Chinese table for determining the sex of a child. Chinese calendar for determining the gender of a child
Rh conflict during pregnancy is a hemolytic disorder that can cause negative consequences of varying severity, up to a critical scenario. It is characterized by a blood mismatch in the Rh factor of the mother and the unborn baby.
An alarming situation of immunological incompatibility is possible only for pregnant women or those planning to conceive with Rh negative; for a Rh positive mother there is no conflict.
Detection of such an alarming state is an extremely dangerous signal, since it destabilizes the normal development of the fetus. Serious risks arise, including the direct danger of losing the child:
- miscarriage;
- antenatal (intrauterine) death;
- stillbirth.
Differences in the Rhesus of the mother and the newborn threaten the baby with a number of disorders, sometimes severe, including from the nervous system:
- hemolytic pathology;
- cerebral palsy (CP);
- epilepsy.
Hemolytic disease in a newborn is manifested by a number of disorders, sometimes severe, including those of the nervous system:
- infantile jaundice (if the pathology worsens or prolongs, bilirubin encephalopathy is possible);
- organ dysfunction;
- hypoxic-ischemic injury - oxygen starvation is caused by red blood cell dysfunction.
In the future, the likelihood of the child falling behind his peers in mental and physical terms increases.
Mild consequences ( initial stage Gospel diseases, minor disturbances in the “work” of organs) are quickly corrected by doctors and the subsequent development of the child occurs according to age, without noticeable deviations.
There are cases of complete absence of rhesus effects in a newborn. conflict situation. Maternal antibodies are not always able to cross the placenta. The above is appropriate in the case of the first pregnancy, but in some episodes this is possible for those preparing to become a mother for the second or even third time.
What is the Rh factor?
general information
Rhesus (Rh) is a congenital hematological feature of a person that is inherited. Determined only by the results of laboratory tests. This blood characteristic has no effect on appearance, behavior, or propensity to certain pathologies.
The Rh system is a complex complex of substances of a protein nature that have antigenic qualities, which are contained or absent in various combinations. cell membrane red blood cells
The name is due to the fact that originally this group proteins were detected on the surface of red blood cells in the monkey of the same name (macacus rhesus). Since the protein fraction (Rh factor) found on monkey erythrocytes was structurally similar to the human antigen, it was taken as the basis for further research, and the name was fixed in the medical literature.
The erythrocyte system of Rh is saturated with more than fifty antigens that can cause the synthesis of immune antibodies (IgM, IgG). The system does not have natural immunoglobulins. Priority clinical significance for issues of immunology, hematology, transfusiology and obstetrics, five protein fractions are allocated:
- D (85%);
- C (70%);
- c(80%);
- E(30%);
- e(97.5%).
Frequency values of “popular” antigens are given in parentheses.
Protein (D) is considered to be the most immunogenic; the immunological activity of the rest is significantly lower, in descending order: c-E-C-e.
Of the proteins that make up the structure of the Rh system, for determining Rh affiliation, only the D antigen is of fundamental importance if it is present in the cell membrane then in humans (Rh+), otherwise negative (Rh-).
The Rh factor itself (a specific protein antigen), whether positive or negative, in life does not correlate in any way with the state of health.
The word factor is “fixed” in the name because this hematological characteristic is considered a factor of blood compatibility during transfusion.
Problems associated with Rh, and extremely serious ones, in addition to the period a woman is waiting for a child, can manifest themselves during the blood transfusion procedure.
Previously, for people who required a transfusion, everything often ended fatally, until it was found out that the Rh compatibility factor of the donor and recipient (patient), along with the blood group, plays a priority role in the positive outcome of the procedure.
Severe complications can arise if red blood cells from an Rh+ donor are “transfused” into an Rh- recipient. The body perceives them as a threat due to the presence of D protein (antigen), which the patient’s immunity has not previously encountered.
The response against the “new, foreign” protein fraction is the synthesis of antibodies, which provoke damage and premature destruction (death) of red blood cells.
With the development of the immune reaction, anti-erythrocyte antibodies (immunoglobulins) gradually destroy their own red blood cells, from mass death erythrocytes, dysfunctions of the liver, spleen (increase in size), and respiratory system occur.
Rh incompatibility can cause complications during or immediately after the blood transfusion procedure:
- chills;
- deterioration of health.
In a negative scenario, including kidney failure, the absence of urgent care in such a situation medical care fatal, capable of causing death.
Similar processes (reactions) occur during pregnancy and are caused by incompatibility of the blood of the mother and fetus according to the group or Rh factor.
Antibodies destroy fetal red blood cells, which leads to a number of dangerous, sometimes critical complications:
- hemolytic pathology;
- abortion;
- antenatal (in utero), intranatal (during childbirth) death for a child.
The consequences of Rh-unmatched blood transfusions are severe, often appearing in women after the second transfusion, in men after the third, sometimes even the fourth.
This “slowness” is due to the fact that the recipient’s Rh factor, unlike blood types does not express itself during the body’s initial acquaintance with donor blood.
Since the Rh system does not have natural immunoglobulins, during the first blood transfusion, the patient’s immunity does not negatively perceive “new”, previously unfamiliar protein fractions. None visible changes not happening.
Hemolysins (antibodies) begin to be produced only after the first or subsequent “acquaintance” with the erythrocyte antigens of the Rh (+) donor; the body’s reaction to such encounters can differ significantly.
With repeated blood transfusions, the recipient's antibodies can cause massive agglutination, gluing of red blood cells into a single mass and the start of hemolysis. The resulting blood “lumps” lead to thickening of the biomass in the vessels and provoke the formation of blood clots.
The risks of transfusion shock are increasing - an extremely dangerous complication of the transfusion procedure, accompanied by intense hemolysis and the release of toxic substances into the recipient.
To avoid the described complications, it is necessary to take into account the Rh compatibility factor of the donor and the patient.
Specific protein D is localized on the surface of the red blood cells of most people; 85-86% of the world's population are positive for Rh. In the remaining 14-15%, the blood is genetically “deprived” of this antigen, but this situation is neutral for the body, since the very fact of the presence or absence of Rh does not affect health in any way.
Approximately fifteen percent of expectant mothers (150 out of every 1000) are genetically endowed with Rh-, the frequency of development of Rh incompatibility (the fetus inherited the Rh+ father) is insignificant, accounting for 2% of the total under these conditions. One case per 150-200 births.
Probability tables
Basic hematological characteristics, such as Rhesus or blood group, can be transmitted genetically from the father or mother with an equal degree of probability.
Special tables will help you assess the possible risks of developing a conflict situation.
