Pregnancy calendar, gender determination for the year. Determining the gender of the unborn child according to the Chinese lunar calendar
Future parents, even when planning the birth of a child, must take a blood test to detect the Rh factor. This is necessary in order to promptly determine possible incompatibility between a man and a woman. Such a study will help prevent adverse consequences - the likelihood of an Rh conflict occurring between the child and the mother.
Rh conflict during pregnancy
During conception, the embryo from one parent receives D-protein, located on top of red blood cells. If the Rh antigen D is present, the blood is considered positive, and if it is absent, the blood is considered negative.Rhesus conflict iswhen the expectant mother is Rh negative, and the partner is Rh positive, because according to statistics, 50% of children receive the Rh factor from their father. In other cases there is no problem. Rhesus conflict during pregnancy threatens spontaneous miscarriage, premature placental abruption, and hemolytic disease of the infant.
Rh conflict during the first pregnancy
In women with Rh (-), only 10% of cases develop a blood conflict if they become pregnant for the first time. This is due to the production of type 1 immunoglobulins, which cannot pass through the placenta and enter the fetal bloodstream due to large sizes. In order for the baby's red blood cells and the mother's antibodies to meet and agglutination (sticking together) to occur, they need to connect between the placenta and the wall of the uterus. If the woman has not previously had an abortion, and also did not have blood transfusions, thenRhesus conflict during first pregnancyis almost completely eliminated.
Rh sensitization occurs more often during repeated pregnancy. In this case, the baby's red blood cells penetrate the mother's blood vessels and trigger a humoral immune response, after which IgG antibodies are produced. Their size is small, so the placental barrier is easily overcome. Antibodies enter the baby's bloodstream and destroy red blood cells, causing hemolysis.Rh conflict during second pregnancyand all subsequent ones, especially with a short time interval, negatively affects the health of the fetus.
Rh conflict during pregnancy - consequences for the child
For an unborn baby, an Rh conflict is dangerous due to the occurrence of hemolytic disease. This is a very risky condition when the baby develops an edematous form of the disease, ascites, while still in the womb. If there is immunological incompatibility, the child may be born in a particularly serious condition or dead. For less severe complications, the mainconsequences of Rh conflict for a child– this is an enlargement of the liver after birth, spleen and other internal organs, pale skin, anemia.
Already in the first day after birth, jaundice appears (in the icteric form), lack of blood circulation, cardiomegaly (increase in the mass and size of the heart) may occur. Other consequences of Rh conflict:
- fast contractions eyeballs;
- generalized seizures;
- high-pitched screams;
- asymmetric spasticity;
- deafness.
Rhesus conflict - reasons
As it has already turned out, Rh-conflict pregnancy occurs if the mother’s Rh factor is negative, and the fetus’s Rh factor is positive. However, the destructive effect does not occur immediately after the “acquaintance” of two organisms. Only at 8-9 weeks, and in some women even after six months, do immunoglobulins appear that can penetrate the placenta.
When the blood flow between a woman and the fetus increases, the amount of anti-Rhesus antibodies in the baby’s body increases, which increases the risk of pathologies. An immunological conflict sometimes arises when a woman is sensitized to Rh(-) during her birth from an Rh(+) mother. There are otherscauses of rhesus conflict, if a woman with Rh (-) had the following pathologies:
- diabetes mellitus;
- Caesarean section in previous births;
- gestosis;
- artificial termination of pregnancy;
- flu;
- acute respiratory infections;
- genetic inheritance;
- ectopic pregnancy;
- donor blood transfusion.
Rh conflict during pregnancy - symptoms
A pregnant woman does not exhibit any specific clinical manifestations. Blood conflict during pregnancy is manifested only by fetal pathologies. Sometimes the development of incompatibility even leads to intrauterine death or miscarriage. The baby may be born still, premature, with an edematous, anemic or icteric form of hemolytic disease. Basicsymptoms of Rh conflictduring gestation and after the birth of the baby:
- the appearance of immature red blood cells;
- hypoxic damage to internal organs;
- anemia;
- thickening of the placenta;
- increase in the size of the fetal abdomen;
- swelling of the scalp tissue;
- bilirubin intoxication of the central nervous system;
- increase in amniotic fluid.
Analysis for Rh conflict during pregnancy
To prevent the likelihood of Rh conflict during pregnancy, mothers with Rh (-) are prescribedanalysis for Rh conflict(for antibodies), which she must undergo monthly. If antibodies are present (any titer), the pregnant woman is observed at a local consultation until the 20th week, after which she is sent to specialized clinics to determine treatment tactics and delivery dates. Starting from the 18th week, the condition of the fetus and other signs of Rh conflict are assessed using ultrasound (ultrasound).
