However, in case of pregnancy, an inappropriate combination of Rhesus parents can lead to the so-called Rhesus conflict.
Reasons
The Rh factor is an antigen (protein) that is found on the surface of red blood cells - erythrocytes. It may be present (Rh positive) or absent (Rh negative). According to medical statistics, about 85% of people are Rh positive, the remaining 15% are Rh negative.
Rh conflict occurs either when transfusion of Rh-incompatible blood occurs, or during pregnancy of a woman with Rh negative, if the blood of the fetus is Rh positive.
What's happening?
When fetal red blood cells carrying proteins of the Rh system enter the blood of a mother with Rh negative, they are perceived by her immune system like aliens. The body begins to produce antibodies to destroy the baby's red blood cells. This causes large amounts of a substance called bilirubin to appear in his blood, which can damage his brain. As the fetus's red blood cells are continuously destroyed, its liver and spleen try to speed up the production of new red blood cells, thereby increasing in size. In the end, they also cannot cope with replenishing the loss of red blood cells. Severe oxygen starvation sets in, and a new round of serious violations develops. In the most severe cases, this can lead to fetal death.
Who is at risk from Rh conflict?
Since the presence of the Rh factor is inherited, the threat of Rh conflict exists only if the expectant mother is Rh negative (Rh-) and the father is Rh positive (Rh+). In this situation, in 75% of cases, the mother and child will be Rh incompatible.
But if a woman Rh negative-factor, but for a man it is positive - this is not a reason to refuse to start a family.
The first pregnancy of such a couple will most likely be normal. If a woman has not previously encountered Rh-positive blood, then she has no antibodies, and therefore no risk of Rh conflict with the fetus. During the first pregnancy, not so many antibodies are produced (this is the “first meeting”, after all). If the number of fetal red blood cells that entered the mother’s blood was significant, “memory cells” remain in the woman’s body, which in subsequent pregnancies organize the rapid production of antibodies against the Rh factor.
With an Rh-incompatible pregnancy, a lot depends on how it ended. After a miscarriage, Rh sensitization (production of antibodies) occurs in 3-4% of cases, after a medical abortion - in 5-6%, after an ectopic pregnancy - in approximately 1% of cases, and after a normal birth - in 10-15. The risk of sensitization increases after cesarean section or if there was placental abruption. That is, it all depends on how many fetal red blood cells penetrate into the mother’s bloodstream.
Prevention
At the antenatal clinic, a pregnant woman must be checked for the Rh factor. If it is negative, it is necessary to determine the father's Rh status. If there is a risk of Rh conflict (the father has a positive Rh factor), the woman’s blood is repeatedly tested for the presence of antibodies to fetal red blood cells and their number. Until the 32nd week of pregnancy, this analysis is carried out once a month, from the 32nd to 35th - twice a month, and then weekly until delivery.
Based on the level of antibodies in the blood of the expectant mother, the doctor can determine possible start Rh conflict and draw conclusions about the expected Rh factor in the child.
In addition, immediately after birth, the baby's Rh factor is determined. If it is positive, then no later than 72 hours after birth, the mother is administered anti-Rhesus serum ( anti-Rhesus immunoglobulin), which will prevent the development of Rh conflict during the next pregnancy.
Rh-negative women should carry out the same prophylaxis with anti-Rhesus serum within 72 hours after an ectopic pregnancy, abortion, miscarriage, transfusion Rh positive blood, platelet transfusions, placental abruption, trauma in a pregnant woman, as well as amniocentesis and chorionic villus biopsy (manipulation of the membranes).
Treatment
If a pregnant woman has antibodies and their number increases, this indicates the beginning of a Rh conflict. In this case, treatment is necessary in a specialized perinatal center, where both the woman and the child will be under constant supervision.
Surely all people have heard about the Rh factor, but most likely, most of them do not really understand what it is. It does not affect human health in any way everyday life, but during pregnancy, the incompatibility of the Rh factors of the father and mother sometimes provokes a Rh conflict. It is about Rh conflict during pregnancy with my husband that we will talk today on the website www.site.
The Rh factor is determined by the presence of a special protein on the surface of red blood cells (erythrocytes). It characterizes the immunological properties of blood. It was discovered relatively recently, in 1940. This was done by scientists Landsteiner and Wiener. In their research they dealt with monkeys and described rhesus macaques, which is where the universal term arose. The Rh factor is designated by the Latin symbols Rh+ or Rh-.
