About Rhesus conflict. What is Rh conflict during pregnancy Types of Rh conflict

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

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

What is the Rh factor?

Naturally, we should start with the concept of Rh factor itself. This word refers to a special protein that is located on the surface of red blood cells. This protein is present in almost all people, but is absent in only 15% of people. Accordingly, the former are considered Rh-positive, and the latter – Rh-negative.

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

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

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

However, in women with a negative Rh factor, pregnancy will most likely proceed normally. If the father of the child is also Rh negative, then there is no basis for conflict. When does Rh conflict occur? When a positive Rh factor is detected in the husband, the child’s blood will also have Rp + with some degree of probability. This is where a Rhesus conflict may arise.

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

What are the causes of Rh conflict? Positive blood of a baby for a mother with negative Rp is a serious threat, and in order to cope with it, the woman’s body begins to produce antibodies, and accordingly, they react with the red blood cells of the fetus and destroy them. This process is called hemolysis.

Maternal and fetal blood occurs in the space between the uterus and placenta. It is in this place that exchange occurs: oxygen and nutrients enter the baby’s blood, and waste products of the fetus enter the mother’s blood. At the same time, some of the red blood cells seem to change places. This is how positive fetal cells end up in the mother’s blood, and her red blood cells end up in the fetal blood.

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

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

Rp inheritance table

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

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

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

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

Symptoms of Rh conflict

How does Rh conflict manifest itself? Unfortunately, there are no external manifestations visible to the naked eye. For the mother, all the processes occurring in her body and associated with Rh conflict are completely harmless and have no symptoms.

Symptoms of Rh conflict can be seen in the fetus during ultrasound examination. In this case, you can see the accumulation of fluid in the cavities of the fetus, swelling; the fetus, as a rule, is in an unnatural position: the so-called Buddha pose. Due to the accumulation of fluid, the abdomen enlarges, and the baby’s legs are forced to spread apart. In addition, a double contour of the head is observed, this also occurs due to the development of edema. The size of the placenta and the diameter of the vein in the umbilical cord also change.

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

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

Antibody test during pregnancy

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

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

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

Studies to determine the extent of fetal damage

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

The first study is scheduled around 18-20 weeks, the next at 24-26, then at 30-32, another at 34-36 weeks and the last one just before birth. However, if the condition of the fetus is assessed as serious, the mother may be prescribed additional ultrasound examinations.

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

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

Separately worth mentioning invasive assessment methods condition of the fetus. There are only 2 of them. The first one is amniocentesis– puncture of the amniotic sac and collection of amniotic fluid for analysis. This analysis allows you to determine the amount of bilirubin. In turn, this allows you to very accurately determine the child’s condition.

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

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

The second research method is cordocentosis. During this test, the umbilical cord is pierced and a blood test is taken. This method even more accurately determines the bilirubin content; in addition, this is the method used to give a blood transfusion to a child.

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

Treatment of Rh conflict during pregnancy

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

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

Delivery in case of Rhesus conflict

In most cases, pregnancy that occurs with the development of Rh conflict ends in planned pregnancy. Doctors monitor the child’s condition in every available way and decide whether it makes sense to continue the pregnancy or whether it would be safer for the child to be born prematurely.

Natural childbirth with Rhesus conflict occurs rarely, only if the condition of the fetus is satisfactory and there are no other contraindications.

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

However, most often birth in case of Rh-conflict occurs by caesarean section, since in this case it is considered more gentle.

Prevention of Rhesus conflict

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

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

Breastfeeding with Rhesus conflict

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

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

We can summarize: Rh conflict between mother and fetus is not a death sentence, and it is quite possible to bear a child with such a diagnosis. Moreover, Rp- in the mother does not mean at all that pregnancy will lead to Rh conflict. Of course, the consequences of Rh conflict can be very dire, but this is not a reason to despair. After all, only 0.8% of pregnant women with Rp- experience this problem.

Blood conflict can arise not only due to Rh conflict, but also due to blood type. But in neither case is it worth talking about the incompatibility of parents. The achievements of immunology today are such that in any case it is quite possible to bear a healthy and strong baby.

Rh conflict during pregnancy (video)

The main danger posed by Rh conflict during pregnancy is blood pathology (hemolysis) of a developing child in utero or a newborn child. This condition is accompanied by the destruction of red blood cells. It leads to oxygen starvation and intoxication of the child with metabolic products.

Rh factor: what is it?

Blood circulates in human vessels, which consists of liquid - plasma and cells, most of which are red cells - erythrocytes. They contain hemoglobin, which carries oxygen and carbon dioxide. There are numerous protein molecules on the surface of red blood cells. One of them is the Rh0(D) protein, or Rh factor.

This protein appears in the embryo in early pregnancy and is present in 85% of Caucasians who are considered Rh positive. If Rh0 is absent on red blood cells, these are Rh-negative patients. The presence or absence of this protein in itself does not affect human health. However, incompatibility of Rh factors during blood transfusion or pregnancy can cause adverse consequences.

When does Rhesus conflict occur?

This is only possible if the mother does not have the Rh factor, but the fetus has it.

The presence of the Rh factor is transmitted to the child with genes from his father. In men, the presence of this protein is controlled by genes located on a pair of chromosomes. The positive Rh factor is controlled by a pair of genes. It appears in two cases:

• Both genes are dominant (DD) in a man. This is observed in 45% of males who have positive Rh. In this case, the child will always be born Rh-positive.
• The man is heterozygous for the Rh factor, that is, on one chromosome there is a dominant gene D, and on the other there is a recessive gene d (Dd set). In such a situation, the father will pass on the positive Rhesus D gene to the child in half the cases. Heterozygous men account for 55%.

Determining the D and d genes is difficult and is not used in practice. To avoid pathology in the fetus, it is considered Rh positive by default. Although we note once again that approximately a quarter of Rh-positive men give birth to an Rh-negative child, and in this case, incompatibility does not appear, despite the different Rhesus values ​​of the parents.

The likelihood of pathology can be predicted in advance only by knowing the set of genes in the father (DD or Dd). It is determined only when necessary. Therefore, it is almost impossible to calculate in advance the possibility of the birth of an Rh-negative baby. With different rhesus levels in parents, it can range from 25 to 75%.

The likelihood of developing incompatibility and Rh conflict, even with different Rhesus of the mother and fetus, with the correct pregnancy management tactics, is small. Thus, during the first pregnancy, pathology develops only in 5% of cases.

How does pathology occur?

In the case when the mother does not have Rhesus, her body reacts to it as a foreign protein, producing appropriate antibodies. This reaction is designed to protect the woman’s internal environment from the penetration of genetically foreign material. A variety of antibodies are produced in response to any foreign antigen.

Normally, the blood of the mother and fetus practically does not mix during pregnancy, so Rh incompatibility usually does not occur during the first pregnancy. However, such a possibility still exists if bearing a child is accompanied by pathology of the placenta and increased permeability of its blood vessels.

How do Rh-positive red blood cells enter the blood of an Rh-negative patient:

• during pregnancy, especially if it is accompanied by the threat of miscarriage or serious illness of the woman; in this case, the integrity of the placental vessels is disrupted, and the fetal blood mixes with the mother’s blood;
• with amniocentesis, cordocentesis or chorionic villus biopsy - diagnostic procedures performed during pregnancy;
• during manual separation, as well as during caesarean section;
• as a result of miscarriage, induced abortion, surgery for ectopic pregnancy;
• in case of Rh-positive blood transfusion.