Prevention of Rhesus conflict
Antenatal prevention is important, that is, prenatal, starting with an analysis for Rh conflict, which should be carried out from the first days of pregnancy. In the absence of antibodies, a woman is given intramuscular injection(injection) of anti-Rhesus immunoglobulin, preventing their further production. If after birth the baby’s Rh is negative, then there is no need to fear the occurrence of hemolytic pathology in the future. The mother is given another dose of immunoglobulin to prevent the risks of immunological incompatibility during subsequent pregnancies.
In case of development of Rh sensitization at any timeprevention of Rh conflict during pregnancyrequires special attention: after 32 weeks, blood tests are carried out 2 times a month, and before childbirth - weekly. Even in the early stages, a woman is admitted to a special clinic, where from 22 to 32 weeks an intrauterine transfusion is performed, when the fetus is given the required blood type. This gives a high possibility of full pregnancy and eliminates future ectopic pregnancy.
Find out about normal indicators during pregnancy and its planning.
The main goal of our immune system is to protect the body from foreign infections and proteins. We rely on her in every possible way. But it happens that immune system brings us many problems, for example, the occurrence of Rh conflict.
How is it formed? When a woman with Rh-negative blood is pregnant with a child with Rh-positive blood, the body begins to resist it. To do this, he creates antibodies that must destroy the “foreign” body. That is, our own body gets rid of the fetus.
Should I be afraid of pregnancy with Rhesus conflict?
Many couples do not think about the Rh issue when planning a child. And some, on the contrary, get very nervous and fall into despair. Here are three precise points that will help some people navigate the situation:
1. Rh conflict in pregnant women occurs only when the negative Rh of the mother and the positive Rh of the father collide. Probability of conflict – 75%.
2. There will be no Rh conflict between mother and fetus if the woman is Rh positive and the father is Rh negative.
3. The first pregnancy and childbirth are almost always perfect.
Let's talk about the third point. Why will the first birth be successful? Rhesus conflict occurs only when the blood of mother and child mixes. During pregnancy, the fetus is protected by the hematoplacental barrier. And our immune system has no idea that anything is wrong. But during childbirth, the baby’s positive red blood cells enter the mother’s blood. A woman’s body, having received a signal, remembers it for life. In subsequent pregnancies, the immune system will work much harder. The more births, the more antibodies will be produced.
How does Rh conflict affect a child?
So, we already know that there is no need to worry about the first birth. If you have not had an abortion, miscarriage or ectopic pregnancy before, then the immune system will not react in any way to a positive Rh fetus.
But what happens in subsequent pregnancies? The most dangerous outcome is hemolytic disease of the newborn, the treatment of which we have already discussed on the pages of the site. It is unrealistic to determine the likelihood of its development. Some antibodies may attack but not cause much harm, while some, on the contrary, will be very active.
Therefore, the number of antibodies will need to be checked throughout pregnancy. Their decrease should not be encouraging, since the question will be, where did they go? They may have found access to the placenta. If you have antibodies, you should definitely take vitamins and medications that will remove allergic manifestations and pacify the immune system.
Some people choose plasmaphoresis. This is the purification of the mother's blood. But you cannot choose the type of protection for your baby on your own. The doctor must carefully study the woman’s entire history, her past births, and the current state of her body.
If hemolytic disease was suspected, then the due date must be correctly calculated.
The perfect solution– give birth between 35 and 37 weeks. A premature or post-term baby is at risk. It is better to induce labor with medication.
There are several ways to determine that Rh conflict has already affected the fetus:
Thickened placenta, enlarged abdomen, hypoxia (all these points are visible on ultrasound);
- analysis of amniotic fluid, bilirubin level.
But even good or bad tests do not provide all the answers. The doctor will examine the baby and tell you whether there is a disease or not.
Clinical picture: consequences for the child
We can divide all the consequences of an antibody attack due to a Rh conflict into three groups:
1. Edema. It is observed in 2% of children. This is the most severe form. The disease develops during pregnancy. On early miscarriage is possible. If the fetus survives the first half of pregnancy, it begins to suffer from severe anemia and edema. Most often, the child dies before being born. The surviving children are weak, pale, with poor reflexes. Cardiopulmonary failure is noted. High mortality rate.
