There are several dozen methods for assessing and analyzing blood composition in hematology, the science that studies it. Most of them are used exclusively by hematologists. But even people far from medicine have heard about blood group and Rh factor.

The Rh factor is a specific antigen protein that is present in approximately 85% of the world's population and is completely absent in the rest. It is located on the surface of red blood cells - erythrocytes. It is this fact that divides human blood into Rh-positive (Rh+) and Rh-negative (Rh-). It was discovered in 1940 by Alexander Wiener and Karl Landsteiner. Similarly, depending on the presence or absence of specific antibodies and antigens, blood is divided into four groups.

Rh factor and blood type can be determined using a simple blood test. Usually men first encounter this at the military registration and enlistment office, and women when planning a pregnancy.

Rhesus conflict

The Rh factor itself is simply one of the immunological characteristics of the body, which in ordinary life does not affect health at all. However, when pregnancy occurs, provided that the mother is Rh negative and the child has inherited a positive factor from the father, numerous complications may develop. In medicine they are united under the general name – Rh conflict.

The baby's positive blood is perceived by the mother's immune system as a threat. Due to the presence of that very specific protein. The mother’s body does not know about its existence, the immune system has never encountered it before and therefore considers it potentially dangerous. In response, it triggers the synthesis of antibodies that provoke the development of hemolysis - the process of destruction of red blood cells.

The blood of the mother and her unborn child meets in a special space located between the uterus and the placenta. All metabolic processes take place here. The baby’s blood is saturated with the substances and oxygen it needs and is cleansed of waste products. Because of this, the baby’s cells also end up in the mother’s blood, getting there along with metabolic substances. In turn, red blood cells, and, consequently, antibodies, penetrate into his blood.

According to statistics, for every thousand expectant mothers, there are about 170 women endowed with Rh negative genetics. The risk of Rh conflict during the first pregnancy is 50%, and during the second it increases by 10–15%.

If this is your first pregnancy

Doctors noticed that the first pregnancy is complicated by Rhesus conflict less often. Most often, the immune system simply does not have time to recognize the threat. And even if it shows speed in this matter, then the produced antibodies of the IgM class turn out to be too large to penetrate the placenta. However, this rule applies if:

• This is indeed the first pregnancy and the woman has not had any miscarriages or abortions before.
• She does not suffer from diabetes, and did not suffer from ARVI or influenza in the early stages of pregnancy.
• She was not prescribed minimally invasive tests, such as collecting amniotic fluid or umbilical cord blood.

If pregnancy is second

Rh conflict occurs more often during the second pregnancy. This is explained by the fact that the immune system is more prepared for the appearance of foreign antigens and reacts faster. And in this case it produces slightly different antibodies, namely IgG, which are characterized by high mobility and small size. But the main thing is that these antibodies are able to easily pass through the placenta and enter the baby’s bloodstream. The danger increases if:

• The first pregnancy ended unsuccessfully or was accompanied by complications.
• The child was born by caesarean section.
• The woman has had an ectopic pregnancy or abortion in the past.

Signs of Rh conflict

The conflict due to Rh incompatibility is insidious in that it develops slowly and may not manifest itself in any way until 28 weeks. On the mother's side, most often there are no signs at all. Sometimes in the early stages she may notice:

1. Fatigue and lower back pain.
2. Swelling of the legs, regardless of the time of day or physical activity.
3. Rapid heartbeat or increased blood pressure, which may occur for no reason.

But all these signs are general in nature and can be a manifestation of completely different pathologies. It is believed that Rh conflict is almost always accompanied by polyhydramnios, but again this symptom can be the cause of a completely different disease.

Ultrasound examination can provide reliable information at a later date. True, all noticeable signs of conflict appear only in the child. These include:

• The Buddha pose is uncharacteristic for a fetus, which appears due to the fact that fluid accumulated in the abdominal cavity spreads the legs to the sides.
• Double contour of the baby's head caused by swelling.
• Enlarged liver and spleen.
• Changed size of the umbilical vein, resulting from impaired blood flow.
• Increased number of blood vessels in the placenta.