In response to the first entry of a foreign protein into a woman’s body, IgM class antibodies are synthesized. Their molecule is large in size and does not penetrate into the bloodstream of the fetus, so most often there are no negative consequences for the child during the first pregnancy. A slight increase in frequency was noted.

A second pregnancy with negative Rh in the mother is accompanied by repeated contact of her body with the positive Rh factor of the fetus. In this case, a large number of much smaller IgG antibodies are quickly produced. They easily penetrate the blood vessels of the placenta and cause hemolytic disease in the child.

Antibodies in Rh negative pregnancy bind to the Rh antigen on the surface of the fetal red blood cells. In this case, blood cells are destroyed, their breakdown products turn into a toxic substance - indirect bilirubin. A decrease in the number of red blood cells leads to anemia, and bilirubin stains the skin, urine and thus causes jaundice.

Anemia (lack of red blood cells, accompanied by oxygen starvation - hypoxia) causes an adaptive reaction - increased formation in the child's body of the hormone erythropoietin, which stimulates hematopoiesis, that is, the formation of red blood cells. This substance acts not only on the bone marrow, which normally synthesizes red blood cells.

Under its influence, extramedullary (outside the bone marrow) foci of red blood cell synthesis arise in the spleen, kidneys, liver, adrenal glands, fetal intestines and placenta. This is accompanied by a decrease in the lumen of the umbilical and hepatic veins, increased pressure in the portal vein system, metabolic disorders and impaired protein synthesis in the liver.

As a result of edema, compression occurs on the smallest vessels - capillaries, in which oxygen, carbon dioxide and metabolic products are exchanged between blood and tissues. Oxygen starvation occurs. Due to the lack of oxygen, under-oxidized (“unburnt”) metabolic products accumulate, and acidification of the body’s internal environment develops (acidosis). As a result, pronounced changes occur in all organs of the fetus, accompanied by a sharp disruption of their functions.

Indirect bilirubin penetrates well into brain tissue and causes damage to nerve centers - encephalopathy and kernicterus. As a result, the child’s central nervous system is disrupted: movements, sucking reflex, muscle tone.

So, what is Rh conflict during pregnancy? This is a state of incompatibility between the child and the mother according to the Rh system, as a result of which the fetus’s red blood cells are destroyed by antibodies from the mother’s blood. Negative consequences for the child are associated with manifestations of hemolytic disease.

How does the Rh factor affect pregnancy?

• There is no immediate threat to the woman herself; The danger lies in miscarriages, premature births and other pathologies resulting from hemolytic disease.
• With a Rh-negative fetus, the course of pregnancy is normal, since the mother’s body does not react with the Rh factor and does not form protective IgG antibodies.
• If the child is Rh positive, the mother's body produces antibodies to its protein, and he may develop hemolytic disease.
• The risk of pathology increases with each subsequent pregnancy, which is associated with the accumulation of IgG in the mother’s blood.

The expectant mother’s well-being does not change; when examined by a doctor, there are also no pathological signs.

If the Rh factor is incompatible with the mother's blood, the child may experience symptoms of Rh conflict. They make up the clinical picture of a hemolytic disease developing in a fetus or newborn baby. The severity of the manifestations of this pathology can vary - from mild temporary jaundice to profound disruption of the functioning of internal organs and the brain.

Hemolytic disease can cause fetal death at 20-30 weeks.

If the fetus continues to develop, increasing anemia and an increase in the content of bilirubin in its blood lead to the appearance of the following signs:

• decrease in the number of red blood cells;
• increase in fetal weight due to swelling of internal organs and subcutaneous tissue;
• accumulation of fluid in its cavities;
• swelling of the placenta;
• disturbance of the heart, reflecting a lack of oxygen.

After the birth of a child, due to damage to the nervous system by toxic bilirubin (kernicterus), the following symptoms appear:

• muscle flaccidity;
• feeding difficulties;
• regurgitation;
• vomit;
• convulsive syndrome, in particular opisthotonus - arching with spasm of the muscles of the arms and hands;
• abdominal enlargement;
• pallor or yellowness of the skin, conjunctiva of the eyes, borders of the lips;
• restlessness and constant high-pitched crying of the baby.

The second or even third pregnancy in a mother with negative Rh, if all the doctor’s recommendations are followed, can end happily. For this, prevention of Rh conflict is necessary. In particular, it is necessary to administer a special drug - immunoglobulin - on time.

If the mother is Rh positive and the child is Rh negative, then incompatibility does not appear and the pregnancy proceeds normally.

Diagnostics

To recognize an Rh conflict, a combination of two approaches is used:

• determination of maternal sensitization, that is, traces of contact between her Rh-negative blood and Rh-positive erythrocytes;
• recognition of hemolytic disease.

Pregnancy with negative Rh in a woman is dangerous for the development of Rh conflict if she has experienced the following situations in the past:

• transfusion of Rh-incompatible blood;
• miscarriage;
• induced abortion;
• intrauterine embryonic death;
• hemolytic disease of the child.

At what age does Rh conflict occur?

The appearance of this pathology is possible as early as 6-8 weeks of intrauterine development, when the corresponding protein appears on the red blood cells of the fetus. Therefore, from the moment of registration in a consultation (6-12 weeks), an Rh-negative woman begins to regularly determine the content of anti-Rhesus antibodies. Analysis for Rh conflict during pregnancy is repeated every month.

The absolute content of antibodies is not significant, because the fetus can be Rh-negative, and then any amount of maternal antibodies will not harm it. Doctors pay attention to an increase in the content of antibodies in the blood - an increase in their titer.

Antibody titer is the highest dilution of maternal blood serum, which still determines their quantity sufficient for gluing (agglutination) of red blood cells. It is expressed by the ratio 1:2, 1:4, 1:8 and so on. The larger the second number in this ratio, the higher the concentration of IgG immunoglobulins.

During pregnancy, the antibody titer may decrease, increase, or remain unchanged. Its sharp increase or abrupt change is dangerous.

Can the Rh factor change during pregnancy?

No, since the presence or absence of this protein is genetically mediated, inherited and does not change throughout life.

Ultrasound examination (US) of the fetus and placenta is used to diagnose hemolytic disease. The first signs of this pathology are visible starting from 18-20 weeks. Ultrasounds are then performed at 24, 30, 36 weeks and before birth. In severe cases, the time between studies is reduced to 1-2 weeks, and sometimes ultrasound must be performed every 3 days or even more often.

The negative effect of ultrasound on the fetus has not been proven, but the consequences of an unrecognized hemolytic disease can be sad. Therefore, you should not refuse a repeat examination, because this will help preserve the life and health of the child, and in some cases, the mother.

What is the danger of Rh conflict during pregnancy according to ultrasound data:

• thickening of the placenta, accompanied by impaired blood flow in it and deterioration in fetal nutrition;
• enlarged liver and spleen;
• and developmental anomalies;
• accumulation of fluid in the fetal peritoneal cavity (ascites), in the pleural cavity (hydrothorax) and around the heart (pericardial effusion);
• enlarged heart (cardiomegaly);
• swelling of the intestinal wall and subcutaneous tissue.

The content of bilirubin in the amniotic fluid is also studied, which helps to assess the intensity of red blood cell breakdown. For this purpose, spectrophotometry is used from 24 weeks, and photoelectrocolorimetry (FEC) is used from 34 weeks.

Examination of amniotic fluid (amniocentesis) is prescribed in the following situations:

• fetal death from hemolytic disease during a previous pregnancy;
• severe hemolytic disease of the newborn in a previous birth, requiring blood transfusion;
• Ultrasound signs of Rh conflict in the fetus;
• antibody titer 1:16 or higher.