2. Jaundice. It is observed in 88% of children. This is the form moderate severity. Signs: jaundice on the first day after birth, anemia. The liver and spleen may become very enlarged. The child is sleepy and lethargic. Bilirubin rises very quickly, resulting in very bright orange color skin. After the peak of the disease, the skin becomes greenish. Urine and feces change color. Treatment of a child with such problems lasts from 1 to 3 months. In most cases, the baby recovers completely.
3. Anemia. This is the simplest form, which occurs in 10% of children. Its essence is the appearance of anemia within 1 week after childbirth. It passes quickly and does not harm the child.
How to prepare for the consequences of a Rhesus conflict?
Despite common problems, you don't have to give up the opportunity to become parents. It’s enough just to prepare both physically and mentally. Here are some simple tips:
Find good specialist who will examine the mother’s body before pregnancy;
Monitor your condition, get tested and undergo an ultrasound scan every month;
Prepare for possible treatment for your baby.
Remember that many women, even with positive Rh, face problems with pregnancy and childbirth. Today, every clinic or maternity ward has extensive experience in working with babies affected by Rhesus conflict. They will help you and your child recover quickly.
The term "Rh factor" applies to one of 36 blood group systems. This is a lipoprotein protein on the surface of red blood cells. If it is present on the membranes of red cells, then the person is Rh positive; if not, he is Rh negative. When the Rh factors of the pregnant woman and the fetus do not match, hemolysis develops, leading to serious complications.
What role does the Rh factor play during pregnancy?
The presence of the Rh factor in itself does not in any way affect human health, including pregnant women. This is just one of the immunological properties of blood.
With a positive Rh factor, it is considered stronger. Only 15% of all people have a negative one. The Rh factor appears in the embryo early in pregnancy. Already at 8 weeks, maternal blood tests determine small quantity fetal erythrocytes. The Rh factor of parents during pregnancy is important for predicting the further development of the child:
- If the parents have the same Rh factor, then the conception and development of the baby will be favorable.
- When the Rh factors of a woman and a man are different, Rh conflict may develop. If the fetus inherits Rh from its father, then it will be incompatible with its mother. This is very dangerous for the child. Miscarriage can occur at any stage of pregnancy.
The mechanism of occurrence of Rh conflict
In the case of Rh conflict, upon contact, the red blood cells of the fetus and the woman stick together, which leads to complications. It is worth noting that Rh-positive blood tolerates this more easily. For this reason, a woman with Rh+ does not experience a Rh conflict during pregnancy with a fetus with Rh–. The mother's blood does not react to the child's Rh, so protective antibodies are not formed.
A dangerous condition is a negative Rh factor in a woman during pregnancy with a Rh-positive fetus. This is observed when a baby inherits Rh from a father with Rh+.
In this case, the following processes occur:
- The meeting of the blood of the mother and the fetus occurs in the space between the placenta and the uterus.
- An exchange takes place there: the baby receives nutrients and oxygen, to the mother - the products of his vital activity.
- Against this background, some of the positive red blood cells of the fetus enter the blood of the pregnant woman, and her negative red cells enter the blood of the child.
- In the same way, antibodies penetrate the baby, which are produced in response to genetically foreign material - fetal red blood cells.
Regardless of how often a woman is pregnant, the entry of positive red blood cells from the fetus into the blood of a mother with negative Rh occurs in several other situations. Main cases:
- Pregnancy, which is accompanied by gestosis, threat of miscarriage or serious illness of the woman.
- Premature placental abruption or manual separation.
- Delivery by caesarean section.
- Cordocentesis, chorionic villus biopsy, amniocentesis are studies that are carried out during pregnancy.
- Mother's Rh-positive blood transfusion.
- Miscarriage, induced abortion or surgery for ectopic pregnancy.
How to determine the Rh factor in a child
Families with negative Rhesus should not worry, although this is rare. Only 3% of men have Rh-. According to the laws of genetics, inheritance comes from the father or mother. Rh transmission principles:
Symptoms
If there are no concomitant diseases, then the woman’s well-being, even with Rh conflict, does not change in any way. This deviation cannot be detected externally. The following studies are used to identify pathology:
Consequences
During the first pregnancy, the likelihood of Rh conflict is practically excluded. This is explained by the fact that the produced IgM immunoglobulins have large sizes, because of which they cannot penetrate the placenta and enter the fetal blood.