By blood type
Group | Probability of conflict | ||
Father | Mother | Child | % |
1 | 1 | 1 | 0 |
1 | 2 | 1 or 2 | 0 |
1 | 3 | 1 or 3 | 0 |
1 | 4 | 2 or 3 | 0 |
2 | 1 | 1 or 2 | 50 |
2 | 2 | 2 or 1 | 0 |
2 | 3 | Any | 25 |
2 | 4 | 1,2,4 | 0 |
3 | 1 | 1 or 3 | 50 |
3 | 2 | Any | 50 |
3 | 3 | 1 or 3 | 0 |
3 | 4 | 1,2,4 | 0 |
4 | 1 | 2 or 3 | 100 |
4 | 2 | 1,2,4 | 66 |
4 | 3 | 1,3,4 | 66 |
4 | 4 | 2,3,4 | 0 |
Rh compatibility chart
Rh factor | Probability of conflict | ||
Father | Mother | Fetus | % |
Plus/Minus | |||
+ | + | 75% 25% | No |
+ | – | 50% 50% | 50 |
– | + | 50% 50% | No |
– | – | 0% 100% | No |
Information about compatibility provided in tables, or obtained from calculations of online calculators, which abound on the Internet, is not considered final.
You will receive accurate information only from the results of laboratory tests.
Etiology
The development of a conflict state is caused by the entry into the bloodstream of the Rh-negative mother of the opposite Rh(+) blood of the fetus, inherited from the father.
Factors predisposing to conflict:
- blood transfusions were carried out without taking into account Rh compatibility (nonsense for modern medical realities, but completely exclude this reason it is forbidden);
- secondary, or even third expectation of a child;
- previous interruptions - artificial (abortion), spontaneous (miscarriage);
- ectopic pregnancy;
- delivery by caesarean section;
- premature detachment of the “baby place” (placenta);
- (can manifest themselves regardless of the period of embryogenesis);
- prenatal (prenatal) diagnostic measures - intrauterine puncture of the umbilical cord vessels, biochemical analysis of amniotic fluid (sampling of amniotic fluid), examination of chorionic villi.
Current or past pathological conditions can act as catalysts for Rh sensitization of the expectant mother’s body:
- diabetes;
- flu;
- dysfunction of organs and systems caused by impaired adaptation of the body to developing pregnancy (preeclampsia).
Pathogenesis
Starting from the 8th week of intrauterine development, the formation of hematopoiesis of the unborn child “starts”. From this date, small amounts of protein D can be laboratory detected in the blood of a mother with a “-” Rh factor.
From the moment the gestational age of the fetus becomes more than two months, risks of Rh conflict arise.
The meeting of red blood cells (RBC) with different rhesus (mother “-“, fetus “+”) is extremely dangerous, leading to agglutination, “sticking together” into single masses.
For the immunity of a Rh-negative mother, positive RBCs of the fetus are perceived by a foreign “agent”, which provokes the body to respond (isoimmunization).
The immune system begins to produce antibodies.
Synthesized anti-Rhesus immunoglobulins (IgM, IgG) “binding” with the D protein prevent agglutination and do not allow red blood cells to unite (stick together).
Conflict during the first gestation
During the first pregnancy, Rh incompatibility rarely leads to complications during pregnancy; in detail, such problems are recorded in isolated episodes.
Antibodies (IgM) produced by maternal immunity are large, “clumsy”, and their concentration is insignificant. This does not allow it to globally overcome the placental barrier, penetrate into the unborn baby and negatively affect the intrauterine development of the unborn baby.
If the end of the first pregnancy is an abortion, or artificial completion of the birth act is forced, then the likelihood of immunization of the female body increases significantly.
In such cases, the risks of Rh conflict (hereinafter referred to as RK) when expecting a child for the second time, and subsequent times, seriously increase.
Immune memory cells are long-lived; synthesized antibodies after the first birth remain circulating in the bloodstream.
Conflict during the second gestation
If a woman is pregnant for the second time with an Rh-positive fetus, then the body’s immune response is clearer, and the reaction to the secondary appearance of a “foreign” protein is much faster and more global.
The number of synthesized anti-Rh antibodies is larger, smaller in size, and much more mobile than IgM.
Its small size allows it to easily overcome the hematoplacental boundary (barrier), penetrating into the baby’s bloodstream and provoking the destruction of the cell membrane of the Rh-positive red blood cells of the unborn baby. The process of hematopoiesis is inhibited.
Intravascular hemolysis (destruction) of Rh “+” erythrocytes of a child contributes to the accumulation of decay products in the fetal bloodstream, which become more and more abundant as the pathological process intensifies.
Bilirubin is especially dangerous; in excess concentrations it has an extremely negative (poisonous) effect on intrauterine growth and becomes a catalyst for hemolytic disease.
The more intense the hemolysis, the more clearly hypoxia affects the organs. In an attempt to compensate for the lack of destroyed red blood cells, the size of the liver and spleen increases.
In a critical scenario, when the brain is practically deprived of oxygen and the spleen is clearly visible, the risks of antenatal death of the baby significantly increase.
Fortunately, given the modern capabilities of medicine, such situations can be avoided in the overwhelming majority of cases.
During the second pregnancy, if the mother’s Rhesus “-” and the unborn baby’s “+” are incompatible, it is more common for the baby to be delivered with a mild or moderate degree of hemolytic pathology.
Rh conflict during third gestation
The risks of conflict between the Rhesus of the mother “-” and the fetus “+” during the third pregnancy are high, since the concentration of anti-Rhesus antibodies by this moment reaches the “peak”, the likelihood of complications for the unborn baby is significant.
Unfortunately, even with timely therapeutic measures taken, in these situations it is not always possible to minimize risks.
If the level of synthesized antibodies rapidly increases, then in order to avoid a severe scenario for the development of intrauterine pathology in the pregnant woman, premature delivery is recommended.
Clinical picture
The threat can be detected exclusively in a laboratory way, by the presence of antibodies to the fetal Rh factor in a woman.
There are no external manifestations of Rh incompatibility between the blood of the expectant mother and the child; sometimes functional disorders are possible, symptomatically reminiscent of signs of gestosis.
Directly during pregnancy, or later after childbirth, RK does not significantly threaten a woman’s health. In the absence of concomitant pathologies, health is not seriously affected.
On the mother's side, while waiting for the baby, there are no specific clinical symptoms. Only indirect signs of a general nature that do not directly signal a conflict problem.
Alarming indicators of an impending threat of Rh conflict can manifest themselves in such a situation exclusively on the side of the unborn child.