Danger to child

The main danger of blood incompatibility is miscarriage. But even if this was avoided, the fluid accumulating in the baby’s body, formed due to the breakdown of red blood cells, leads to impaired formation of almost all organs. As a result, the baby is born with a severe pathology - hemolytic disease of the newborn.

General symptoms of this disease:

1. The presence of anemia, due to the fact that red blood cells are constantly being destroyed, and new ones do not have time to form in sufficient quantities.
2. Enlarged liver and spleen.
3. Oxygen starvation caused by the fact that red blood cells cannot cope with their function.
4. Jaundice develops.
5. There is general lethargy, pallor, lack of weight and poor appetite.

Bilirubin is detected in the blood, causing general intoxication of the body. At high concentrations, damage to the brain and central nervous system occurs. The child may develop bilirubin encephalopathy, accompanied by convulsions, oculomotor disturbances, the development of cerebral palsy, renal infarctions and impaired liver function.

What to do?

As you know, it is easier to prevent a disease than to treat its consequences. This rule is also relevant in the case of Rh conflict. If you do not know the properties of your blood, then be sure to do a test to determine them. It happens that the conflict is provoked not only by rhesus, but also by the incompatibility that arises between different blood groups.

Blood type incompatibility develops when the mother has the first blood group, designated as 0 (I), and the child inherited from the father the second - A (II) or the third B (III).

Analysis for Rh conflict

All mothers who fall into the risk group, that is, those who have the first blood group or a negative Rh factor, must be tested for antibodies:

• From the first to 32 weeks of pregnancy - once a month.
• Starting from 32 weeks - twice a month.
• From 35 weeks until the moment of birth - once a week.

The sooner doctors catch the onset of Rh conflict, the fewer negative consequences you and your baby will experience in the future.

The composition of human blood is constantly changing. Even what you ate and drank the day before affects it. For the most reliable results, you must take an antibody test during pregnancy according to the rules. Blood for analysis is taken from a vein in the morning, on an empty stomach, without consuming any drinks other than water. Two days before the analysis, it is better to remove fatty, spicy, salty and smoked foods, strong tea, coffee and fruit juices from your diet. If you are taking medications that cannot be interrupted, be sure to tell your doctor.

Antibodies during pregnancy are determined by diluting blood serum and checking its reaction in diluted form to Rh-positive red blood cells. The title is always a multiple of two 1:2, 1:8, 1:16 and so on.

If antibodies are not detected at all in the mother’s blood, then there is no Rh conflict. A titer of up to 1:2 is also considered normal. If the analysis shows a titer value of 1:4 or more, then the danger, although small for now, is there. If the titer continues to increase, the doctor prescribes treatment to help smooth out the consequences of the Rh conflict.

Treatment

Unfortunately, it is impossible to predict in advance the occurrence of a conflict based on Rh or group antibodies. After all, they develop only during pregnancy, and even then only when the baby inherits the positive Rh and blood type of the father. But even if trouble happens, there is no need to panic.

If doctors insist on hospitalization, be sure to listen to them, even despite your excellent health. It will be much easier to control the situation in a hospital. It happens that if the situation worsens, a woman may be prescribed injections of anti-Rhesus immunoglobulin, and the baby may need a blood transfusion performed in utero. Natural births with Rhesus conflict are rare; doctors usually perform a cesarean section.

Most pregnant women with a negative Rh factor or first blood group become happy mothers of healthy babies. The main thing is to strictly follow the doctors’ recommendations and take the necessary tests on time.

Human blood has two important characteristics - blood group (AB0 system) and Rh factor (Rh system). Most often, during pregnancy, problems arise with pregnancy due to incompatibility according to the Rh system, so we will analyze it first.

What is the Rh factor?

Rh factor (Rh) is an erythrocyte antigen of the Rh system. Simply put, it is a protein located on the surface of red blood cells (erythrocytes).

People who have this protein are Rh+ (or Rh positive). Accordingly, negative Rh Rh- (or negative Rh) indicates the absence of this protein in human blood.

What is Rh conflict and how is it dangerous for the fetus?

