Many women, while pregnant, are faced with a diagnosis such as Rh conflict. Most people know that this is something dangerous, both for the mother and for the unborn baby. But not everyone knows what Rh conflict during pregnancy actually is, what the signs of the conflict are, and what the consequences are.
Theory about the conflict of Rh factors during pregnancy
The Rh factor is an antigen that, among others, has been found on the surface of blood cells (red blood cells). But not all people have it available. So, if there are proteins on the surface of your red blood cells called “Rh factors”, then you are Rh positive, and if this antigen is missing, then you are Rh negative.
It turns out that people are divided into carriers of Rh-positive and Rh-negative factors.
You cannot rely on the name of the rhesus to determine which one is good and which one is bad. They're just different. However, people who have positive Rh may not remember it, and women who have Rh negative-factor should study information about Rhesus conflict.
If, suppose, red blood cells with proteins of the Rh system enter the blood of such a person, they are perceived by the immune system as “strangers”. The body urgently begins to produce antibodies. And a Rhesus conflict arises.
The risk of such a pathology occurs when a person is transfused with blood incompatible with his Rhesus and in pregnant women if the mother is Rh negative and the baby is Rh positive.
What is the probability
If the mother has negative Rh blood and the father has positive blood, then almost 75% of pregnant women develop an Rh conflict. In other cases, for example, if, on the contrary, dad is negative, and mom is positive, then there will be no conflict.
However, if the likelihood of a conflict developing is high, this is not a reason to refuse to have a child together. Firstly, competent prevention can reduce the consequences of this event to nothing. Secondly, not everyone develops this pathology during pregnancy.
If such a problem arose during your first pregnancy, then it is important to know how this pregnancy ended in the first place. If a miscarriage, then sensitization (antibodies in the blood) will occur in 3-4% of cases, after an abortion - in 5-6%, after an ectopic - in 1%, and after a normal birth - in 10-15%.
A particular risk for sensitization is C-section or cases of placental abruption. That is, the more red blood cells from the fetal blood enter a woman’s blood, the greater the risk. In any case, it is necessary to prevent such a dangerous consequence of Rh conflict as hemolytic disease of the fetus.
First pregnancy
In the case of Rh conflict during the first pregnancy, the woman does not yet have antibodies, and therefore there is no strong conflict, because this is the first meeting of blood cells charged with different Rhesus. If a significant amount of red blood cells enters the mother’s blood, then a so-called “cell memory” arises, which, during the second and all subsequent pregnancies, quite quickly produce antibodies against foreign blood cells.
The main signs of Rh conflict during pregnancy are the results of tests during pregnancy and immediately after the birth of the baby. The fact is that the mother’s antibodies, penetrating the placenta, enter the baby’s blood and attack the red blood cells. At the same time, a large amount of bilirubin begins to be produced in the baby’s blood, which turns the baby’s skin yellow.
This effect is called " hemolytic jaundice"and is the main sign of conflict. The most terrible consequence of Rh conflict during pregnancy is brain damage. The child's red blood cells are constantly destroyed by the mother's antibodies, while the spleen and liver increase in size.
As a result, they also cease to cope with such an attack and oxygen starvation occurs, new disorders and deviations are formed. If the case is very severe, edema (dropsy) may develop and the fetus may die.
Treatment
Treatment of Rh conflict during pregnancy is carried out by perinatal centers, where mother and baby are under constant supervision. If there is a possibility of developing this pathology, then the woman’s blood is regularly drawn and the antibody titer is monitored. If the pregnancy can be extended to 38 weeks, a planned caesarean section is performed.
If there is a risk of premature birth, then an intrauterine blood transfusion into the umbilical cord vein in the amount of 30-50 ml of red blood cell substance is performed through the anterior wall of the mother’s peritoneum. All this is done under ultrasound control.
Prevention
To avoid negative consequences, especially if there is a danger of Rh conflict during the second pregnancy, it is useful to carry out prevention. Most the best prevention Rh conflict during pregnancy is the prevention of Rh conflict. For this purpose, specific D-immunoglobulin is used.
Immediately after birth, the baby's blood is taken for analysis and its Rh factor is determined. And if the baby is negative, then the mother must be administered this drug within 72 hours to prevent the development of Rh conflict in subsequent pregnancies.