In the later stages, an ultrasound scan of the fetus can provide a reliable information picture, but it is important to “catch” the onset of the conflict as early as possible, therefore for all pregnant women, especially those with a negative Rh factor and blood type O, a regular antibody test is considered a mandatory diagnostic measure.
Having performed an ultrasound, the doctor will receive a detailed picture of how severely the cancer has developed, and what treatment regimen to choose in order to minimize the negative impact this pathological process brings to the child.
The severity of RK manifestations is determined by the concentration of anti-Rhesus antibodies in the pregnant woman, plus the degree of fetal maturity.
During an ultrasound examination, attention is paid to alarming indicators indicating the development of hemolytic disease of the fetus (HDF), which after birth is called hemolytic disease of the newborn (HDN):
- , increase in the diameter of the umbilical “cord” (vein);
- abnormally large belly of the fetus;
- the binary contour of the head of the unborn baby, due to the resulting edema;
- excessive accumulation of fluid in the chest and abdominal cavity of the child;
- growth of the liver and spleen is noted;
- unnatural position of the fetus, due to the large belly, the legs are pulled to the sides.
Forms of GBP:
- anemic;
- icteric;
- edematous.
The edematous variant is extremely dangerous; it is severe in case of RK, and is accompanied by a number of serious disorders:
- hepato- and splenomegaly;
- distinct anemia;
- thickening of the “baby spot”;
- polyhydramnios;
- ascites, generalized fetal hydrops;
- edema-hemorrhagic syndrome;
- a drop in the concentration of albumin (a key protein in the blood serum).
The icteric form of hemolytic disease is inferior in severity to edematous, although it is also considered a dangerous pathological condition, the accompanying manifestations are:
- increase in the size of organs (liver, spleen, heart);
- hyperbilirubinemia (increased bilirubin levels)
- icteric discoloration of the skin (not to be confused with infectious jaundice).
Bilirubin intoxication is extremely dangerous, since this bile pigment, at elevated concentrations, can affect the child’s central nervous system, which has an extremely negative effect on development.
Manifestations of high bilirubin vary, for some children it is:
- lethargy;
- slowness;
- poor appetite.
Others, on the contrary, have the opposite symptoms:
- increased excitability;
- is constantly capricious;
- cries for a long time, especially at night;
- often shudders.
Poisoning of the body with bilirubin in RK can become a catalyst for constant regurgitation and vomiting of the baby, hearing and reflexes deteriorate, and convulsions are possible.
Ultimately, hyperbilirubinemia (which destroys brain cells) leads to a sharp lag in development (mental, mental, physical), which is expressed in a number of serious illnesses and contributes to the disability of a child from early childhood.
Fortunately, a similar course of tension-type headache in RC is recorded in rare, isolated episodes.
The anemic scenario of HDP is characterized by a slight degree of pathology and is accompanied by the appearance of a large number of immature red blood cells.
A timely identified Rh conflict provides the opportunity to quickly take the necessary therapeutic actions to protect the unborn child from the negative consequences of this pathological condition.
The impressive progress of medicine allows us to identify and solve such problems in a timely manner in the overwhelming (90-95) percentage of cases with a favorable prognosis.
A woman with Rh(-) planning a child for the first time, or who has already given birth, in order to avoid blood transfusion shock, must warn doctors about her hematological characteristics.
Diagnostics
Testing for RK begins with determining the Rh factor and blood type. If the Rh affiliation of the expectant mother is revealed to be “-“, then a similar procedure is indicated for the baby’s father. If the father’s result shows Rh(+), then control over the progress of the pregnancy is significantly enhanced.
It is preferable if such a procedure is carried out in advance, at the stage of planning the first child, or in the early stages of gestation.
It is possible to determine Rh mismatch exclusively in a laboratory, by analyzing the presence and level of anti-Rh antibodies. If confirmed problematic situation it is important to fix the class of allocated female body immunoglobulins IgM, IgG.
The frequency of such research is determined by gestational age:
- up to the 20th week, it is indicated every 28 days, then it is advisable to be observed under the supervision of doctors at the perinatal center - a specialized wide-profile medical institution dealing with pregnancy management;
- at 32-35 weeks of gestation, the intensity of blood testing for antibodies increases to twice a month, then after 35 weeks the analysis is performed every week.
Dynamic monitoring of fetal growth is carried out using ultrasound; in the gestation interval from 18 to 36 weeks, such a study is carried out four times, the final fifth immediately before birth.
The results of an ultrasound examination make it possible to make predictions about the development of RK, to understand how seriously the pathological process has affected the fetus, and it becomes possible to assess:
- size of the placenta;
- location (position) of the baby;
- degree of swelling;
- the size of the future baby’s tummy, certain organs (spleen, liver).
With the help of ultrasound, disorders associated with RK are detected:
- varicose veins of the umbilical vein;
- increased volume of amniotic fluid (amniotic fluid);
- abdominal ascites.
An obstetrician-gynecologist, dynamic monitoring of the progress of pregnancy, in addition to ultrasound of the fetus, is helped by other non-invasive techniques:
- CTG - cardiotocography helps to assess the current condition of the unborn baby, the severity of hypoxic-ischemic damage to the central nervous system;
- FCG - phonocardiography analyzes the cardiac activity of the fetus using ultrasonic waves;
- ECG - testing the bioelectric potential of the cardiac system;
- Dopplerometry - evaluates the intensity of blood movement in the vessels.
Prenatal diagnosis of RK:
- Biochemical examination of amniotic fluid - mainly prescribed at gestational ages of 34-36 weeks, reveals the level (optical density) of bilirubin in the amniotic fluid. It is necessary to take into account the risk of negative nuances of such a procedure, among possible pathological conditions are leakage, premature rupture of amniotic fluid, bleeding, infection;
- cord blood analysis - diagnoses the severity of anemia in RC, allows you to determine a number of necessary hematological characteristics;
Treatment of Rh conflict during pregnancy
If the expectant mother tests positive for antibody titer, then for a woman such a situation is not a reason to panic, but a weighty argument to strengthen control over the condition.
For an obstetrician-gynecologist accompanying pregnancy, the detection of anti-Rhesus antibodies is an indicator signaling the need to begin therapeutic actions.
Unfortunately, if RK is detected, it is impossible to completely protect the woman and the unborn baby from the negative impact of such a pathological condition, but doctors can significantly minimize the risks created and mitigate the consequences of Rh incompatibility.
All pregnant women with negative Rh are given courses of anti-sensitizing nonspecific treatment three times during gestation:
- increase vitamin intake;
- means that improve metabolism;
- additionally prescribe iron/calcium containing drugs;
- oxygen therapy.