According to statistics, the majority (85%) of people on Earth have a positive Rh factor, i.e. this protein is present in their body. 15% of people do not have this protein and are Rh negative. Rhesus affiliation is determined together with the blood group, but it does not depend on it in any way, it is a genetic sign of a person, his individual feature, as well as eye or hair color. It is inherited from one of the parents, remains unchanged throughout life and does not indicate any physiological disorder or disease.
Rh conflict can occur during blood transfusions if it is Rh incompatible, also during pregnancy, when the mother is Rh negative and the child is Rh positive.
With a combination of a “negative” mother and a “positive” child, the occurrence of Rh conflict is more likely than in the opposite case, as well as the consequences of such a combination may be more serious. This is known from many years of observations of pregnant women.
Why is different rhesus dangerous during pregnancy?
When a person's blood negative Rh factor positive red blood cells enter, the body immediately reacts to them as a foreign object and begins to produce antibodies to neutralize the uninvited guests. These “protectors” enter the blood of the unborn child through the placenta and cause hemolytic disease, because they destroy his red blood cells, which carry oxygen. Due to a lack of oxygen, the fetus develops a pathological condition, oxygen starvation, the consequences of which are not difficult to predict.
But this does not mean that a woman with a negative Rh factor will certainly have a difficult pregnancy. Rhesus conflict is provoked by antibodies produced in the mother’s blood; everything depends on their quantity. In most cases, antibodies are either absent altogether, or their amount is minimal and not dangerous for the child.
What affects the production of antibodies in a mother with a negative Rh factor?
How larger number childbirth and abortion in a woman, the higher the likelihood of Rh conflict occurring. Everything is due to the fact that in this case, foreign red blood cells most likely have already entered the woman’s blood, i.e. the mechanism for producing antibodies has already been launched; her body already has experience in dealing with this kind of foreign bodies.
When the placenta is damaged and infections thin it, the penetration of red blood cells into the bloodstream also increases. The production of antibodies can also increase if the mother had a blood transfusion without taking into account the Rh factor, even if this procedure was a very long time ago. As a rule, the first pregnancy in women with a negative Rh factor is normal, because her body has never encountered “foreign” red blood cells and the protective mechanism, which is dangerous for the fetus, has not yet gained strength.
Determination of Rh factor
In order to avoid Rh conflict with your husband during pregnancy, the first thing that expectant parents need to do is take tests to determine this blood factor. When a woman has the same Rh as her husband, there will be no problems with compatibility. If the future father is “positive”, then the child will most likely genetically inherit positivity as a stronger trait. If the future father has a homozygous genotype, which is responsible for the Rh factor, then the child will 100% be born with Rh positive. If the future father has a heterozygous genotype responsible for the Rh factor, then the probability of having a child with a positive Rh factor is 50%.
When there is a risk of Rh conflict while carrying a baby, the expectant mother needs to regularly do a blood test for the presence of antibodies. This is usually especially important from the 35th week. From this gestation period this is done weekly.
If the test results do not show an increase in the level of antibodies, then the doctor may give an anti-Rhesus immunoglobulin vaccine as a preventive measure so that it blocks the baby’s red blood cells from entering the mother’s blood.
If the level of antibodies increases and reaches a critical state, the expectant mother will be sent to the perinatal center so that she is under constant supervision of specialists. They will have to control:
* dynamics of increase in antibodies in the mother’s blood;
* baby’s reaction – is the liver enlarged, is the placenta changing, is fluid appearing in the pericardium and abdominal cavity;
* condition of fetal fluid and umbilical cord blood.
With progressive Rh conflict, doctors do C-section so that the mother's protective antibodies do not harm the child. At a short stage of pregnancy, when artificial childbirth is not yet possible, it is necessary to resort to intrauterine blood transfusion.
If there are no complications during pregnancy and no antibodies are produced, then after birth, within about 2 days, the mother should receive an injection of anti-Rhesus immunoglobulin. This will reduce the risk of Rh conflict in the next pregnancy.
Such vaccination for women with negative Rh is also necessary for miscarriages, abortions, ectopic pregnancies and blood transfusions.
Successful advances in clinical immunology have recently shown that negative Rh is not a death sentence at all, it only forces one to approach the bearing and birth of a child more responsibly.
