband to a woman, and some others are considered ineffective, or not at all effective. Therefore, the only answer to the question of what to do in case of a Rh conflict is constant monitoring by a doctor and following all his recommendations.

Delivery in Rh conflict

In most cases, a pregnancy that occurs with the development of an Rhesus conflict ends up being planned. Doctors monitor the condition of the child by all available means and decide whether it makes sense to continue the pregnancy or whether it would be safer for the child to be born prematurely.

Natural childbirth with Rhesus conflict rarely occurs, only with a satisfactory condition of the fetus and the absence of other contraindications.

At the same time, doctors constantly monitor the condition of the baby, and if difficulties arise, they decide on the further conduct of childbirth, often prescribing a caesarean section.

However, most often childbirth with a Rh conflict takes place by caesarean section, since in this case it is considered more gentle.

Prevention of Rhesus conflict

Prevention of Rh conflict during pregnancy, fortunately, is possible. For this purpose, a woman is injected with a special substance - immunoglobulin. Immunoglobulin is usually given within 72 hours of delivery, abortion, miscarriage, bleeding, or blood transfusion to the baby.

Immunoglobulin will help not only when planning a pregnancy after an Rhesus conflict. In some cases, it is also administered during pregnancy for a period of about 28 weeks, but only with the consent of the patient.

Breastfeeding with Rh conflict

A separate issue is breastfeeding with an Rhesus conflict. This issue is very sensitive and there is no consensus on it. First of all, doctors assess the child's condition, possible risks, and after that they may recommend that you refrain from breastfeeding for several days until all antibodies are removed from the mother's body.

According to other sources, there is no need to restrict breastfeeding. However, all these studies have not yet been fully confirmed, and the equipment of our clinics still leaves much to be desired. Therefore, it is not worth arguing with the opinion of doctors, because they are guided both by the condition of your child and their capabilities in case of any complications.

It can be summed up: the Rhesus conflict of the mother and fetus is not a sentence, and it is quite possible to bear a child with such a diagnosis. Moreover, Rp- in the mother does not mean at all that pregnancy will lead to Rh conflict. Of course, the consequences of the Rhesus conflict can be very deplorable, but this is not a reason to despair. In the end, only 0.8% of pregnant women with Rp- face this problem.