Similar courses of additional treatment are carried out at the following times:
- 1 time - 10-12 weeks of gestation;
- 2 times - 22-24 weeks;
- 3 times - 32-34 weeks.
After 36 weeks, the possibility of independent delivery (natural birth) is allowed, provided there is no or low titer (level) of antibodies and the doctor has no reason to worry about the condition of the fetus.
If the situation worsens, a high titer leads to complications, the condition becomes severe, then childbirth is carried out earlier, after 37 weeks. Delivery is carried out by caesarean section.
Until this moment, in order to provide the child with the opportunity to fully develop and “mature,” they try to support the pregnant woman with medication.
Unfortunately, this is not always possible; sometimes, in order to avoid the loss of the baby’s life, doctors have to make a decision on early delivery by cesarean method.
Severe variants of HDP (edematous, icteric forms) serve as an indication for fetal blood transfusion - intrauterine transfusion of donor blood to the fetus through the vessels of the umbilical cord.
To minimize the risks, such a surgical procedure is performed under ultrasound control, as a result it is possible to partially neutralize the anemia and hypoxia accompanying HDP. Prolong pregnancy, giving the unborn baby the opportunity for full intrauterine development.
Among other methods of counteracting Rh conflict during pregnancy, plasma is prescribed by centrifugation.
Centrifugal plasmapheresis is performed in the second half of gestation, the main task This procedure can reduce the concentration of antibodies to Rh-positive erythrocytes of the fetus.
As a result of the actions taken Negative influence the baby's Rh incompatibility will temporarily subside.
The plasmapheresis procedure should not cause significant concerns; it is safe and well tolerated, however, the above is of course relevant, subject to full compliance with the technology (rules) of the procedure.
Before starting the procedure, the doctor must inform the pregnant woman about the possible development of side effects:
- dizziness;
- nausea;
- a fall blood pressure.
Expressiveness side effects weak, disappear mainly on their own, over a short time interval.
Among the absolute contraindications:
- violation of coagulation (blood clotting).
Relative contraindications (strict medical supervision during the procedure):
- tendency to develop anaphylaxis;
- exacerbation of infectious pathologies;
- liver dysfunction;
- low hemoglobin concentration;
- cardiovascular disorders.
Plasmapheresis sessions have a positive effect on the course of pregnancy, however, to achieve the desired result and prevent the development of negative consequences, such manipulation should only be carried out by an experienced hematologist.
A child born with severe hemolytic disorders, after birth (immediately), undergoes a replacement blood transfusion (transfusion) of Rh (-) same-group blood or plasma, which helps to avoid serious complications. Treatment of hypertension in the newborn is started.
Prevention
In order to avoid severe complications for the child during an Rh incompatible pregnancy, priority is given to preventing Rh immunization and directly to the conflict of Rhesus levels of the maternal and fetal blood.
Preventive criteria:
- taking into account compatibility during blood transfusion of Rh(-) women and donor;
- preservation of the first pregnancy, absence of abortions.
Among preventive measures one of the main roles is given to competent planning of the child; the expectant mother needs to be examined in advance:
- find out the Rh factor and blood group;
- for antibodies.
Risk of developing Rh conflict, detection of antibodies, contraindication to conception, or interruption of the current gestation is not considered, but a woman with negative Rh needs to be aware that she will have to donate blood more often during pregnancy compared to other pregnant women.
It is possible to exclude, almost 100%, the absence of a conflict situation regarding Rhesus in such conditions only if the partner is Rh(-), and with an identical blood group.
However, in the absence of such a match, refusing pregnancy only for reasons of Rh incompatibility or the partner’s blood type is a rash decision.
Rh medicine is not able to completely resolve the identified conflict, but doctors are able to significantly minimize the possible negative consequences for the child.
Women with negative Rh, whose analysis for antibodies to the Rh antigen showed their absence, are prescribed intramuscular injections of donor anti-Rhesus immunoglobulin to prevent RK. If the antibodies have already been “fixed”, then it is difficult to expect tangible results from such vaccination.
Such a therapeutic measure prevents isoimmunization of the body, significantly reducing the likelihood of developing a Rh conflict situation. In the future, the risks of having a baby with manifestations of hemolytic disease are significantly reduced.
To achieve a noticeable preventive effect from the injection of anti-Rhesus immunoglobulin, it is necessary to comply with the timing of drug administration.
Women with Rh(-) are advised to undergo RhoGAM no later than three days; the indications for such a preventive injection are:
- Rh(+) blood transfusion;
- abortion;
- bleeding, even minor;
- surgical intervention due to ectopic pregnancy.
To prevent hemolytic pathology of the fetus, pregnant women with Rh(-) are prescribed RhoGAM at 28 weeks of gestation, sometimes the injection is repeated at 34 weeks.
After birth, if the child was born Rh(+), and the mother’s test for antibodies to Rh showed a negative result, then the injection of anti-Rhesus immunoglobulin is repeated.
This reduces the risk of Rh sensitization (conflict) during subsequent pregnancy.
For new gestations, women with Rh(-), due to the likelihood of Rh conflict, the injection must be repeated.
FAQ
Lactation
If there is a difference in the Rhesus of the mother (-) and the baby (+), combined with the absence of disorders associated with HDN, breastfeeding is generally not contraindicated.
For children born with HDN (mild degree), it is not recommended for a young mother to breastfeed for the first 10-14 days, then the issue is resolved at the discretion of the neonatologist. The discharge will probably go through the hospital, but in such a situation it is better to play it safe, the baby’s health is most important.
Severe hemolytic disorders in a newborn are considered an indisputable ban on breastfeeding.
For medical reasons, sometimes lactation is “stopped” artificially, for example, to avoid the development of mastopathy.
To suppress the formation of milk in the breasts of a nursing mother, hormonal medications may be prescribed immediately after childbirth.
Such decisions are made exclusively by a neonatologist, who will select the optimal medicine with minimal side effect, correctly choose the dosage of use.
Independent actions in such a situation are categorically unacceptable.
There was rhesus incompatibility during the first gestation (mother “-“, child “+”), is it possible to give birth to a second child without conflict?
The answer is positive, if the baby inherits a negative Rh, then a conflict situation can be avoided, however, anti-Rh antibodies in the mother’s bloodstream can be diagnosed throughout the entire gestation, and at a fairly high concentration.
Their presence should not cause any significant concern, since they are neutral to a fetus with a negative Rh factor.