Rhesus conflict– the immune response of the mother’s body to the appearance of a “foreign” agent within itself. This is the so-called struggle of the mother’s Rh-negative blood bodies with the child’s Rh-positive blood bodies, which is fraught with the appearance of hemolytic anemia or jaundice, hypoxia and even fetal hydrops.

During the first pregnancy, the bloodstream of the mother and child function separately from each other and their blood does not mix, but during previous births (possibly also during abortions and miscarriages), the child’s blood may enter the mother’s blood, and as a result, the woman’s body becomes Rh negative -factor will produce antibodies to the antigen even before the next pregnancy occurs. Therefore, a repeat pregnancy can result in intrauterine embryo death and, as a consequence, miscarriage even at an early stage.

The first pregnancy usually proceeds without complications, since the mother’s blood does not yet have antibodies to the “foreign” blood of the child.

Simply put, fetal blood cells penetrate through the placenta into the pregnant woman’s blood and if the blood is incompatible, the expectant mother’s body perceives the baby as a “stranger,” after which the protective reaction of the woman’s body produces special antibodies that destroy the baby’s blood cells.

The destruction of fetal red blood cells by antibodies is called hemolysis, which leads to anemia in the baby. The pregnant woman’s condition does not worsen, and the woman is not even aware of the previous threat to the baby’s health.

When does Rh conflict occur during pregnancy?

If the mother's Rh is positive, Rh conflict will never arise, no matter what the blood of the child's father is.

If both future parents have a negative Rh factor, there is also no reason to worry, the child will also have a negative Rh factor, it cannot be any other way.

If the blood Rh factor is negative in the pregnant woman and the father of the child is positive, the baby can inherit both the Rh factor of the mother and the Rh factor of the father.

If the father of the child is Rh-positive, homozygous, and has the DD genotype, and the pregnant woman is Rh-negative, then in this case all children will be Rh-positive.

If the father is Rh-positive, heterozygous, and has the Dd genotype, and the pregnant woman is Rh-negative, then in this case a child can be born with both Rh-positive and Rh-negative factors (the probability in this case is 50 to 50).

Therefore, it is also important for a man to donate blood for the Rh factor to determine the genotype in case of a negative blood group in a woman planning a pregnancy or carrying a fetus.

If there is a possibility of developing an Rh conflict, a pregnant woman is prescribed a blood test to check for the presence of Rh antibodies.

Table 1 - Probability of developing Rh conflict during pregnancy

Judging by the table above, we can say that Rh conflict occurs only when the pregnant woman has a negative Rh and the child’s father has a positive Rh, and only in 50 cases out of a hundred possible.

That is, it is not necessary to experience a Rh conflict during pregnancy. The fetus can also inherit negative Rh from the mother, then there will be no conflict.

It should also be noted that during the first pregnancy, antibodies are produced for the first time, and therefore they are larger in size than during a second pregnancy. It is more difficult for large antibodies of the IgM type to penetrate the placental barrier into the child’s blood; they seem to be unable to “get through” the walls of the placenta, and during the next pregnancy, other, more “modified” antibodies of the IgG type are produced. They are smaller, and their ability to penetrate the walls of the placenta is much higher, which is more dangerous for the fetus. Then the antibody titer increases.

Therefore, first-time mothers should not worry about Rh conflict, just be vigilant (it is enough to determine the antibody titer once a month), and enjoy the pregnancy period, because the worries of caring for the baby and raising him lie ahead.

Prevention and treatment of Rh conflict

During the first pregnancy (i.e., there have been no abortions or miscarriages in the past), the first test for antibodies is carried out from 18-20 weeks 1 time per month (until 30 weeks), then from 30 to 36 weeks - 2 times a month, and after 36 weeks of pregnancy – 1 time per week.

In case of repeated pregnancy, they begin to donate blood for antibodies from the 7-8th week of pregnancy. If the titer is no more than 1:4, then this test is performed once a month, and if the titer increases, more often, once every 1-2 weeks.

An antibody titer of up to 1:4 inclusive is considered acceptable (normal) during a “conflict” pregnancy.

Titles of 1:64, 1:128 and more are considered critical.