In subsequent pregnancies, the number of such antibodies increases. In addition, their size decreases, which increases the likelihood of Rh conflict. If the fetus does not die at 20–30 weeks, then the following complications develop after birth:
- hemolytic disease of newborns;
- muscle flaccidity;
- regurgitation;
- feeding difficulties;
- children's cerebral palsy;
- abdominal enlargement;
- pallor or yellowness of the skin, borders of the lips, conjunctiva of the eyes;
- constant high-pitched crying, anxiety;
- opisthotonus - arching with spasms of the arm muscles.
Treatment methods
Rhesus conflict pregnancy requires special attention from doctors. If anti-Rhesus antibodies were detected in the woman’s blood or specialists established signs of hemolytic disease in the child, nonspecific treatment is carried out. Treatment regimen in this case:
Treatment method | Description |
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Physiotherapy |
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Undercooked liver or liver extracts must be included in the diet. |
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Diathermy of the perirenal area | This is a method of physical treatment in which the specified area is heated using high-frequency currents. The procedure is prescribed if there is a high risk of spontaneous miscarriage. |
Early birth | Indicated when previous methods are ineffective. Carried out in two ways:
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There is also a specific treatment for Rh conflict. Unlike nonspecific measures, it has slightly different indications. This treatment is prescribed to all women with negative Rhesus in following cases:
- after childbirth, miscarriages, abortions;
- after surgical treatment of ectopic pregnancy.
Specific therapy is the intramuscular administration of anti-Rhesus immunoglobulin immediately after childbirth or surgery. The injection should be given no later than 48–72 hours after medical procedures. Otherwise, the drug will not bring the desired effect. Anti-Rhesus immunoglobulin works as follows:
- Destroys fetal red blood cells in a woman’s body that managed to enter her blood during childbirth or surgery.
- As a result, antibodies do not have time to form.
- During the next pregnancy, the risk of Rh conflict is minimized.
Is it possible to prevent Rh conflict?
Prevention of Rh conflict is necessary for all Rh-negative women, especially if their partner is Rh-positive. Vaccination with anti-Rhesus immunoglobulin helps prevent this pathology. It is administered at 28 and 32 weeks of pregnancy. Other preventive measures:
- blood transfusion only taking into account group and rhesus compatibility;
- preservation of the first pregnancy in a woman with Rh–;
- vaccination with anti-Rhesus immunoglobulin in Rh-negative women after childbirth, abortion, miscarriages, ectopic pregnancies.
Video
Formation of immunological conflict between organisms expectant mother and the child in her womb leads to serious illnesses. Moreover, it can cause death for the baby. Therefore, such pathology is given great attention from the doctors. Pregnancy of an Rh-negative mother with a “positive” child requires careful monitoring from the supervising obstetrician-gynecologist. This will help you accept necessary measures to save the child’s life, to provide all possible assistance for the normal course of gestation.
Rh conflict during pregnancy: when and how it happens, and what to do next
Rh conflict is a pathological phenomenon based on incompatibility between mother and fetus, which occurs at the immunological level. For a conflict to develop, the expectant mother must have a negative Rh, and the baby in the womb must have a positive Rh. But mother’s sensitization does not always develop, since this requires some additional factors. This pathology is quite dangerous because it can cause the child to develop serious illnesses or even die.
What is Rh conflict between fetus and mother?
An immunological conflict as a result of incompatibility of the Rhesus values of the expectant mother and the child develops either during the process of bearing the child or during his birth. The Rh factor itself is a lipoprotein, otherwise called D-agglutinogen, and is attached to red blood cells. In people with this agglutinogen, Rh is read as positive, and in its absence - negative. Incompatibility develops as a result of the fact that the fetus inherits a positive factor from the father. When during pregnancy, for any reason, the red blood cells of the baby and the mother begin to interact, they agglutination occurs, which is also called clumping.
Causes of Rh conflict: risk factors
Incompatibility may occur for various reasons, which will depend on certain characteristics of pregnancy.
First pregnancy
During the first pregnancy of a baby, conflict rarely appears, and some situations in the life of the expectant mother can provoke it:
- Carrying out blood transfusions when they do not pay attention to Rh compatibility.
- Previous artificial termination of pregnancy according to indications or at the request of the woman.
- Spontaneous abortions in the past.
Sensitization can also occur in the following cases:
- Severe gestosis, with a violation of the integrity of the structures of the vascular bed of the placenta.
- Carrying out amniocentesis, cordocentesis, or taking a biopsy of chorionic villus tissue to diagnose the condition of the fetus.
- Development of early placental abruption
Without such phenomena, sensitization can only occur during the interaction of the blood of the child and the mother during childbirth, which will be reflected in the next gestation.