Competent pregnancy planning is an extremely important issue; before making a decision, it is strongly recommended to visit a geneticist. A specialist will help you figure out how likely it is that an Rh conflict will develop and that the future baby will inherit one or another hematological characteristic of the parents.
Father's Rh unknown
After registering a pregnant woman at the antenatal clinic and identifying “-” Rh, the doctor invites the father of the unborn child to take a test (to determine Rh, blood type).
Knowing the hematological characteristics of both parents, the doctor is able to timely take the necessary therapeutic measures to minimize the possible negative consequences of Rh incompatibility.
However, situations are different, sometimes it is not possible to find out the father’s Rh, or in order to achieve pregnancy, the procedure of in vitro fertilization with donor ejaculate was used.
In such circumstances, a woman will have to take a blood test more often, compared to other pregnant women with similar hematological parameters. It is important to react in time to the “start” of the conflict, if one occurs.
How does Rh(-) affect fertility?
It has no effect, this factor has nothing to do with the ability to get pregnant, the etiology of decreased fertility is due to other reasons:
- addictions;
- friendship with caffeine;
- complicated medical history
- pathologies of the reproductive and urinary systems.
Is vacuum abortion during the first gestation safe for an Rh(-) pregnant woman?
No, methods of terminating a pregnancy do not matter; the D-protein of the fetus still penetrates into the mother’s bloodstream, provoking a response from the woman’s immune system.
The result of the first pregnancy was an abortion, what are the risks during the second gestation?
The likelihood of a conflict situation developing in such conditions is a relative formulation; no one is able to specify the answer 100%.
Based on statistical data, the doctor has the opportunity to approximately estimate the chances of sensitization of the mother’s body after the first unsuccessful gestation:
- early abortion (short term) - an additional 3-4% increase in the likelihood of Rh incompatibility;
- artificial “stopping” of pregnancy increases the risks by six percent;
- surgical intervention caused by an ectopic complication of pregnancy - an increase in risks by 1-2%;
- artificial termination of labor on time with a live fetus - an additional 15% risk;
- artificial completion of the birth act by cesarean method is a high, up to 50% chance of Rh conflict during the second pregnancy.
However, do not forget that it is not recommended to engage in such “calculations” on your own; only a doctor will help you competently assess the likelihood of a conflict, after carrying out the necessary diagnostics.
A woman with a negative Rh who decides to become a mother for the second and subsequent times is required to have a detailed consultation with a gynecologist before starting to carry out her plans.
Is the presence of antibodies in the mother's bloodstream a signal that the child will be born with HDN?
This does not happen in all cases; the aggressive effect of anti-Rhesus antibodies on the child is partially mitigated by special “filters” located in the placenta.
In small quantities, maternal immunoglobulins are not capable of significantly harming the baby, however, there are a number of pathological catalysts that increase the likelihood of a decrease in the protective barrier of the placenta, increasing the risks of HDP:
- premature aging of the “children’s place”;
- low level of amniotic fluid;
- , including common ARVI;
- lack of medical supervision when taking medications.
It is necessary to remember that during the first gestation, if “fixation” of antibodies occurs, then due to their large molecular structure it is difficult for them to overcome the placental barrier, but with subsequent pregnancies the situation changes.
The maternal body’s immune response to the foreign D-protein is sharp, the antibodies produced are smaller, more mobile, “meaner,” and the risks of developing HDP increase.
Is conflict possible even if both parents are with Rh(-), contrary to predictions and probability tables?
It would not be correct to state with 100% probability that it is impossible for a Rhesus conflict to develop in such a situation, although the chances of such an option are close to zero.
An experienced obstetrician-gynecologist will not rule out the phenomenon of blood chimerism, and any of the three could be a “chimera”:
- Mother;
- dad;
- child.
This phenomenon occurs extremely rarely and is characterized by the presence of two different blood groups in a person.
Issues related to genetics have not yet been fully studied; the possibility of “surprises” from nature cannot be ruled out.
Rhesus conflict during pregnancy should not be perceived as a disaster and panic; by taking control of the situation in time, you will be able to successfully complete the gestation, save and give birth to a healthy child.
Take an interest in health in time, goodbye.
Pregnancy is an extremely important stage in the life of every woman. The future of the child, the state of his health and immunity directly depends on its course. It is necessary to foresee the most likely dangers and eliminate all risk factors, which include Rh conflict during pregnancy. When a future woman in labor registers with the antenatal clinic (LC), she will be given a referral for a variety of tests and studies. They are necessary to identify possible diseases and risks of bearing a child.
Each time, not only the blood type is determined, but also the Rh factor, Rh, which is considered a fundamental indicator. It is present in approximately 85% of humanity, they are considered Rh positive. Those 15% of the population in which this protein is not detected are Rh negative. In everyday life, it is absolutely not important which Rh factor is inherent in an individual.
This indicator becomes important after conception, in particular when registering. When does Rh conflict occur during pregnancy? This mainly occurs when the mother is Rh negative and the father is positive. This is the case when unborn child inherits Rhesus biological father. Therefore, there is a discrepancy between the Rhesus blood of the mother and the fetus. And here Rhesus conflict is diagnosed. The risk of this conflict reaches, according to various estimates, 75%. If a woman is Rh positive and the father is Rh negative, there is no conflict, and the pregnancy (especially the woman’s first) will pass without complications.
![](https://i1.wp.com/ladies365.ru/wp-content/uploads/2017/07/Konflikt-rezusov-otca-i-materi.jpg)
Reasons for development
Rh conflict occurs if the blood of a fetus with Rh “+” enters the mother’s system with a negative status. More often, pathology is diagnosed during the second and each subsequent pregnancy, extremely rarely during the first, if there has been a blood transfusion with components or whole blood without determining Rh. An imbalance occurs when the baby’s blood becomes foreign to the mother’s body and antibodies are synthesized. Positive and negative red blood cells at the moment of “meeting” stick together - agglutination. To prevent this, the immune system synthesizes antibodies - immunoglobulin. This substance comes in 2 types, it tries to destroy them, hemolysis occurs.
![](https://i1.wp.com/ladies365.ru/wp-content/uploads/2017/07/posledstvya-rezus-konflicta.jpg)
As pregnancy progresses, there is a constant exchange of oxygen and nutrients between mother and baby. The woman receives the waste products of the child. In the same way, mother and baby exchange red blood cells, the baby’s blood is filled with antibodies. Rh conflict during the first pregnancy is a rare case. It produces antibodies of the LgM type. They have a large diameter and penetrate the fetus to a limited extent without causing any problems. With each subsequent conception, starting from the second, the likelihood of a Rh conflict increases, since the mother’s body already produces other antibodies - LgG. They are much smaller in size, and a larger number of them enter the fetal circulatory system, bypassing the placenta.