– an invasive procedure that includes puncturing the amniotic sac and collecting amniotic fluid for analysis. It increases the risk of an Rh conflict, since it can be accompanied by contact of the blood of a woman and her child. Therefore, in recent years it has been used less and less.

To narrow the indications for this study, ultrasound determines the speed of blood flow in the middle cerebral artery of the fetus. It has been proven that the higher this indicator, the lower the child’s hemoglobin level and the greater the likelihood of hemolytic disease. If the blood flow rate is close to normal, amniocentesis may not be performed. However, the question of the need for the procedure must be decided taking into account all other data about the health of the woman and the developing child.

The most accurate method for diagnosing Rh conflict is umbilical cord blood testing, or cordocentesis. It is carried out from 24 weeks and is prescribed in the following cases:

• high density of bilirubin according to spectrophotometry (2C or 3);
• Ultrasound signs of hemolytic disease;
• antibody titer 1:32 or more;
• pathology of the previous pregnancy (see indications for amniocentesis).

In umbilical cord blood, the group, rhesus, the content of hemoglobin, red blood cells, and bilirubin are determined. If the fetus is Rh negative, hemolytic disease is impossible. Further monitoring of the woman is carried out as for a healthy pregnant woman.

If the fetal blood is Rh-positive, but the hemoglobin content and hematocrit are within normal limits, repeat cordocentesis is performed a month later. If the tests are bad, intrauterine treatment is started.

To diagnose oxygen starvation of a child, repeat cardiotocography is performed - a study of the heartbeat.

Therapy

In mild cases, treatment is aimed at strengthening the blood vessels of the placenta, preventing oxygen starvation of the child and maintaining pregnancy. The woman is placed on special registration, and her health status is constantly monitored by an obstetrician-gynecologist.

General restoratives, vitamins, and vascular medications are prescribed. If necessary, hormones are used to preserve the developing fetus (gestagens).

If hemolytic disease is diagnosed, treatment of Rh conflict during pregnancy begins. If the child's life is at risk, an intrauterine blood transfusion is performed. The positive impact of this procedure is very noticeable:

• the level of hemoglobin and hematocrit in the child’s blood increases;
• the likelihood of the most severe form of hemolytic disease - edema - is reduced;
• the preservation of pregnancy is ensured;
• when transfusion of washed red blood cells weakens the immune response of the mother's body and the severity of the Rh conflict.

Before intrauterine transfusion, cordocentesis is performed and hemoglobin content is analyzed. If it is possible to determine the fetal blood type, the same is transfused. If this determination fails, blood group 1 Rh negative is used. Depending on the stage of pregnancy and laboratory parameters, the required volume is determined and slowly injected into the umbilical cord. Then a control blood test is done.

This procedure is usually performed after 22 weeks. If transfusion is necessary at an earlier date, blood can be injected into the abdominal cavity of the fetus, but the effectiveness of this method is lower.

Intrauterine transfusion should be performed in a well-equipped hospital. It can cause various complications, including bleeding and fetal death. Therefore, the procedure is performed only when the risk of a child’s pathology due to hemolytic disease exceeds the likelihood of complications. All questions about this should be discussed with your doctor.

It is believed that the hematocrit in severe hemolytic disease decreases by 1% every day. Thus, the need for a repeat procedure arises after 2-3 weeks. Repeated transfusions in severe cases can be performed several times until 32-34 weeks, after which delivery is performed.

Plasmapheresis or immunosorption can also be used. These are methods of purifying the mother’s blood from anti-Rhesus antibodies using special filters that retain these immunoglobulins. As a result, the concentration of IgG against the Rh factor in the woman’s blood decreases, and the severity of the conflict decreases. These methods relate to extracorporeal detoxification and require modern equipment and qualified personnel.

Birth tactics:

• in a period of more than 36 weeks, with a prepared birth canal and a mild course of hemolytic disease, natural childbirth is possible;
• in severe cases of the disease, it is better to do so to avoid additional risk to the child.

The consequences of Rh conflict during pregnancy include anemia, fetal jaundice, swelling of the skin and internal organs. For treatment, blood, plasma, red blood cell transfusions, detoxification, and phototherapy are used. Breastfeeding begins after the baby’s condition improves, usually 4-5 days after birth. Antibodies contained in breast milk do not enter the baby's blood and are not dangerous for him.

Prevention of Rh incompatibility

Prevention of Rh conflict during pregnancy includes:

• blood transfusion only taking into account group and Rh factor compatibility;
• continuation of the first pregnancy in an Rh-negative woman;
• Rh prophylaxis in a Rh-negative patient after any end of pregnancy (miscarriage, abortion, childbirth);
• Rh prophylaxis in Rh-negative pregnant women without signs of sensitization.

If the patient is Rh negative and has not yet developed sensitization, that is, there has been no contact with the red blood cells of the fetus, and therefore there are no antibodies in the blood (for example, during the first pregnancy), she requires prophylactic administration of specific antibodies.

Immunoglobulin for Rh negative during pregnancy is a special protein that, when released into a woman’s blood, binds her antibodies, which can be formed upon contact with Rh-positive red blood cells, that is, during sensitization. If this does not happen, the injected immunoglobulin will not work, since the patient’s body will not begin to produce its own IgM and IgG. If sensitization does appear, the “vaccine” for negative Rhesus inactivates maternal antibodies, which are dangerous to the fetus.

If during the initial determination and subsequently the woman does not develop antibodies, a “vaccination” is done at 28 weeks with a negative Rh. Later, fetal red blood cells can already penetrate into the maternal blood and cause an immune response, so the introduction of immunoglobulin at a later date is not so effective.

At 28 weeks, if the father is Rh positive (that is, when there is a possibility of Rh conflict), 300 mcg of a specially developed drug - anti-Rh0 (D) - immunoglobulin HyperROU S/D is administered. It does not cross the placenta and has no effect on the fetus. The administration is repeated after any invasive procedure (amniocentesis, cordocentesis, chorionic villus biopsy), as well as in the first 3 days (preferably in the first 2 hours) after the birth of an Rh-positive child. If a baby with negative Rh is born, there is no threat of sensitization to the mother, and in this case immunoglobulin is not administered.

If during childbirth manual separation of the placenta was carried out or there was its detachment, as well as after cesarean section, the dose of the drug is increased to 600 mcg. It is administered intramuscularly.

During the next pregnancy, if antibodies do not appear in the blood, the prophylactic administration of immunoglobulin is repeated.

Immunoglobulin does not destroy fetal red blood cells, as can sometimes be read. It is not directed against the Rh protein, but against the protein of maternal anti-Rh antibodies. The prophylactic immunoglobulin does not react in any way with the Rh factor itself, located on the surface of red blood cells.

Preventive immunoglobulin is not anti-Rhesus antibodies. After its administration, antibodies to Rhesus should not appear in the mother’s blood, because it is intended specifically to prevent their production. There is a lot of conflicting unprofessional information on numerous sites devoted to this topic. All questions regarding antibodies and preventive immunoglobulin should be clarified with a doctor.

A negative Rh factor during pregnancy is not a death sentence for a woman. Even if she already has sensitization, and her first children were born with severe hemolytic disease, she can give birth to a healthy baby. For this there is one condition: the child’s father must be heterozygous for the Rh factor, that is, have a set of genes not DD, but Dd. In this case, half of his sperm may give the child Rh negative.

For such a pregnancy to occur, in vitro fertilization is required. After the formation of embryos, only those that have inherited Rh negative from both the mother and the father are used for implantation into the uterus. In this case, the Rh conflict does not appear, the pregnancy proceeds normally and a healthy child is born.