Repeated gestation
During the second and subsequent pregnancies, the baby’s red blood cells penetrate the wall of the mother’s blood vessels, which activates the response coming from the immune system and the production of immunoglobulin type G. Such immunoglobulins are small; they simply penetrate the placental barrier into the fetal bloodstream. As a result of this phenomenon, the structure of the fetal red blood cells is disrupted and hemolysis is formed. This process leads to the formation of bilirubin ( toxic substance) and further development of hemolytic disease.
Multiple pregnancy
Conflict between rhesus multiple pregnancy often occurs only if this conception is not the first. If twins or triplets accompany the first pregnancy, then if the gestation proceeds without complications and timely prevention, the expectant mother need not worry.
When the mother's blood type is first "-"
If the expectant mother has the first blood type with a negative factor, then a conflict may arise if the baby inherits from the father not only positive Rh, but also certain group blood:
- The first or the second, when my father had a second.
- The first or the third, when dad has the third.
- The second or third, when a man has a fourth.
Blood Rp inheritance table: incompatible groups and the likelihood of conflict formation
Genetic studies have made it possible to understand how great the threat of Rh conflict occurring during gestation is. These risks are analyzed by doctors so that they can minimize possible complications such a state.
There are two main tables:
- Rh risk.
- Risk by blood type.
If you evaluate the presence or absence of an agglutinogen:
If the emphasis is on the blood group, then the table takes on a different look:
Father | Mother | Child | Chances of conflict |
0 | 0 | 0 | — |
0 | A | 0 or A | — |
0 | IN | 0 or B | — |
0 | AB | A or B | — |
A | 0 | 0 or A | 50% |
A | A | 0 or A | — |
A | IN | Any option is possible | 25% |
A | AB | 0, A or AB | — |
IN | 0 | 0 or B | 50% |
IN | A | Any option is possible | 50% |
IN | IN | 0 or B | — |
IN | AB | 0, A or AB | — |
AB | 0 | A or B | 100% |
AB | A | 0, A or AB | 66% |
AB | IN | 0, V or AB | 66% |
AB | AB | A, B, AB | — |
To navigate the table, you must take into account that 0 is the first blood group, A is the second, B is the third, AB is the fourth.
Danger of incompatibility for the fetus and mother: the influence of a negative factor
Rh incompatibility between the expectant mother and her child is a dangerous condition. It threatens the woman herself only psychologically, due to the experiences associated with such a situation. But for the fetus, the consequences of the pathology are much more serious.
In the first trimester
The most serious violation associated with the first period of bearing a baby is the possibility of termination of pregnancy. A conflict between the mother’s immune system and the fetus that has just begun to form can lead to disturbances in the development and attachment of the zygote.
Since this period is associated with the active formation and formation of basic systems, the immunological conflict negatively affects them. Disturbances appear in the structure of the central nervous system, after intoxication, the liver and kidneys are exposed.
In the second trimester
The middle of a woman’s pregnancy with a conflict between Rhesus factors is associated with the following possible complications:
- Development of kernicterus.
- Disturbances in the structure of the brain leading to mental retardation.
- Enlarged spleen and liver, which are unable to function normally.
In the third trimester
For the final stage of gestation, immunological incompatibility of the expectant mother and her child can become the basis for a number of situations:
- Early birth.
- Anemia in the baby.
- Jaundice.
- Hemolytic disease.
- Developmental delays in the future.
How is diagnostics carried out?
Diagnostic measures to identify immunological incompatibility are quite simple. If they are performed in a timely manner, the doctor will be able to easily interpret the results and select the appropriate tactics for further action.
At what time is it diagnosed?
If a pregnant woman with negative Rh is determined that the child will be Rh positive, she needs monitoring:
- If she is pregnant for the first time and is unsensitized, the examination is repeated every 2 months.
- If a woman is sensitized, then the analysis is carried out once every 30 days until the 32nd week, then once every half month from the 32nd to 35th week of gestation and every 7 days from the 35th week of gestation.
What tests are taken?
The main diagnostic method is for a woman to donate blood to determine the titer of anti-Rhesus antibodies.
A high titer of antibodies does not indicate the conflict itself, but indicates its possibility and the need to take preventive measures.
Some diagnostic methods are also used to track the child’s condition:
- Ultrasound, it is performed 4 times over 20-36 weeks and before the birth of the baby.
- Electrocardiography.
- Phonocardiography.
- Cardiotocography.
The last three methods are aimed primarily at analyzing the severity of hypoxia in the baby in order to quickly begin therapy.