![](https://i2.wp.com/ladies365.ru/wp-content/uploads/2017/07/tablica-rezus-konfliktov-pri-beremennosti.jpg)
The process of hemolysis occurs, and the toxin bilirubin begins to accumulate. Antibodies were released in previous pregnancies; how they ended does not matter.
The “provocateurs” of the conflict are considered to be:
- previous natural childbirth;
- Caesarean section operation;
- abortions and terminations of pregnancy;
- miscarriage;
- placental abruption before term and manual separation.
Symptoms and signs
The woman’s well-being during such a conflict is practically not affected, the symptoms are not clearly expressed. Slight anemia may occur, problems with liver function may occur, and toxicosis may become more pronounced. However, there is real danger for a child. If Rh conflict occurs during pregnancy, the risk to the fetus is very serious. Hemolytic disease is diagnosed, and it often provokes premature or complicated labor and death in the womb. Pregnant women need to undergo an ultrasound examination to identify possible pathologies.
Symptoms of intrauterine Rh conflict:
- increased swelling, especially in the abdominal cavity, in the pericardial sac;
- the spleen, liver, heart may increase in volume;
- the soft tissues of the head swell, a double contour appears;
- due to the enlarged tummy, the child’s limbs look to the sides;
- the placenta thickens, the diameter of the umbilical vein increases.
Dangers for the baby
The resolution of red blood cells affects the functioning of the child’s body. The culprit is bilirubin, a breakdown byproduct. The functioning of the nervous system, heart, kidneys and liver is most severely disrupted. The intrauterine death of a baby can result from the accumulation of fluid in the tissues of the body. There is a high risk of miscarriage and premature birth.
How dangerous is this conflict for a newborn child? The following stages of hemolytic disease are possible:
- Anemic. The child has a reduced number of red blood cells, pale skin, lethargy, and suppressed sucking reflexes. The baby's heart beats faster, its tones are muffled.
- Jaundice is the most common variant of the disease. Signs of Rh conflict are determined by an increase in the concentration of bilirubin in the child’s blood, which occurs after the destruction of red blood cells. The liver and spleen increase in size. The skin usually has a pronounced yellow. In more severe cases, it may affect nervous system, bilirubin encephalopathy is diagnosed. At the same time, muscle tone changes, reflexes are weakened, and intracranial pressure increases. Perhaps the appearance of seizures.
- The most serious form is edematous. It occurs if antibodies begin to be produced early enough, in the second trimester. In this case, the integrity of the vascular wall is compromised, and fluid and proteins come out of the tissues. This causes the appearance of edema in the internal organs.
Prevention
To prevent hemolytic disease, a woman may be offered a vaccination; a vaccine based on anti-Rhesus immunoglobulin is used. The first injection is given at 28 weeks, since most often at this period the risk of Rh conflict is maximum. The second injection is indicated in the first three days after delivery.
To minimize potential complications during subsequent pregnancies, immunoglobulin in the form of serum must be injected in the first 3 days after birth. It destroys Rh-positive components that have entered the circulatory system of the mother in labor from the fetus. At the same time, the risk of such pathologies occurring during subsequent pregnancy is significantly reduced.
Diagnostics
Usually, after determining the mother’s conflict, a similar study is carried out on the child’s father. When determining the father's Rh-positive status, it is necessary to do an analysis to determine the concentration of antibodies. All patients with Rh-negative status are prescribed a repeat test in the middle of pregnancy. From the thirty-second week it is carried out twice a month, and from the thirty-fifth - weekly. It is important not to miss a sharp increase in the number of antibodies. Already from 18-20 weeks it is necessary to do an ultrasound. Repeated examinations are carried out at least three more times. If necessary, a woman is prescribed Doppler measurements and cardiotocography; they are necessary to assess the well-being and development of the fetus.
If necessary, the doctor may prescribe invasive testing methods:
- Amniocentesis. During this examination, a small amount of amniotic fluid is collected and the level of bilirubin in it is determined.
- Cordocentesis. For the study, a small volume of the baby’s blood is extracted by puncturing the umbilical cord, and the concentration of bilirubin is also determined.
![](https://i2.wp.com/ladies365.ru/wp-content/uploads/2017/07/vyavlenie-rezus-konflicta.jpg)
Treatment methods
Now, in fact, only intrauterine blood transfusion can be considered an effective treatment for such a pathology. The procedure is prescribed only if the child suffers from anemia, which affects his growth and development. This method of treatment is carried out in a hospital, with its help it is possible to achieve significant stabilization of the baby’s condition, reduce the risk of early delivery, the occurrence of serious pathologies after childbirth.
Most often, such treatment is intended for those women who have been diagnosed with excess permissible norm antibodies in the first half of the 1st trimester, as well as for patients who had a previous pregnancy with Rh conflict. These patients are sent for observation and treatment in a hospital (usually an inpatient facility). Methods for purifying blood (plasma) from antibodies, for example, plasmapheresis, hemosorption, and techniques for increasing the activity of the immune system have been recognized as ineffective, and are almost never used today.
Delivery in case of Rhesus conflict
Quite often, delivery is carried out ahead of time, since in the last weeks the concentration of antibodies increases sharply. The resolution option is determined based on the condition of the pregnant woman and the baby. It is generally accepted that with a caesarean section the risks for the baby are minimized; in certain cases, only this operation is performed. If the baby is in satisfactory condition, the gestation period exceeds 36 weeks, natural childbirth is already allowed. They must be carried out by highly qualified personnel, it is necessary to carefully monitor the condition of the woman and the fetus, and carry out methods to prevent hypoxia.
Some doctors speculate that antibodies may end up in breast milk, this fact was not confirmed. Most often, obstetricians recommend abstaining from breastfeeding for a short time. This is necessary so that potentially harmful substances leave the woman’s body. Some doctors are confident that there are no risks and you can feed immediately after delivery. It is almost always possible and necessary to continue breastfeeding. It is very useful for the baby, especially weakened by such a difficult pregnancy.
If a Rhesus conflict is established, parents need to be extremely attentive to the state of health and begin to take care of the unborn child at the stage of planning for conceiving a child. Be sure to get tested in a timely manner and visit your doctor. This will avoid many dangers and problems.
Isoserological incompatibility of the blood of 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 Rh conflict. In the absence of adequate therapy and timely assistance, this condition threatens spontaneous termination of pregnancy, fetal death in the later stages, or the development of hemolytic disease. Serious consequences They are expecting a baby even after birth. What should a woman know about this dangerous pathology?