If there is a risk of developing a “conflict” pregnancy, but antibodies were never detected before week 28 (or were detected, but not more than 1:4), then later they may appear in significant quantities.

Therefore, for preventive purposes, pregnant women are given human anti-Rhesus immunoglobulin D at 28 weeks, which blocks the work of the woman’s immune system to destroy foreign bodies, i.e. after the injection, the woman’s body will not produce antibodies that destroy the blood cells of the embryo.

It is advisable to carry out an immunoglobulin injection in the absence of antibodies in the blood of a pregnant woman, since in other cases it is simply useless.

The vaccine does not have a negative effect on the health of the mother and fetus; it is completely safe.

After an injection (provided there are no antibodies in the blood shortly before the injection, or at least when their titer is no more than 1:4), it is not reasonable to donate blood for antibodies, since a false-positive result may be observed.

It is also advisable to monitor the baby’s cardiac activity by regularly performing cardiotocography (CTG), starting at 26 weeks.

Doppler or Doppler is an ultrasound examination of blood flow in the fetal vessels, uterine arteries and umbilical cord.

When the fetus is suffering, the blood flow velocity (V max) in the middle cerebral artery will be higher than normal. When this indicator approaches the 80-100 mark, an emergency CS is performed to prevent the baby from dying.

If an increase in antibodies is observed and the child’s health deteriorates, this indicates the development of hemolytic disease of the fetus (abbreviated as HDP), then it is necessary to carry out treatment, which consists of intrauterine fetal blood transfusion.

In case of a “conflict” course of pregnancy, the following signs of hemolytic disease of the fetus may be observed during an ultrasound examination:

• enlargement of the fetal abdomen due to the accumulation of fluid in its abdominal cavity, as a result of which the baby takes the “Buddha pose”, spreading the bent legs to the sides;
• swelling of the subcutaneous fatty tissue of the head (ultrasound shows a “double contour” of the fetal head);
• an increase in the size of the heart (cardiomegaly), liver and spleen;
• thickening of the placenta up to 5-8 cm (normal 3-4 cm) and expansion of the umbilical cord vein (more than 10 mm).

Due to increased swelling, the weight of the fetus will increase by 2 times compared to the norm.

If it is not possible to carry out a blood transfusion, then it is necessary to discuss the issue of early delivery. You cannot delay, and if the baby’s lungs have already formed (the 28th embryonic week or more), then it is necessary to perform labor stimulation, otherwise the pregnant woman risks losing the child.

If the baby has reached 24 weeks, a series of injections can be given to mature the fetal lungs so that he can breathe on his own after an emergency delivery.

After the baby is born, he is given a replacement blood transfusion, plasmapheresis (filtration of blood from dangerous cells) or phototherapy, otherwise the destruction of the baby’s red blood cells will continue to occur.

Modern labor intensive care services are capable of delivering a premature baby even if it is born at 22 weeks of pregnancy, so in a critical case, entrust saving the baby’s life to qualified doctors.

Group incompatibility of mother and fetus

Less frequently, but still, blood type incompatibility does occur.

Blood type is a combination of surface antigens (agglutinogens) of red blood cells of the AB0 system, genetically inherited from biological parents.

Each person belongs to a certain blood group according to the AB0 system: A (II), B (III), AB (IV) or 0 (I).

This system is based on a laboratory test to determine two agglutinogens (A and B) in human blood.

• Blood group I - otherwise it is group 0 (“zero”), when agglutinogens neither A nor B were found on red blood cells during a blood group test.
• Blood group II is group A, when the red blood cells contain only A agglutinogens.
• Blood group III is group B, that is, only B agglutinogens are found.
• Blood group IV is group AB; both A and B antigens are present on red blood cells.

Group incompatibility is often observed if the expectant mother has blood type I, and the future father of the child has IV, then the fetus will inherit blood group II or III. But there are other options for blood group incompatibility (see Table 2).

Table 2 - Probability of developing a blood group conflict during pregnancy

Typically, group incompatibility is much easier than Rh incompatibility, so blood group conflict is considered less dangerous, and babies who have suffered a blood group conflict are born with normal jaundice, which soon goes away.