In addition to the measures listed, amniocentesis is allowed from 34 to 36 weeks. This helps to identify not only the level of antibody titer in water shell fetus, but also the degree of maturity of its lungs, bilirubin density.
Treatment
Therapeutic measures to help expectant mothers and their children at risk of developing Rh incompatibility include methods of nonspecific desensitization: vitamin therapy, metabolites, calcium and iron, antiallergic drugs, oxygen therapy. But main way to prevent incompatibility - vaccination of the expectant mother with immunoglobulin.
If the conflict caused serious condition child, then by 37-38 weeks a caesarean section is performed.
What is anti-Rhesus immunoglobulin or vaccine for women with negative Rhesus
Anti-Rhesus immunoglobulin is a medical product with high level antibodies, the purpose of which is to strengthen the immune system. It contains a protein fraction that has immunological activity, which is obtained from human plasma or donor serum. Before creating a vaccine source material examined to confirm the absence of antibodies to the immunodeficiency virus, hepatitis C and B.
When is anti-D immunoglobulin prescribed?
Anti-D immunoglobulin is prescribed to women during gestation with a high risk of developing Rh conflict. In some cases it is a drug with a therapeutic effect, but it can also have a preventive function.
How often is anti-Rhesus immunoglobulin administered during pregnancy?
The serum is administered intramuscularly for the first time at 28 weeks of gestation, then another dose is administered immediately after the birth of the child.
Is it necessary to administer immunoglobulin during the second gestation?
If the results of the examination show that the antibody titer is within normal limits, the doctor will recommend the administration of immunoglobulin, but this procedure may not be carried out at the woman’s discretion.
How can Rh conflict affect a child: pathologies and consequences for the fetus
Immunological incompatibility is extremely dangerous for an unborn baby; it can cause:
- Jaundice of newborns.
- Dropsy of the brain.
- Severe brain and heart defects.
- Stillbirths.
- Premature labor.
What immunoglobulin injections are used: list of popular drugs
The most current immunoglobulin preparations:
- Immunoglobulin G anti-Rhesus Rh0 (D).
- HyperROU S/D.
- Immunoro Kedrion.
- Partobulin SDF.
- BayRow-Dee.
- Human anti-rhesus immunoglobulin Rh0 (D).
- Resonant.
All these tools are analog, but are not 100% equivalent. The choice of drug is made by a specialist who supervises the woman throughout her pregnancy. He focuses on individual characteristics her body, selecting the most beneficial and effective remedy. The doctor also selects the dosage that is most suitable for the patient.
Is it possible to avoid Rhesus conflict without resorting to medications?
It is not possible to independently avoid incompatibility with a child due to the Rh factor without using medications.
A woman must understand that the products offered traditional medicine, are not effective and only timely assistance received by her in a medical institution will be the key to the birth of a healthy baby.
It is also possible to refuse to administer the drug if the expectant mother has contraindications, for example:
- Hypersensitivity.
- Hyperthymia.
- Dyspepsia.
- Any type of diabetes.
- Already identified sensitization.
Immunological incompatibility is not dangerous for the expectant mother, but it has an extremely adverse effect on the fetus and can even cause its death. In accordance with this, this phenomenon requires not only careful monitoring of the course of gestation by a doctor, but also following all recommendations by the mother.
Useful video
Most often, the question of what the Rh conflict is fraught with during a second pregnancy arises already during this very pregnancy or at the stages of preparation for it. However, the interest associated with this blood feature for every woman with a negative Rh factor is by no means idle, because the life and health of her future children depend on this information.
If for most families two children are the norm, then in families where the mother has a negative Rh factor and the father has a positive one, this is not always the case. Often, the second pregnancy of such women is associated with certain difficulties, which are to blame for small proteins on the surface of red blood cells, which the father of the child has, but she does not. But let's talk about everything in order!
Rh factor - brief information
On the eve of the Second World War back in 1940, scientists, or rather Wiener and Landsteiner, were not bored. They studied the blood of rhesus monkeys. But this seemingly boring activity led to an unexpected, but very significant discovery on a global scale: on the surface of red blood cells, some individuals have certain proteins, and some do not. And they named this unexpected factor, without further ado, in honor of these same monkeys - “Rhesus factor”. If a factor is present, it is indicated by the Rh(+) symbol, and if absent, then by the Rh(-) symbol.
It is the presence or absence of these very specific proteins that is the basis for classifying blood as positive or negative value Rh factor. According to statistics, Rh positive blood occurs in almost 80-85%, while Rh negative is much less common, only in 15-20%. This affiliation does not obligate anyone, since the value of the Rh factor does not affect human health in any way and is simply an immunological property of the blood itself. But when put into practice, knowing your Rh status can often save your life.