Rhesus: general concepts
Each person’s body contains specific antibodies that determine the Rh status of their blood. Rhesus is a set of 50 special antibodies - proteins located on red blood cells. IN practical medicine highest value have group D antibodies. It is these proteins that determine the Rhesus of each person.
The Rh factor is established at the moment 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 population globe 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 suffer from various diseases equally often. Rhesus does not affect the conception of a child. Problems arise only in Rh-negative women during pregnancy. It has been proven that the absence of an important protein can have a fatal effect on fetal development under certain circumstances.
Excursion into genetics
The rhesus of the embryo is laid at the moment of conception and is determined by the rhesus of its parents:
Based on these data, several conclusions can be drawn:
- In an Rh-positive woman, the conflict never develops, and the Rh of the fetus does not matter at all.
- A Rh-negative woman can give birth to an Rh+ or Rh- child.
- If an Rh mother carries an Rh child, there will be no conflict.
Rh conflict occurs in one and only case: when an Rh-negative woman is pregnant with an Rh-positive fetus.
Causes of Rh conflict
The essence of the problem is that there are no specific antibodies in the blood of an Rh- woman, while they are present on the red blood cells of the Rh+ embryo. During gestation, the blood of mother and child inevitably mixes. Antibodies from the fetus enter the mother's bloodstream. Here they are perceived as some kind of alien object. A woman’s immune system 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 Rh conflict during pregnancy.
Rh antibodies that have entered a woman’s bloodstream are very aggressive. They are not at all dangerous for the mother, but they represent real threat health and life of the fetus. Moreover, the first pregnancy for an Rh woman usually ends successfully. The likelihood of developing Rh 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. Subsequently, upon repeated contact (second pregnancy), class G (YgG) antibodies are formed, which easily pass through the placenta, enter the fetal bloodstream and exert their negative effects.
Rh-positive antibodies enter a woman’s bloodstream in the following situations:
- during childbirth;
- during abortions, miscarriages;
- with an ectopic pregnancy (at the time of its termination).
The risk of developing antibodies increases in the following situations:
- in case of bleeding during pregnancy;
- during invasive manipulations during pregnancy (amniocentesis, cordocentesis, chorionic villus biopsy);
- during traumatic childbirth;
- with manual separation of the placenta;
- during a caesarean section.
In all these situations, it enters the maternal bloodstream. large number fetal red blood cells carrying Rh+ antibodies. It is also possible for antibodies to form when transfusion of Rh-positive (incompatible) blood to a woman. This phenomenon is called Rh sensitization.
In most cases, a woman is immunized during her first birth. In this case, the child is born healthy, but Rh antibodies penetrate into the mother’s body. Once they appear, they remain in the bloodstream forever. It is impossible to get rid of Rh antibodies. During another pregnancy, these antibodies quickly recognize the Rh+ fetus and send a signal to the immune system. That is why repeated pregnancy with an Rh+ fetus leads to the development of serious complications, including its termination. With each subsequent pregnancy, the severity of the possible consequences increases.
Symptoms in women
There are no specific manifestations of Rh conflict. Future mom does not notice any changes in his condition. The woman’s well-being is not affected. Without laboratory diagnostics and ultrasound, it is impossible to determine pathology based on clinical symptoms alone.
Some experts talk about the existence of “mirror syndrome”. There is an opinion that with an increase in antibodies in the blood, a woman experiences characteristic symptoms of gestosis as a sign of a violation of the body’s adaptation to pregnancy. There is the appearance of edema, increased blood pressure, and deterioration in general condition. Currently, the connection of these signs with Rh 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 disruption of life important functions fetus and are at risk of developing the following complications:
- spontaneous miscarriage;
- premature birth (after 22 weeks);
- HDP – hemolytic disease of the fetus;
- HDN is a hemolytic disease of the newborn.
The first two complications should be considered as manifestations of tension-type headache, but it is not always possible to find out the exact cause of termination of pregnancy.
Hemolytic disease of the fetus and newborn
Passing through the hematoplacental barrier and penetrating the fetal bloodstream, Rh+ antibodies enter into a specific reaction with fetal antigens located on red blood cells. As a result of all these actions, hemolysis develops - the destruction of red blood cells, and a chain of pathological reactions starts:
- 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 forces the fetal liver and spleen to work harder, as a result of which these organs increase in size.
- The load on the kidneys increases, which leads to their failure up to the complete cessation of their function.
- There is damage to fetal brain cells.
Hemolytic disease makes itself felt in the second half of pregnancy. Pathology is detected by 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, Rh conflict appears after the birth of a child. This condition is called hemolytic disease of the newborn (HDN). The symptoms are similar to HDP, since the initial symptoms of the pathology are noted during the period of intrauterine development.
Forms of hemolytic disease (HD):
Anemic form
Most easy option flow of GB. With this form it is noted:
- 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 the baby's life, the skin becomes pale. General state the baby is not disturbed. Anemia can be corrected quite well. In the future, this form of hypertension has virtually no effect on the child’s development.
Jaundice form
Main symptoms:
- anemia;
- early jaundice of a newborn (before the 2nd day of life);
- enlarged liver and spleen.
In utero this form of pathology is practically not expressed in any way. All major changes occur after the birth of the child. Jaundice indicates the rapid breakdown of hemoglobin and an increase in the product of its destruction - bilirubin - in the blood. The baby's condition is deteriorating, and neurological symptoms are noted. Treatment is carried out in a specialized department or in intensive care.
Edema form
The most severe variant of headache. The first symptoms are noted during the period of intrauterine development. Massive hemolysis of red blood cells leads not only to anemia, but is also accompanied by swelling of all tissues. A child is born in extreme in serious condition with impaired vital function important organs. The prognosis is unfavorable, but under certain conditions it is possible to save the child’s life. Often the edematous form leads to early termination of pregnancy.
Diagnostic methods
The following methods are used to detect pathology:
Laboratory research
All women registered for pregnancy donate blood three times to determine their blood type and Rh status:
- at first appearance;
- at 30 weeks;
- before childbirth.
If Rh is detected, an analysis is carried out every month. The antibody titer must be determined over time. Absolute titer value special significance does not have. The doctor pays attention to the growth rate of antibodies. Too rapid growth or abrupt changes in antibody titer may indicate the development of complications. Regular monitoring of antibody levels helps to detect the onset of Rh 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 HDP can be detected at 18-21 weeks, during the second ultrasound screening. Further tactics will depend on various factors:
- In the absence of Rh sensitization (according to a blood test, i.e. in the absence of antibodies in the mother’s blood), a repeat ultrasound is performed at 32-34 weeks (III screening).