It is necessary to remember the need for careful diagnosis before blood transfusion. A Rh-negative woman should be transfused only with Rh-negative blood, preferably of the same group. If this is not possible, a blood group compatibility table is used:

Women with the first blood group are allowed to receive only the same blood transfusion. Patients with the fourth - blood of any group. If there is blood of group II or III, compatibility must be clarified according to the table.

Under no circumstances should the concept of the possibility of blood transfusion be extended to the compatibility of a married couple! People of any group affiliation can have healthy children, since the red blood cells of the mother and father never mix with each other. A conflict between the blood type of a woman and her child is also practically impossible.

If the father of the child has a positive Rh factor, and the mother has a negative Rh factor, it is necessary to register in time for pregnancy and follow all doctor’s orders:

• regularly do tests to determine anti-Rhesus antibodies;
• do an ultrasound of the fetus on time;
• if antibodies are not found in the blood, carry out prophylactic administration of immunoglobulin;
• if it is necessary to perform amniocentesis or cordocentesis, agree to these procedures.

If these conditions are met during the first and subsequent pregnancies, the likelihood of Rh incompatibility and hemolytic disease is significantly reduced.

The time of bearing a child is one of the most beautiful times in a woman’s life. Every expectant mother wants to be calm about the baby’s health and enjoy the period of waiting for a new addition. But every tenth woman, according to statistics, has Rh-negative blood, and this fact worries both the pregnant woman herself and the doctors who observe her.

What is the possibility of Rh conflict between mother and baby, and what the danger lies, we will tell you in this article.

What it is?

When a woman and her future toddler have different blood counts, immunological incompatibility may begin; this is what is called Rh conflict. Representatives of humanity who have a Rh factor with a + sign have a specific protein D, which is contained in red blood cells. A person with Rhesus does not have a negative value for this protein.

Scientists still don't know for sure why some people have the specific Rhesus monkey protein and others don't. But the fact remains that about 15% of the world’s population have nothing in common with macaques; their Rh factor is negative.

There is a constant exchange between the pregnant woman and the child through the uteroplacental blood flow. If the mother has a negative Rh factor, and the baby is positive, then protein D entering her body is nothing more than a foreign protein for the woman.

The mother's immune system very quickly begins to react to the uninvited guest, and when protein concentration reaches high values, Rh conflict begins. This is a merciless war that the pregnant woman’s immune defense declares on the child as the source of a foreign antigen protein.

Immune cells begin to destroy the baby's red blood cells with the help of special antibodies that he produces.

The fetus suffers, the woman experiences sensitization, the consequences can be quite sad, including the death of the baby in the mother’s womb, the death of the baby after birth, or the birth of a disabled child.

A Rh conflict can occur in a pregnant woman with Rh (-), if the baby has inherited her father’s blood characteristics, that is, Rh (+).

Much less often, incompatibility occurs based on such an indicator as blood group, if a man and a woman have different groups. That is, a pregnant woman whose own Rh factor has positive values ​​has nothing to worry about.

There is no reason to worry for families with the same negative Rhesus, but this coincidence does not happen often, because among the 15% of people with “negative” blood, the vast majority are representatives of the fair sex, men with such blood characteristics are only 3%.

Toddlers' own hematopoiesis begins in the womb at approximately 8 weeks of gestation. And from this moment on, in maternal blood tests, a small number of fetal red blood cells is determined in the laboratory. It is from this period that the possibility of Rh conflict arises.

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Probability tables

From a genetic point of view, the probability of inheriting the main characteristics of blood - type and Rh factor from father or mother is estimated at 50%.

There are tables that allow you to assess the risks of Rh conflict during pregnancy. And timely weighed risks give doctors time to try to minimize the consequences. Unfortunately, medicine cannot eliminate the conflict completely.

By Rh factor

By blood type

Dad's blood type	Mom's blood type	Child's blood type	Will there be a conflict?
0 (first)	0 (first)	0 (first)
0 (first)	A (second)	0 (first) or A (second)
0 (first)	B (third)	0 (first) or B (third)
0 (first)	AB (fourth)	A (second) or B (third)
A (second)	0 (first)	0 (first) or A (second)	Probability of conflict - 50%
A (second)	A (second)	A (second) or 0 (first)
A (second)	B (third)	Any (0, A, B, AB)	Probability of conflict - 25%
A (second)	AB (fourth)
B (third)	0 (first)	0 (first) or B (third)	Probability of conflict - 50%
B (third)	A (second)	Any (0, A, B, AB)	Probability of conflict - 50%
B (third)	B (third)	0 (first) or B (third)
B (third)	AB (fourth)	0 (first), A (second) or AB (fourth)
AB (fourth)	0 (first)	A (second) or B (third)	Probability of conflict - 100%
AB (fourth)	A (second)	0 (first), A (second) or AB (fourth)	Probability of conflict - 66%
AB (fourth)	B (third)	0 (first), B (third) or AB (fourth)	Probability of conflict - 66%
AB (fourth)	AB (fourth)	A (second), B (third) or AB (fourth)

Causes of the conflict

The likelihood of developing a Rh conflict greatly depends on how and how the woman’s first pregnancy ended.

Even a “negative” mother can quite safely give birth to a positive baby, since during the first pregnancy the woman’s immune system does not yet have time to develop a killer amount of antibodies to protein D. The main thing is that before pregnancy she is not given a blood transfusion, without taking into account the Rh factor, as sometimes happens in an emergency situations to save lives.

If the first pregnancy ended in miscarriage or abortion, then the likelihood of a Rh conflict during the second pregnancy increases significantly, since the woman’s blood already contains antibodies ready to attack at a very early stage.

In women who underwent a caesarean section during the first birth, the likelihood of conflict during the second pregnancy is 50% higher compared to women who gave birth to their first child naturally.

If the first birth was problematic, the placenta had to be separated manually, and there was bleeding, then the likelihood of sensitization and conflict in a subsequent pregnancy also increases.

Diseases during pregnancy also pose a danger to an expectant mother with a negative Rh factor. Influenza, ARVI, gestosis, diabetes in the anamnesis can provoke a structural disorder chorionic villi, and the mother’s immunity will begin to produce antibodies that are harmful to the baby.

After childbirth, the antibodies that were developed during pregnancy do not disappear. They represent long-term immune memory. After the second pregnancy and childbirth, the number of antibodies becomes even greater, as well as after the third and subsequent ones.

Danger

The antibodies that maternal immunity produces are very small in size; they can easily penetrate the placenta into the baby’s bloodstream. Once in the baby’s blood, the mother’s protective cells begin to inhibit the fetal hematopoietic function.

The child suffers and experiences oxygen deficiency, since decaying red blood cells are the carriers of this vital gas.

In addition to hypoxia, hemolytic disease of the fetus may develop, and subsequently the newborn. It is accompanied by severe anemia. The fetus' internal organs enlarge - liver, spleen, brain, heart and kidneys. The central nervous system is affected by bilirubin, which is formed during the breakdown of red blood cells and is toxic.

If doctors do not take measures in time, the baby may die in utero, be born still, or be born with severe damage to the liver, central nervous system, and kidneys. Sometimes these lesions turn out to be incompatible with life, sometimes they lead to profound lifelong disability.

Diagnosis and symptoms

The woman herself cannot feel the symptoms of a developing conflict between her immunity and the blood of the fetus. There are no symptoms by which the expectant mother could guess the destructive process that is taking place inside her. However, laboratory diagnostics can detect and track the dynamics of the conflict at any time.