Problems with these miniature squirrels begin with any attempt to combine blood with a different sign of the Rh factor, be it a blood transfusion or... pregnancy.
In cases where the mother has a positive blood type, the immune system calmly perceives the situation: either the child also has these specific proteins - and this is a variant of the norm, because the immune system sees its own proteins; or he won’t detect them (the baby is negative) - and this is also normal, because there are no proteins - no problems. But in a situation where everything is the other way around, difficulties arise. After all, antigens in Rh factor proteins begin to form already from the end of the first trimester, that is, at approximately 8-9 weeks of pregnancy.
How can Rh conflict be dangerous?
When talking about Rh-conflict pregnancy, experts, first of all, mean a situation in which an Rh-negative mother develops an Rh-positive baby inside. It is this situation that is potentially dangerous for the fetus. Please note that for the mother, all these situations are not at all dangerous, because the immune system is the guardian of her health.
The statistics are such that three quarters of cases of pregnancy of a woman with Rh(-) blood from a man with Rh(+) blood is accompanied by a conflict between the immune systems of the mother and baby according to the Rh factor.
In such a case, the immune system of the mother, whose red blood cells are not burdened with additional proteins, perceives the baby’s red blood cells with Rh-positive proteins on them as something wrong, and seeks to destroy them. To do this, the mother’s body produces antibodies that kill the baby’s red blood cells.
As a result, the baby’s oxygen-carrying red blood cells become fewer and oxygen starvation occurs, which the child tries to compensate for by hypertrophied development of the heart and spleen. In addition, a caustic and toxic breakdown product of red blood cells - bilirubin - accumulates in the fetus's body. In such conditions, development proceeds poorly, sometimes incorrectly, and without proper prevention, pregnancy may end unfavorably. Scientifically, all these symptoms are called hemolytic disease of the newborn, abbreviated as HDN.
However, now such situations are possible only in remote corners civilized world, since obstetrician-gynecologists who manage pregnancy very closely monitor the pregnancy of women with negative group blood, promptly taking the necessary compensatory measures if necessary.
Moreover, even in the case of an Rh-incompatible pregnancy, Rh conflict will not necessarily develop. After all, the baby is quite tightly isolated in the placenta and there are not many options for the baby’s blood to enter the mother’s blood, which means that antibodies are not produced in the mother’s body due to the absence of a threat. Often, blood can mix during childbirth, which skilled doctors competently prevent. However, it is this factor that has great importance The fact is that the likelihood of having a Rhesus conflict during a second pregnancy increases.
Why does Rh conflict occur more often during the second pregnancy?
As mentioned above, the important thing is not that the mother is Rh negative during her second pregnancy, she was already like that before. And if in a woman’s life there were no unsuccessful blood transfusions accompanied by Rhesus conflict, and during the previous birth everything went in an organized and clear manner, then antibodies never appear, which means that the second and subsequent pregnancies will be the same as the first.
The important thing is that during the first birth there is a high probability that the mother’s Rh-positive blood will enter the mother’s body, for which the woman’s body immediately prepared perfect weapon a new type - IgG antibodies. They are produced precisely upon repeated contact with Rh(+) blood and are so small that they easily penetrate the main protective system of the fetus - the placenta.
If the first pregnancy is incompatible for Rh factor, it is very important how and how it ended, since this is what determines the statistical probability of problems occurring and the formation of antibodies in the mother’s blood. After a standard miscarriage, this percentage is only 3-4%, in the case of a medical abortion it is approximately 5-6%, even an ectopic pregnancy brings its own 1% risk. But a normal birth has as much as a 10-15% chance that the blood will mix and the mother will receive whole set fearsome antibodies, ready to cope with any subsequent hint of a positive Rh factor. Placental abruption, amniocentesis (cord blood sampling for analysis) and even cesarean section also increase the risk percentage.
Provoking factors
In what cases does it become possible to develop IgG type antibodies? Provoking factors are:
- The baby's blood enters the mother's blood. This can be absolutely any method, from cord blood collection and placental abruption to abortion or the birth process itself.
- A mother with a negative blood type has already had an unsuccessful blood transfusion, just a single case.
- The process of antibody formation occurs spontaneously, without visible objective reasons.
The age-old question: what should women with a negative blood type do?