Rh factor is a special substance found in human blood. It owes its name to the animal, the rhesus monkey, in which it was first discovered. It has been proven that the absence of this substance in a woman’s blood can negatively affect the fate of her pregnancy.

The Rh factor (D antigen) is a protein located on the surface of red blood cells (red blood cells - blood cells that bring oxygen to tissues). Accordingly, a person whose red blood cells contain the Rh factor is Rh positive (about 85% of the population), and otherwise, if this substance is absent, such a person is Rh negative (10-15% of the population). The Rhesus status of the fetus is formed in the earliest stages of pregnancy.

When is Rh conflict possible?

The likelihood of Rh conflict during pregnancy (incompatibility between mother and fetus for D-antigen) occurs if the expectant mother is Rh negative, and the future father is Rh positive, and the child inherits the Rh positive gene from the father.

If the woman is Rh positive or both parents are Rh negative, Rh conflict does not develop.

The cause of Rh conflict, or Rh sensitization, during pregnancy is the penetration of Rh-positive red blood cells of the fetus into the bloodstream of the Rh-negative mother. In this case, the mother's body perceives the fetal red blood cells as foreign and reacts to them by producing antibodies - compounds of protein structure (this process is called sensitization).

To make it clear why antibodies are formed in the body, let’s make a small digression. Antibodies are immunoglobulins in the blood plasma of humans and warm-blooded animals, synthesized by lymphoid tissue cells under the influence of various antigens (foreign agents). By interacting with microorganisms, antibodies prevent their reproduction or neutralize the toxic substances they release; they contribute to the development of immunity, that is, antibodies work against the antigen. The process of immunization (sensitization) in the case of Rh incompatibility can occur starting from 6-8 weeks of pregnancy (it is at this period that fetal red blood cells are detected in the mother’s bloodstream); the action of maternal antibodies is aimed at eliminating fetal red blood cells.

At the first meeting of the expectant mother's immune system with Rh-positive erythrocytes of the fetus, antibodies (immunoglobulins) of class M are produced, the structure of which does not allow them to penetrate the placenta; thus, these antibodies have no effect on the developing fetus. After this meeting, “memory cells” are formed in the mother’s immune system, which, upon repeated contact (occurring during subsequent pregnancies), produce antibodies (immunoglobulins) of class G, which penetrate the placenta and can lead to the development of hemolytic disease of the fetus and newborn (see below for more details). ). Once they appear, class G antibodies remain in a woman’s body for life. Thus, Rh antibodies in the body of a Rh-negative woman can appear during artificial or spontaneous abortion or, after the first birth, at the birth of a Rh-positive child. Rh sensitization is also possible if a woman has ever had a blood transfusion without taking into account the Rh factor. The risk of developing Rh sensitization increases with subsequent pregnancies, especially in the case of termination of the first pregnancy, bleeding during pregnancy and childbirth, manual separation of the placenta, and also during delivery through surgery. This is explained by the fact that in the above situations, a large number of Rh-positive erythrocytes of the fetus enter the mother’s bloodstream and, therefore, the mother responds with the formation of a large number of antibodies.

According to medical literature, after the first pregnancy, immunization occurs in 10% of women. If Rh immunization did not occur during the first pregnancy, then during a subsequent pregnancy with an Rh positive fetus, the probability of immunization is again 10%. Rh antibodies circulating in the bloodstream of the expectant mother do not harm her health, but, penetrating the placenta, they can pose a serious danger to the fetus.

Hemolytic disease of the fetus

Once in the bloodstream of the fetus, immune Rh antibodies react with its Rh-positive red blood cells (antigen-antibody reaction), resulting in the destruction (hemolysis) of red blood cells and the development of hemolytic disease of the fetus (HDF). The destruction of red blood cells leads to the development of anemia (a decrease in the amount of hemoglobin) in the fetus, as well as damage to its kidneys and brain. As red blood cells are continuously destroyed, the fetal liver and spleen try to speed up the production of new red blood cells, while increasing in size. The main manifestations of hemolytic disease of the fetus are enlargement of the liver and spleen, an increase in the amount of amniotic fluid, and thickening of the placenta. All these signs are detected using ultrasound during pregnancy. In the most severe cases, when the liver and spleen cannot cope with the load, severe oxygen starvation occurs, hemolytic disease leads to intrauterine death of the fetus at various stages of pregnancy. Most often, Rh conflict manifests itself after the birth of a child, which is facilitated by the entry of a large number of antibodies into the baby’s blood when the integrity of the placental vessels is disrupted. Hemolytic disease is manifested by anemia and.