To do this, a pregnant woman with Rh-negative blood, regardless of the blood group and Rh factor of the father, takes a blood test from a vein to determine the content of antibodies in it. The analysis is done several times during pregnancy, the period from 20 to 31 weeks of pregnancy is considered especially dangerous.

The antibody titer obtained as a result of laboratory testing indicates how severe the conflict is. The doctor also takes into account the degree of maturity of the fetus, because the older the baby is in the womb, the easier it is for him to resist an immune attack.

Thus, titer 1:4 or 1:8 at 12 weeks of pregnancy is a very alarming indicator, and a similar antibody titer at 32 weeks will not cause panic in the doctor.

When a titer is detected, the analysis is done more often to monitor its dynamics. In a severe conflict, the titer increases rapidly - 1:8 can turn into 1:16 or 1:32 in just a week or two.

A woman with antibody titers in her blood will have to visit the ultrasound diagnostic room more often. Using an ultrasound, it will be possible to monitor the development of the child; this research method provides fairly detailed information about whether the child has hemolytic disease, and even about what form it has.

In the edematous form of hemolytic disease of the fetus, an ultrasound will reveal an increase in the size of the internal organs and brain, the placenta thickens, and the amount of amniotic fluid also increases and exceeds normal values.

If the expected weight of the fetus is 2 times higher than normal, this is an alarming sign- hydrops of the fetus is not excluded, which can lead to death in the mother’s womb.

Hemolytic disease of the fetus associated with anemia cannot be seen on ultrasound, but can be diagnosed indirectly on CTG, since the number of fetal movements and their nature will indicate the presence of hypoxia.

Damages to the central nervous system will become known only after the birth of the child; this form of hemolytic disease of the fetus can lead to developmental delays in the baby and hearing loss.

Doctors at the antenatal clinic will be involved in diagnostics from the very first day a woman with a negative Rh factor is registered. They will take into account how many pregnancies there were, how they ended, and whether children with hemolytic disease have already been born. All this will enable the doctor to assume the possible likelihood of a conflict occurring and predict its severity.

During the first pregnancy, a woman will have to donate blood once every 2 months, during the second and subsequent ones - once a month. After the 32nd week of pregnancy, the analysis will be done once every 2 weeks, and from the 35th week - every week.

If an antibody titer appears, which can occur at any time after 8 weeks, additional research methods may be prescribed.

In case of a high titer that threatens the life of the child, a cordocentesis or amniocentesis procedure may be prescribed. The procedures are carried out under ultrasound control.

During amniocentesis, an injection is made with a special needle and a certain amount of amniotic fluid is taken for analysis.

During cordocentesis, blood is taken from the umbilical cord.

These tests make it possible to judge what blood type and Rh factor is inherited by the baby, how severely his red blood cells are affected, what is the level of bilirubin in the blood, hemoglobin, and with 100% probability determine the gender of the child.

These invasive procedures are voluntary and the woman is not forced to undergo them. Despite the current level of development of medical technologies, interventions such as cordocentesis and amniocentesis can still cause miscarriage or premature birth, as well as death or infection of the child.

The obstetrician-gynecologist who is managing her pregnancy will tell the woman about all the risks when performing procedures or refusing them.

Possible consequences and forms

Rhesus conflict is dangerous both during the period of bearing a baby and after its birth. The disease with which such children are born is called hemolytic disease of the newborn (HDN). Moreover, its severity will depend on the amount of antibodies that attacked the baby’s blood cells during pregnancy.

This disease is considered severe; it is always accompanied by the breakdown of blood cells, which continues after birth, edema, jaundice of the skin, and severe bilirubin intoxication.

Edema

The most severe form of HDN is the edematous form. With it, the little one is born very pale, as if “bloated”, swollen, with multiple internal edema. Such babies, unfortunately, in most cases are born dead or die, despite all the efforts of resuscitators and neonatologists, they die in the shortest possible time from several hours to several days.

Jaundice

The icteric form of the disease is considered more favorable. Such babies, a couple of days after their birth, “acquire” a rich yellowish skin color, and such jaundice has nothing in common with the common physiological jaundice of newborns.

The baby's liver and spleen are slightly enlarged, and blood tests show anemia. The level of bilirubin in the blood increases rapidly. If doctors fail to stop this process, the disease can develop into kernicterus.

Nuclear

The nuclear variety of HDN is characterized by lesions of the central nervous system. The newborn may experience convulsions and may involuntarily move his eyes. The tone of all muscles is reduced, the child is very weak.

When bilirubin is deposited in the kidneys, a so-called bilirubin infarction occurs. A greatly enlarged liver cannot normally perform the functions assigned to it by nature.

Forecast

Doctors are always very careful when making predictions for TTH, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the baby in the future.

Children undergo detoxification infusions in intensive care conditions; very often there is a need for a replacement transfusion of blood or donor plasma. If on the 5th-7th day the child does not die from paralysis of the respiratory center, then the forecasts change to more positive ones, although they are rather conditional.

After suffering from hemolytic disease of newborns, children suck poorly and sluggishly, they have decreased appetite, disturbed sleep, and have neurological abnormalities.

Quite often (but not always) such children experience a significant lag in mental and intellectual development, they get sick more often, and hearing and vision impairments may occur. Cases of anemic hemolytic disease end most successfully; after the level of hemoglobin in the baby’s blood can be raised, it develops quite normally.

A conflict that has developed not because of a difference in Rh factors, but because of a difference in blood groups, proceeds more easily and usually does not have such destructive consequences. However, even with such incompatibility, there is a 2% chance that the baby will develop quite serious disorders of the central nervous system after birth.

The consequences of the conflict for the mother are minimal. She will not be able to feel the presence of antibodies; difficulties can arise only during the next pregnancy.

Treatment

If a pregnant woman has a positive antibody titer in her blood, this is not a reason for panic, but a reason for starting therapy and taking it seriously on the part of the pregnant woman.

It is impossible to save a woman and her baby from such a phenomenon as incompatibility. But medicine can minimize the risks and consequences of the influence of maternal antibodies on the baby.

Three times during pregnancy, even if antibodies do not appear during pregnancy, the woman is prescribed courses of treatment. At 10-12 weeks, at -23 weeks and at 32 weeks, the expectant mother is recommended to take vitamins, iron supplements, calcium supplements, drugs that improve metabolism, and oxygen therapy.

If titers are not detected before 36 weeks of gestation, or they are low, and the development of the child does not cause concern to the doctor, then the woman is allowed to give birth naturally on her own.

If the titres are high and the child’s condition is serious, then delivery can be carried out ahead of schedule by cesarean section. Doctors try to support a pregnant woman with medications until the 37th week of pregnancy, so that the baby has the opportunity to “mature.”

Unfortunately, this possibility is not always available. Sometimes you have to decide on an earlier caesarean section in order to save the baby’s life.

In some cases, when the baby is clearly not yet ready to come into this world, but remaining in the mother’s womb is very dangerous for him, an intrauterine blood transfusion is performed to the fetus. All these actions are performed under the control of an ultrasound scanner; every movement of the hematologist is verified so as not to harm the baby.

In the early stages, other methods of preventing complications can be used. So, there is a technique for suturing a pregnant woman with a piece of her husband’s skin. The skin flap is usually implanted on the lateral surface of the chest.

While the woman’s immune system is putting all its effort into rejecting the foreign skin fragment (which takes several weeks), the immunological load on the child is somewhat reduced. Scientific debate continues about the effectiveness of this method, but reviews from women who have undergone such procedures are quite positive.