And so you, so negative, found a very Rh positive father for your children and started thinking about pregnancy. No, the story begins even earlier, from the day you learned that you have a negative blood type. This knowledge places a very great responsibility on you both in terms of contraceptives and caution when surgical operations requiring blood transfusions, and when planning children. Miscarriages, abortions, placental abruptions are not for you. Once you become pregnant, you must take care of yourself and your baby like the best Czech crystal!
If you know that you have an Rh(-) blood value, you realize that in any situation, if pregnancy occurs, your task is to prevent fetal blood from entering your blood, or at least reduce the likelihood of such a development of events. Then your negative Rh during your second pregnancy will not be dangerous. However, prevention is necessary, starting right from the moment you realize: you are pregnant again!
Prevention of complications during Rh conflict pregnancy
When a second pregnancy occurs with negative Rh, as a rule, the woman is already more savvy in matters related to positive or negative blood factors. However, let us remind you: It is very important to register with your consultation as early as possible! If you are in doubt, you can find another private doctor in parallel - for the reliability of information about your condition coming from two different sources.
The first test you will undergo regarding your problem is a test for the Rh factor. If there is a risk of Rh conflict, an analysis for the presence of antibodies and their relative amount to the woman’s blood is carried out regularly throughout pregnancy. Up to 30-32 weeks, it is enough to carry out this examination once a month, after - up to 35-36 weeks, about 2-3 times a month, but closer to childbirth, a blood test for the presence of antibodies is carried out weekly. Blood flow between the fetus and mother increases after the 28th week of pregnancy, introducing additional risks if there is a conflict.
Immediately after birth, doctors take a blood sample to determine the Rh factor in the newborn and, if the result is positive, the mother is injected with a specialized serum, the so-called anti-Rh immunoglobulin. This is important as it prevents the occurrence of Rh conflict in subsequent pregnancies. This is done on the first day after birth, as well as in other cases of threat of the baby’s blood getting into the mother’s blood.
If everything went well, then no changes occur in the woman’s blood, and her immunity, even after childbirth, does not suspect that there are other, strange red blood cells with strange proteins in the world.
Treatment of Rh conflict during pregnancy
As already written, the risks of getting Rh conflict during the second pregnancy increase many times, but you can encounter it in the first pregnancy. If, during regular tests for antibodies, a critical increase in titers occurs, it is necessary to hospitalize the pregnant woman in a maternity hospital or perinatal center, where doctors can monitor the dynamics of the conflict, the condition of the baby according to ultrasound and aminocentesis (analysis of amniotic fluid).
If the baby's condition worsens, the child is given an intrauterine blood transfusion. If, with an active Rh conflict, it is possible to carry the pregnancy to term, a planned cesarean section is performed, since it is better to isolate the baby from hostile antibodies as early as possible.
After childbirth, if antibodies have not been developed during pregnancy, it is necessary to administer anti-Rhesus immunoglobulin serum to the mother within 24 to 72 hours; this point should not be left to the discretion of doctors and should be monitored independently, taking care of subsequent children. The same serum is administered to a woman in case of complications during pregnancy, for example, placental abruption or after 28 weeks as a preventive measure.
Delivery and breastfeeding with Rhesus conflict
It is the responsibility of a good doctor to predict Rh conflict, track changes in the baby’s condition and make a decision on the timing and method of birth. As a rule, if there is an active conflict regarding the Rh factor, doctors make a decision on early delivery by cesarean section. This method is used in cases where early birth is less harmful to the child than his further development under attack from the mother's antibodies. In addition, when caesarean section the likelihood of the baby's blood entering the mother's blood is much reduced.
The newborn will likely spend some time in the ward intensive care, there's nothing wrong with that. Hemolytic disease can have three stages: edematous, icteric and anemic. In the first case, a blood transfusion is possible. In the second case, the baby will probably spend some time under a drip, depending on the bilirubin level. The anemic form of HDN is the mildest.
Breastfeeding is in some cases undesirable and depends on the condition of the newborn and the level of bilirubin in the blood. In some cases, after feeding breast milk the child's condition may worsen. If, for medical reasons, doctors recommend that you not feed your baby for the first few days until his condition normalizes, do not forget to express milk - upon arrival home, you and your baby, with due diligence, will establish breast-feeding.
Rhesus conflict is not a death sentence, but a reason to be more careful
Despite the fact that the chance of getting a Rhesus conflict during a second pregnancy increases, this is not a reason to deny your first-born a brother or sister. No more than 0.8% of pregnant women face the problem of Rh conflict, and this is not so many. And there is nothing wrong with this in our 21st century, you just need to be more attentive, careful and responsible.
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