Immunoglobulin administration is also required after an ectopic pregnancy, abortion, miscarriage, transfusion Rh positive blood, platelet mass, trauma in a pregnant woman, placental abruption, chorionic villus biopsy, amniocentesis.
The newborn is examined for the presence of hemolytic jaundice, the level of bilirubin in the blood is detected and appropriate treatment is given. With timely and high-quality care, the risk of developing complications becomes minimal.
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 positive red blood cells enter the blood of a person with a negative Rh factor, 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, expectant parents first need to 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 perform a cesarean 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.
Every person is a carrier of one type of Rh factor: either positive or negative. The Rh factor is the presence or absence of a protein that is found on the surface of erythrocytes (red blood cells that carry oxygen to tissues). And every woman planning a pregnancy, in order to avoid negative consequences, is obliged to establish her Rh factor, as well as her blood type. After all, it can largely affect the course of pregnancy, as well as the development and condition of the fetus.
Future mother and father may have excellent Rh factors. So, if the mother and father are Rh positive, then the child will inherit a similar Rh factor in the future. The same thing happens if both parents are present in the blood negative Rh factor. In case mom positive Rh factor, and the father is Rh-negative, there will also be no complications during pregnancy. But if it turns out that the mother is the owner of an Rh-negative factor while the father has an Rh-positive factor, an Rh conflict arises, which carries a certain threat.
The fact is that in the body of a Rh-negative pregnant woman, in response to the positive Rh factor of the fetus, antibodies begin to be produced - immune system perceives the baby's Rh-positive red blood cells as foreign. Rh antibodies are able to penetrate the placenta, where they begin to destroy the fetal red blood cells. The consequence of this state of affairs for the child may be (decrease in hemoglobin), intoxication, and disruption of the functioning of vital organs. All this together is called hemolytic disease. It most often develops immediately after the baby is born, and its treatment is quite complicated. Sometimes a newborn also requires a blood transfusion - he is given Rh negative blood and carry out resuscitation measures.
In fact, all these terrible consequences can be avoided if you approach it thoughtfully and carefully. Many women only learned after a spontaneous abortion that the miscarriage was caused by the presence of an Rh-negative factor in their blood. Since 15-20% of the female population are their carriers, it is necessary to establish your blood type and Rh factor in the process of pregnancy planning. If pregnancy has already occurred, then the antenatal clinic must take blood to determine Rh status. If it turns out that a pregnant woman is a carrier of the Rh-negative factor, she is taken into special registration. Careful control in this case is simply necessary. So, a woman will have to donate blood from a vein quite often - this way doctors will be able to monitor whether there are antibodies in the pregnant woman’s body, and if so, how their number changes. Until 32 weeks, blood is donated once a month, from 32 to 35 weeks - twice a month, and from this time until delivery weekly. Modern medical equipment allows you to constantly monitor the condition and development of the fetus, timely identify the severity of hemolytic disease and, if necessary, perform an intrauterine blood transfusion. The main goal of this procedure is to improve the condition of the fetus and prolong pregnancy. Early or late birth if the mother has a negative Rh factor will be dangerous, best time the baby is born - 35-37 weeks.
It should be noted that during the first pregnancy, the risk of developing Rh conflict is low, because the mother’s immune system encounters foreign red blood cells for the first time. In this regard, antibodies capable of destroying fetal red blood cells are produced in small quantities. Therefore, if it turned out that expectant mother is the owner of a negative Rh factor, termination of pregnancy is contraindicated - this way there is a chance of the birth of a healthy, full-fledged baby. In the case of the next pregnancy, the situation gets worse: the pregnant woman’s blood already contains antibodies left over from the previous pregnancy. And now they are able to penetrate the placenta and destroy the baby’s red blood cells.
In any case, if the mother has a negative Rh factor, strict medical control is necessary. The necessary treatment is prescribed by the doctor after carefully studying all the facts. The good news is that today the development of Rh conflict can be prevented by introducing a special vaccine - anti-Rhesus immunoglobin. This drug, which is administered immediately after the first birth or terminated pregnancy, binds aggressive antibodies and removes them from the mother's body. Thus, they will no longer be able to harm the unborn baby.
Especially for- Tatyana Argamakova