In the second half of pregnancy, if a conflict has been established, the expectant mother may be prescribed plasmapheresis sessions, this will slightly reduce the number and concentration of antibodies in the mother’s body, and accordingly, the negative load on the baby will also temporarily decrease.

Plasmapheresis should not frighten a pregnant woman; there are not many contraindications to it. Firstly, it is an acute respiratory viral infection or another infection in the acute stage, and, secondly, there is a threat of miscarriage or premature birth.

There will be about 20 sessions. Approximately 4 liters of plasma are purified in one procedure. Along with the infusion of donor plasma, protein preparations are administered, which are necessary for both mother and baby.

Babies who have suffered hemolytic disease are advised to undergo regular examinations by a neurologist, massage courses in the first months after birth to improve muscle tone, as well as courses of vitamin therapy.

Prevention

A pregnant woman is given a kind of vaccination at 28 and 32 weeks - anti-Rhesus immunoglobulin is administered. The same drug must be administered to a woman in labor after childbirth no later than 48-72 hours after the birth of the baby. This reduces the likelihood of developing conflict in subsequent pregnancies to 10-20%.

If a girl has a negative Rh factor, she should know about the consequences of an abortion during the first pregnancy. It is desirable for such representatives of the fair sex save the first pregnancy at any cost.

Blood transfusion without taking into account the Rh affiliation of the donor and recipient is not permissible, especially if the recipient has his own Rh with a “-” sign. If such a transfusion occurs, the woman should be given anti-Rhesus immunoglobulin as soon as possible.

A complete guarantee that there will be no conflict can only be given by a Rh-negative man, preferably with the same blood type as his chosen one. But if this is not possible, you should not postpone pregnancy or refuse it just because a man and a woman have different blood. In such families, planning a future pregnancy plays an important role.

A woman who wants to become a mother needs to undergo blood tests to detect antibodies to protein D before the onset of an “interesting situation”. If antibodies are detected, this does not mean that the pregnancy will have to be terminated or that pregnancy cannot be achieved. Modern medicine does not know how to eliminate conflict, but it knows very well how to minimize its consequences for the child.

The introduction of anti-Rhesus immunoglobulin is important for women who do not yet have antibodies in their blood that are not sensitized. They need to get such an injection after an abortion, after even minor bleeding during pregnancy, for example, with a slight placental abruption, after surgery for an ectopic pregnancy. If you already have antibodies, then you shouldn’t expect any special effect from vaccination.

Common Questions

Is it possible to breastfeed a child?

If a woman with a negative Rh factor gives birth to a child with a positive Rh factor, and there is no hemolytic disease, then breastfeeding is not contraindicated.

Babies who have experienced an immune attack and were born with hemolytic disease of the newborn are not recommended to feed on breast milk for 2 weeks after the administration of immunoglobulin to the mother. In the future, decisions about breastfeeding are made by neonatologists.

In severe hemotylic disease, breastfeeding is not recommended. To suppress lactation, a woman after childbirth is prescribed hormonal drugs that suppress milk production in order to prevent mastopathy.

Is it possible to carry a second child without conflict if there was conflict during the first pregnancy?

Can. Provided that the child inherits a negative Rh factor. In this case, there will be no conflict, but antibodies in the mother’s blood can be detected throughout the entire period of gestation, and in a fairly high concentration. They will not affect a baby with Rh (-) in any way, and there is no need to worry about their presence.

Before getting pregnant again, mom and dad should visit a geneticist who will give them comprehensive answers about the likelihood of their future children inheriting a particular blood characteristic.

Dad's Rh factor is unknown

When the expectant mother is registered at the antenatal clinic, immediately after her negative Rh is detected, the father of the future baby is also invited to the consultation to take a blood test. This is the only way the doctor can be sure that he knows exactly the initial data of the mother and father.

If the father’s Rh is unknown, and for some reason it is impossible to invite him to donate blood, if the pregnancy resulted from IVF with donor sperm, then a woman will have her blood tested for antibodies a little more often than other pregnant women with the same blood. This is done in order not to miss the moment of the beginning of a conflict if it occurs.

And the doctor’s offer to invite my husband to donate blood for antibodies is a reason to change the doctor to a more competent specialist. There are no antibodies in the blood of men, since they do not become pregnant and do not have any physical contact with the fetus during their wife’s pregnancy.

Is there an impact on fertility?

There is no such connection. The presence of negative Rh does not mean that it will be difficult for a woman to get pregnant.

The level of fertility is influenced by completely different factors - bad habits, caffeine abuse, excess weight and diseases of the genitourinary system, a burdened medical history, including a large number of abortions in the past.

Are medical or vacuum abortion safe for terminating a first pregnancy in an Rh-negative woman?

This is a common misconception. Moreover, unfortunately, such a statement can often be heard even from medical workers. The method of performing an abortion does not matter. Whatever it is, the baby’s red blood cells still enter the mother’s bloodstream and cause the formation of antibodies.

If the first pregnancy ended in abortion or miscarriage, how great are the risks of conflict in the second pregnancy?

In fact, the magnitude of such risks is a rather relative concept. No one can say with one percent accuracy whether there will be a conflict or not. However, doctors have certain statistics that estimate (approximately) the likelihood of sensitization of the female body after an unsuccessful first pregnancy:

• miscarriage at a short term - +3% to a possible future conflict;
• artificial termination of pregnancy (abortion) – +7% to the probable future conflict;
• ectopic pregnancy and surgery to eliminate it – +1%;
• delivery at term with a live fetus – + 15-20%;
• delivery by cesarean section – + 35-50% to a possible conflict during the next pregnancy.

Thus, if a woman’s first pregnancy ended in abortion, the second in a miscarriage, then while carrying the third, the risk is estimated at approximately 10-11%.

If the same woman decides to give birth to another baby, provided that the first birth went well naturally, then the probability of a problem will be more than 30%, and if the first birth ended in a cesarean section, then more than 60%.

Accordingly, any woman with a negative Rh factor who is planning to become a mother again can weigh the risks.

Does the presence of antibodies always mean that a child will be born sick?

No, this doesn't always happen. The child is protected by special filters that are in the placenta; they partially restrain aggressive maternal antibodies.

A small amount of antibodies will not cause much harm to the child. But if the placenta ages prematurely, if the amount of water is small, if a woman is sick with an infectious disease (even a common ARVI), if she takes medications without supervision from the attending physician, then the likelihood of a decrease in the protective functions of the placenta filters increases significantly, and the risk of giving birth to a sick baby will increase. .

It should be borne in mind that during the first pregnancy, antibodies, if they appear, have a fairly large molecular structure, it can be difficult for them to “break through” the defense, but with a second pregnancy, the antibodies are smaller, more mobile, fast and “evil”, so the immunological attack becomes more probable.

Does conflict occur during pregnancy, contrary to all forecasts and tables, in two negative parents?

This cannot be ruled out, despite the fact that all existing genetic tables and teachings indicate that the probability tends to zero.

One of the three mother-father-child may turn out to be a chimera. Chimerism in people sometimes manifests itself in the fact that once transfused blood of a different group or rhesus “takes root”, and the person is a carrier of genetic information about two types of blood at once. This is a very rare and little-studied phenomenon, although experienced doctors will never discount it.

Everything related to issues of genetics has not yet been studied well enough, and any “surprise” can be obtained from nature.

History knows several cases when a mother with Rh (-) and a father with a similar Rh gave birth to a child with positive blood and hemolytic disease. The situation requires careful study.

For more information about the likelihood of Rh conflict during pregnancy, see the following video.