If you and your baby may have a Rhesus conflict, don’t despair. Advances in medicine will help resolve it in favor of both of you. Alla Protasova, therapist
During the first examination at the antenatal clinic, a specialist will determine your Rh factor. If it is positive, then you don’t have to worry about anything. If your and your husband’s Rh factors do not match, and yours is negative, you need to be especially careful about your health.
Rh negative blood does not indicate any disease, but rather confirms your uniqueness. After all, the additional antigen D, which is responsible for the Rh factor, is absent in your blood. That is why we belong to the 15% of those with “negative” blood. Find out all about how it affects your pregnancy.
1. What is serological mismatch?
If you have a negative Rh factor, your blood may “quarrel” with the blood of the fetus. The fact is that the baby’s positive Rh factor enters your blood through the placenta. The body perceives it as foreign and begins to fight it. How does he know that for you, from head to toe, your baby is your dearest? Antibodies can be produced in the blood that are harmless to expectant mother, but can harm the health of the baby. They penetrate his blood and destroy red blood cells - erythrocytes.
2. Is there a threat to the fetus if the parents have different Rh factors?
This incompatibility is dangerous only when your blood is Rh negative and your husband’s blood is Rh positive. All other combinations (both have the same Rh, or your blood has a plus sign, and your husband’s has a minus sign) do not fail to influence normal development fetus
3. When do antibodies appear that destroy blood cells?
They are formed in only 10% of expectant mothers with Rh-negative blood. So it’s not at all necessary that you are one of them. If this is your first pregnancy, there is practically no threat to the baby’s health. During this time, the body produces almost no antibodies. And the small amount of them that circulates in your blood reaches the baby in insignificant quantities. With each new pregnancy, more and more of them are produced. If you have had miscarriages or abortions before, tell your doctor about this at your first appointment. In this case, the likelihood of antibodies appearing in the blood increases significantly.
4. Is Rh factor mismatch treated during pregnancy?
Depending on the results of the blood test of the expectant mother, the doctor prescribes appropriate treatment. As a rule, Rh conflict can be dealt with with the help of medications and vitamins. Therapy includes glucose, vitamin C, B vitamin, nicotinic acid, iron, methionine, calcium gluconate and other drugs. An ultrasound, which is performed additionally, shows the condition of the baby’s internal organs. In more serious cases, the attending physician will recommend you to a hospital to undergo an individual course. Expectant mothers with Rh-conflict are sent to the maternity hospital a little earlier, at 34-36 weeks. This gives you the opportunity to undergo additional examination, which will tell you whether you will need a caesarean section. Strictly follow your doctor's recommendations. Timely treatment will help maintain the health of the child.
5. How to detect a serological conflict?
The first step is to analyze the level of antibodies in your blood. When it is too high, advanced diagnostics are required. Doctors will take blood from the baby's umbilical cord to find out if he has developed metolytic disease. The antibody titer in the mother’s blood is determined once a month until the 32nd week. Then the analysis is repeated twice a month - from the 32nd to the 35th week, and then weekly. Blood is taken from a vein.
6. What happens if the disease starts?
When the fetal red blood cells disintegrate, its liver and spleen try to quickly replenish the loss, therefore they increase in size, which leads to anemia, changes in the appearance and functioning of internal organs, especially the liver. When your baby is born, you may be surprised by the yellow color of his skin. This is due to the fact that a large amount of bilirubin is produced in the blood, which causes jaundice.
7. How to treat a child?
Most effective way stabilization of the baby's health after birth - replacement blood transfusion. During the first 36 hours, a large amount of Rh is administered. negative blood. But this is a last resort method. It’s in your power to take care of your baby’s health even before he’s born.
8. Is a caesarean section always necessary?
9. Is it possible to avoid problems with the Rh factor?
While expecting your second (third, fourth) child, the risk of antibodies developing in your blood increases. But after the first pregnancy, 10% of women giving birth are immunized. If you avoid this, then during your next pregnancy with a “positive” fetus you again have a chance to gain immunity. Modern advances in medicine make it possible to protect the baby from the consequences of Rh conflict. Every woman with a negative Rh factor at the most early stages During pregnancy, an anti-Rhesus immunoglobulin vaccine is administered, which destroys in the blood of the expectant mother all the red blood cells of the fetus that could enter it. Therefore, it is very important to register with the antenatal clinic as early as possible so as not to miss the optimal time for this procedure. Listen to the advice of experts - and the Rh conflict will quickly be resolved.