- In case of Rh sensitization and satisfactory condition of the fetus, ultrasound monitoring every 2 weeks is indicated.
- If HDP is detected, ultrasound is performed every 3-7 days (if indicated - daily).
Ultrasound signs of HDP:
- an increase in the thickness of the placenta by 0.5 cm or more (relative to the norm at this stage of pregnancy);
- increase in the size of the liver and spleen;
- polyhydramnios;
- dilation of the umbilical vein more than 10 mm (additional sign).
An accurate diagnosis can only be made with the edematous form of HDP. In this case, there is a pronounced enlargement of the liver and spleen, ascites, and significant thickness of the placenta (up to 6-8 cm). The heart increases in size. Effusion in the pleural cavity, swelling of the intestinal walls, subcutaneous tissue of the head, and fetal extremities are diagnosed.
Determining the blood flow velocity in the middle cerebral artery using Doppler measurements is of great importance. An increase in this indicator by more than 1.5 MoM for a specific period of pregnancy indicates severe anemia. In this case, additional invasive diagnostics are indicated.
Invasive procedures
To assess the condition of the fetus, the following is indicated:
- amniocentesis – collection of amniotic fluid (from 16 weeks);
- cordocentesis – umbilical cord blood collection (from 18 weeks).
Cordocentesis is an accurate method for diagnosing HDP. 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 itself increases the risk of sensitization and growth of antibodies.
During cordocentesis, the resulting portion of blood is examined and the level of hemoglobin, hematocrit, and bilirubin is determined. The data obtained is checked against the norm for each stage of pregnancy.
Non-invasive diagnostics
Determining the Rh factor of the fetus from the mother’s blood is a modern procedure used in many progressive clinics. The woman donates blood for analysis, and fetal red blood cells are detected in the resulting material. The laboratory determines the blood type and Rh factor of the fetus. Establishment of Rh-fetal blood in early dates 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 Rh 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 medications that can change the level of antibodies in the mother's blood or reduce the likelihood of developing HDP.
The only method to compensate for severe anemia in the fetus is intrauterine blood transfusion. The manipulation is carried out during cordocentesis. After receiving the material, the necessary laboratory tests are carried out, and the volume of red blood cells for transfusion is determined. Red blood cells of 0 (I) blood group Rh- are introduced. After completion of the blood transfusion, a control blood sample is taken and the necessary parameters are re-determined.
If necessary, the procedure is repeated until the 34th week of pregnancy. Next, the issue of possible delivery is decided.
Childbirth with Rhesus conflict
Since the operation increases the risk of further sensitization and massive entry of fetal red blood cells into the mother’s bloodstream, they try to deliver the baby through the natural birth canal. Indications for cesarean section may include the following conditions:
- severe condition of the fetus with HDP;
- immature cervix;
- the presence of extragenital pathology or other factors.
Prevention
Specific prevention of Rh conflict involves timely administration of anti-Rhesus immunoglobulin in certain situations:
- During pregnancy with an Rh+ fetus at 28 weeks.
- In natural or surgical childbirth (maximum period - 72 hours after delivery).
- After a spontaneous miscarriage, induced abortion, or interrupted ectopic pregnancy within 72 hours.
- When performing 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 administering the drug is 72 hours.
Nonspecific prevention:
- Preservation of the first pregnancy in an Rh woman.
- Competent contraception.
- Refusal of abortion.
- Blood transfusion taking into account the Rh factor.
Why is it so important to save your first pregnancy? In most cases, there is no immunization during the first pregnancy, and the woman can give birth to a healthy baby without any problems. During the second and subsequent pregnancies, the risk of developing HDP increases significantly (without specific prevention). If a woman has an abortion during her first pregnancy and does not administer 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 into the uterus. In this situation, there is no Rh conflict, and the woman can safely carry the pregnancy to term.
Part of the body's humoral immunity is the blood antigen system. Thus, on the plasma membranes of erythrocytes there are glycoprotein corpuscular antigens, among almost fifty of which the Rhesus conflict during pregnancy can most often cause agglutinogen D or the Rh factor (Rh).
During the current and all subsequent pregnancies, antibodies are able to penetrate into the blood of the fetus, and if their level is high enough, antigen-antibody complexes are formed with Rh-positive fetal red blood cells, and hemolysis (destruction) of red blood cells in the child’s blood occurs. The fetus develops fetal hemolytic anemia due to Rh conflict.
At the same time, there is usually no risk of Rh conflict during the first pregnancy, and the difference in the Rh factors of the parents does not cause problems with the child’s health. Immunologists explain this by saying that when the expectant mother carries her first child, the corresponding antibodies simply do not have time to be produced (remember the physiological immunosuppression characteristic of pregnancy). However, this can only happen if there are no certain circumstances in the pregnant woman’s medical history (which are listed in the Risk Factors section).
In most cases, Rh conflict occurs during the second pregnancy, Rh conflict during the third pregnancy, etc. This is due to the fact that isoimmunization occurs over time: enough antibodies are already produced in the blood of a woman with Rh- that can attack the child’s red blood cells. And each time the problems can become more serious. The risk increases with multiple pregnancy, when Rh conflict develops during pregnancy with twins - if the Rh+ father is inherited.
Usually, childbirth with Rhesus conflict (in the absence of contraindications due to other pathologies) takes place naturally. However, if the child’s condition is serious, planned C-section with Rh conflict (at 37 weeks). But in both cases, breastfeeding with Rh conflict is prohibited.
The first signs of the development of Rh conflict in the fetus can be determined by ultrasound examination of the condition of such internal organs, like the spleen, liver, heart (they will be enlarged). The placenta may also be thicker, and an accumulation of fluid is visualized in the fetal abdominal cavity on ultrasound.
Forecast
Despite all the achievements of modern medicine, a 100% positive prognosis for the birth of healthy children in couples in which the woman has negative blood Rh and the man has positive blood is impossible. After all, Rh conflict is a consequence of the reaction immune system blood, and red blood cells not only carry oxygen into tissues, remove them from carbon dioxide, provide adenosine triphosphate (ATP) to all biochemical processes in the body, but also exhibit immunomodulatory activity.
- Presentation for a physics lesson on the topic “heat engines” Presentation on the topic “use of heat engines”
- Propagation of radio waves presentation by physics teachers
- Presentation, report on the beliefs of the ancient Yakuts Yakutia as part of the Russian state
- Forces that fought on the German side