For centuries, the birth of a healthy baby has been a real miracle. Almost every woman in the past centuries was faced with the situation of miscarriage or an terminated pregnancy. Nowadays, on the contrary, a negative result has become an almost unique case. The discovery of human Rh factors played a significant role in improving the situation, which helped eliminate Rh conflict between mother and fetus.

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The role of the Rh factor

Modern scientists and doctors know well what the Rh factor is.

Important! The inhabitants of our planet are distinguished by the presence or absence of a special protein on the surface of red blood cells.

Most of the population, about 85%, have it. Such people are classified as Rh+ positive. The rest of the population is Rh-negative and not has such a protein.

This difference does not play any role in ordinary life. Affects immune status only. It is important to know the Rh factor in case of blood transfusion, and when assessing the Rh factor during pregnancy, every experienced doctor will determine the symptoms during an examination.

Negative factors if incompatibility occurs in this indicator between the mother and her unborn baby, the following may occur:

• miscarriage;
• death of the fetus inside the womb;
• stillbirth;
• habitual miscarriage.

Reasons for the conflict

The immunological status of people with negative or positive particles is incompatible. Critical for bearing a child is the combination of a mother, who has a negative type of Rh factor, and a baby, whose appearance is expected by both parents, who received positive indicators from the father.

The female body perceives the one who develops in it as foreign substance. Sensitization occurs, that is, increased sensitivity to foreign substances. As a result, the body decides to rid the woman of the constant negative influence. The development of the conflict occurs due to the penetration of the child’s red blood cells into the mother’s body through the placenta.

The level of the problem increases with each pregnancy. A negative reaction occurs only when this situation is already known to the antibodies. For example, a mother in Rh- has already given birth to a child with Rh+. Or for the first time the result of gestation was abortion or miscarriage. In some cases, symptoms are caused by an incorrectly performed blood transfusion, during which blood with the wrong Rh was introduced into the body.

This is due to the entry of antibodies from a “positive” child or other entry of “positive” blood into the body of a “negative mother”. During the first pregnancy, such a problem does not threaten the woman and her child. During all 9 months, the closely related organisms of the fetus and woman are not connected and act independently. When ingested again, the woman’s body already has experience of encountering foreign elements, so it begins to fight them.

What characterizes the problem?

It is difficult to say exactly at what period the Rhesus conflict can be guaranteed to manifest itself. The first manifestations can be detected at the earliest stages of development, or appear after the birth of the child. But still, a titer table will help you try to identify Rh conflict during pregnancy. This technique is used to test the blood of a waiting woman for antibodies. The first such study is being conducted at 18-20 weeks pregnancy. If the titers are not higher than 1:4, further testing is performed once every 3-4 weeks.

In cases where the pregnancy is considered to be a conflict due to this factor, the test is carried out once every two weeks. In the case when titers are maintained at 1:4, the development of negative manifestations may not occur at all. For the life of the fetus The titre parameters 1:32, 1:64 are critical.

Carrying out such an analysis is necessary only when there is a combination of a “minus” in the expectant mother and a “plus” in the future father. When both parents have the same status or in the case where the father is negative, there is no risk.

Each couple at the first visit to the gynecologist when registering in the consultation definitely informs doctor about what blood type he is a carrier of. It is impossible to find out the Rhesus conflict, how to determine it in the case when the father, for various reasons, cannot come to the appointment. In this case, the likelihood of Rh conflict will have to be determined through careful monitoring of the health status of the woman and her unborn baby.

It is recommended to donate blood for Rhesus conflict in the earliest stages of development of the future daughter or son. The analysis is performed in any clinic. Under the compulsory health insurance policy, every woman can receive consultations free of charge, as well as register for health monitoring completely free of charge.

Possible treatment

Previously, the mismatch between the blood of mother and fetus always ended critically. For mothers with Rh- it is recommended maintain and carry the first pregnancy. All subsequent attempts to carry and give birth to a baby could be unsuccessful.

Modern medicine has been able to overcome this problem of “negative” Rhesus women. When establishing a “conflict” pregnancy, the gynecologist carefully monitors the amount of antibodies in the tests of expectant mothers.

An injection helps to counter the potential risk of a woman’s body fighting a foreign inhabitant, with the help of which a human body is introduced into the mother’s body. anti-Rhesus immunoglobulin D. Such an injection allows you to block the immune system of the expectant mother, who is trying to begin developing a program for destroying a foreign body. This injection is given to the expectant mother at 28-32 weeks carrying a child.

The injection is performed only if there are no antibodies in the expectant mother’s body. The substance itself is completely neutral for the organisms of a woman and her unborn child. This injection will definitely need to be given again as soon as a positive child is born. The administration of immunoglobulin will protect women during subsequent pregnancies.

Sometimes Rh conflict during pregnancy does not allow starting treatment at the very end of the term. However, modern medicine knows ways to get rid of the problem in cases where an increase in antibody levels was noted at about 20 weeks or even earlier. In cases where the fact of a “conflict” pregnancy was not detected in the early stages of development, fetal death often occurs at the stage of 20-30 weeks.

When a Rhesus conflict is detected so early, you can find out what to do from an experienced gynecologist:

1. Antibody testing is performed at least once every two weeks.
2. Careful monitoring of fetal cardiac activity is performed using CTG.
3. The child’s condition is assessed using Doppler, that is, an ultrasound examination of the blood vessels of the unborn son or daughter. The suffering of the fetus will show an increase in the level of blood flow in the middle cerebral artery. With an indicator of 80-100 to save the life of a child An emergency caesarean section is recommended.

Indicators are assessed by taking tests for Rhesus conflict during pregnancy. When indicators persist, experts recommend intrauterine transfusion. It is performed on intrauterine steel. This procedure is recommended if the development of hemolytic disease in the expected baby is detected.

Danger to child

In the event of a struggle with a child, whom nature has decided to accept as a foreign and dangerous element, a woman’s body practically does not suffer. At the mother's reproductive function is preserved. Danger can come from pregnancy interruptions and miscarriages.

It is much more important to understand why Rh conflict is dangerous for the fetus. The body of the mother who is so waiting for the baby to be born, regardless of her wishes, begins to produce antigens. They pass through the hematoplacental barrier to the future newborn. The formation of red blood cells is inhibited. Arises hemolytic disease. The child’s hematopoiesis process is disrupted, which in most situations ends in his death.

When the fetus survives without proper treatment, disruptions occur in many systems of its body. Including happen various developmental pathologies, the brain, heart, and internal organs increase. Toxic damage to the central nervous system of the unborn baby occurs. Often such pathologies are accompanied by an increase in the size of the fetus. Dropsy may be detected.

The degree of manifestation of symptoms directly depends on the number of antibodies that the mother produces during the months of waiting.

Group incompatibility options

Not only the negative Rh factor of the mother of the unborn baby becomes a negative factor.

Attention! Problems with the combination of blood groups of the father and mother can lead to developmental problems and pathologies.

More details about group incompatibility can be obtained from the treating gynecologist. In this case, future parents fall into the “risk zone” with 0(I) blood group, during whose pregnancy such a negative nuance does not arise only in the case when similar blood flows in the veins of the father. The combination of mother 0 (I) and father AB (IV) is guaranteed to cause problems in 100% of cases, although in most situations they are not as global as in rhesus conflict.

Rh factor during pregnancy. Rh conflict during pregnancy

Months of waiting for the birth of a daughter or son require parents to pay maximum attention to the health of the fetus. Regular observation in the antenatal clinic these days helps to avoid a significant part of the potential problems with the birth of the long-awaited and healthy baby.

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Humanity consists of men and women, blondes and brunettes, tall and short, and also of those who have a protein in their red blood cells called Rh antigen and those who do not. Everything would be fine - owners of positive and negative Rhesus live very friendly and often form couples, but some combinations of Rhesus parents during pregnancy can lead to Rh conflict between mother and baby.

What it is? How dangerous? Is it possible to prevent Rh conflict and how to treat its consequences? Is breastfeeding allowed? Elena TELINA, obstetrician-gynecologist, deputy chief physician for obstetrics and gynecology at the AVICENNA Medical Center of the Mother and Child Group of Companies, tells the story.

What is Rh conflict?

First, let's figure out what the Rh factor is. This is a special protein - Rh antigen, which is located (or not located) on the surface of erythrocytes - red blood cells. If this protein is present in the blood, then Rh is considered positive, and if it is not present, it is considered negative. In 1940, doctors K. Landsteiner and A. Wiener helped discover the Rh antigen from rhesus monkeys - this protein was first isolated from their red blood cells. The Rh factor got its name in honor of these monkeys.

About 85% of the European population of the planet have a positive Rh factor, about 15% have a negative Rh factor. The largest percentage of people with a negative Rh factor is found among the Basques. Interestingly, among Asians, Africans and the indigenous population of North America, negative Rh is extremely rare - approximately 1% of cases, so Rh conflict is very rare for them.

” A negative Rh factor does not affect a person’s life in any way; such a difference cannot be determined by eye. However, during pregnancy, a discrepancy between the Rh factors of mother and baby can cause a rather serious complication - Rh conflict.

“Rh-positive” and “Rh-negative” blood are incompatible. The entry of the Rh antigen into the blood of a person with negative Rh causes a strong immune response - the body perceives the foreign protein as a serious disease that must be destroyed. An entire army of antibodies is urgently produced that attack and destroy “positive” antigens.

What will happen if the source of such “foreign” antigens appears inside the body and firmly settles there for 9 months? The concentration of antibodies will constantly increase, they will increasingly attack proteins that are unsafe for them, trying to completely destroy their source. This is what happens when the mother has a negative Rh factor, and the baby has a positive Rh factor. Mom's body protects itself by attacking unfamiliar antigens. This condition is called Rhesus conflict.

” The risk of developing Rh conflict exists if the mother is Rh negative and the father is Rh positive. Other combinations will not provoke such a conflict.

Expert commentary

Rh conflict is the incompatibility of the blood of mother and fetus according to the Rh factor. This condition can develop only in a pregnant woman who is Rh negative and has an Rh positive fetus (and the father is Rh positive).

Rhesus conflict and first pregnancy

As a rule, during the first pregnancy, the concentration of antibodies in the mother’s blood is relatively low and the fetus develops calmly, practically without experiencing their harmful effects. However, each subsequent pregnancy with this combination causes increasingly active formation of antibodies, increasing the risks.

Expert commentary

The risk of developing Rh conflict during the first pregnancy is not common (specifically the 1st pregnancy, and not childbirth, since all pregnancies interrupted at a short period may not produce laboratory markers, but antibodies will accumulate with each subsequent pregnancy).

Analysis for Rh factor and antibodies

You can find out whether there is a risk of Rh conflict for a given pregnancy using blood tests. At the beginning of pregnancy, a woman is tested to determine her blood type and Rh factor.

If Rh is negative, then the doctor prescribes the following test to determine the level of antibodies to the positive Rh factor. In the future, it is recommended to take this analysis monthly - this is the only reliable way to timely monitor possible sensitization and prevent the occurrence of serious complications.

Recently, pregnant women with negative Rhesus have another opportunity - non-invasive determination of the Rh factor of the fetus using the mother's blood. The disadvantages of this analysis are that it is not widespread in Novosibirsk and is expensive.

Examples of the cost of such analysis in Novosibirsk clinics:

"Ultrasound studio": Determination of the Rh factor of the fetus using the mother's blood using the PRENETIX method, cost - 12,000 rubles.

"Avicenna": Non-invasive determination of the Rh factor of the fetus. price - 7,800 rubles.

Expert commentary

The penetration of fetal Rh antibodies into the mother’s blood and, accordingly, the emergence of a conflict is possible from the 9th week of pregnancy, when the uteroplacental blood flow begins to actively work (during physiological pregnancy, fetal red blood cells penetrate the placenta in 3% of women in the 1st trimester, in 15% in the 2nd trimester). , and in 45% in the 3rd trimester). From 9 weeks of pregnancy, we can use a special laboratory test to determine the blood type and Rh factor of the child from the mother’s blood. The test has high specificity and gives the correct result. In the future, knowing about the negative Rh of the baby, we can no longer control the presence of Rh antibodies during pregnancy - they cannot be, but if we get a Rh-positive blood type of the child, control of Rh antibodies should be done once a month (mother’s blood test for Rh antibodies).

If the baby is Rh-positive, conflict may not arise in the first pregnancy, but traces of “conflict”, “wary” cells will always remain, which can manifest themselves more actively in subsequent pregnancies with a Rh-positive child and cause clinical manifestations already in the baby form of development of hemolytic disease.

Anti-Rhesus immunoglobulin

The development of Rh conflict or sensitization reaction can be prevented by injection of anti-Rh immunoglobulin. In fact, it represents a dose of ready-made antibodies that bind to the baby’s antigens entering the mother’s bloodstream. In this way, “foreign elements” are neutralized and the mother’s body does not need to produce its own army of antibodies.

” Anti-Rhesus immunoglobulin is administered to women with a negative Rh, pregnant with a “positive” fetus at 28-32 weeks and within 72 hours after birth.

Rh conflict, that is, a rare increase in the concentration of antibodies to the Rh antigen, is triggered when Rh-positive red blood cells enter the bloodstream of a Rh-negative mother. Therefore, all situations associated with bleeding during a potentially “conflict” pregnancy and delivery also require immediate administration of anti-Rhesus immunoglobulin.

Factors that increase the risk of Rh conflict:
. artificial termination of pregnancy;
. miscarriage;
. ectopic pregnancy;
. childbirth and caesarean section;
. gestosis;
. bleeding during pregnancy;
. invasive procedures during pregnancy: cordocentesis, amniocentesis, chorionic villus biopsy;
. abdominal injuries during pregnancy;
. history of blood transfusion without taking into account the Rh factor.

It is important to understand that sensitization can occur without injury - the penetration of fetal red blood cells through the placenta into the mother’s bloodstream is possible even during the physiological course of pregnancy.

Expert commentary

Today, the world and our country use a special anti-Rhesus immunoglobulin, which prevents the development of Rh conflict. This drug is administered intramuscularly during pregnancy 28-32 weeks and within 72 hours after birth, if the newborn has a laboratory confirmed Rh positive blood type. At the birth of a Rh negative child, repeated administration of anti-Rhesus immunoglobulin is not advisable. The administration of anti-Rhesus globulin is also indicated in patients with an interrupted pregnancy (abortion, miscarriage, ectopic pregnancy) because the volume of fetal blood in the mother's bloodstream increases with increasing pregnancy and reaches about 30-40 ml with any termination of pregnancy, with the accumulation of Rh antibodies in the woman.

Risks and consequences of Rhesus conflict

The concentration of antibodies dangerous to the fetus in most cases increases with each “conflict” pregnancy. These antibodies can freely penetrate into the bloodstream of the fetus and begin to increasingly damage positive red blood cells and hematopoietic organs. As a result, the baby develops hemolytic disease, which, if left untreated, can lead to very serious consequences.

Risks of pregnancy with Rhesus conflict:

• premature birth, miscarriage;
• hemolytic disease of the fetus;
• hemolytic jaundice.