Depending on the severity of hemolytic disease, several forms are distinguished.

Anemic form. The most benign variant of the course of HDN. It manifests itself immediately after birth or during the 1st week of life as anemia, which is associated with pallor of the skin. The size of the liver and spleen increases, there are slight changes in test results. The general condition of the baby is little affected, the outcome of this course of the disease is favorable.

Jaundice form. This is the most common moderately severe form of tension-type headache. Its main manifestations are early jaundice, anemia and an increase in the size of the liver and spleen. The baby's condition worsens as the breakdown product of hemoglobin, bilirubin, accumulates: the baby becomes lethargic, drowsy, his physiological reflexes are inhibited, and muscle tone decreases. On the 3rd - 4th day without treatment, the level of bilirubin can reach critical levels, and then symptoms of kernicterus may appear: stiff neck, when the baby cannot tilt his head forward (attempts to bring the chin to the chest are unsuccessful, they are accompanied by crying), convulsions, wide open eyes, piercing scream. By the end of the 1st week, bile stagnation syndrome may develop: the skin acquires a greenish tint, feces become discolored, urine darkens, and the content of conjugated bilirubin in the blood increases. The icteric form of HDN is accompanied by anemia.

Edema form- the most severe variant of the disease. With the early development of an immunological conflict, it can occur. As the disease progresses, massive intrauterine hemolysis - the breakdown of red blood cells - leads to severe anemia, hypoxia (oxygen deficiency), metabolic disorders, decreased levels of proteins in the bloodstream and tissue swelling. The fetus is born in an extremely difficult condition. The tissues are swollen, fluid accumulates in the body cavities (thoracic, abdominal). The skin is sharply pale, shiny, jaundice is mild. Such newborns are lethargic, their muscle tone is sharply reduced, and their reflexes are depressed.

The liver and spleen are significantly enlarged, the abdomen is large. Cardiopulmonary insufficiency is pronounced.

Treatment of HDN is aimed primarily at combating high levels of bilirubin, removing maternal antibodies and eliminating anemia. Moderate and severe cases are subject to surgical treatment. Surgical methods include exchange blood transfusion (RBT) and hemosorption.

ZPK still remains an indispensable intervention for the most severe forms of HDN, as it prevents the development of kernicterus, in which bilirubin damages the nuclei of the fetal brain, and restores the number of blood cells. The PZK operation consists of taking the blood of a newborn and transfusing donor Rh-negative blood of the same group as the newborn’s blood into his umbilical vein). In one operation, up to 70% of the baby’s blood can be replaced. Usually blood is transfused in an amount of 150 ml/kg of the child’s body weight. In case of severe anemia, a blood product is transfused - red blood cells. The PZK operation is often repeated, up to 4-6 times, if the bilirubin level again begins to reach critical levels.

Hemosorption is a method of extracting antibodies, bilirubin and some other toxic substances from the blood. In this case, the baby’s blood is taken and passed through a special apparatus, in which the blood passes through special filters, and the “purified” blood is infused into the baby again. The advantages of the method are the following: the risk of transmitting infections with donor blood is eliminated, and the baby is not injected with foreign protein.

After surgical treatment or in the case of a milder course of HDN, transfusions of solutions of albumin, glucose, and hemodez are performed. In severe forms of the disease, intravenous administration of prednisolone for 4-7 days has a good effect. In addition, the same methods are used as for transient conjugation jaundice.

The method of hyperbaric oxygenation (HBO) has found very widespread use. Pure humidified oxygen is supplied to the pressure chamber where the baby is placed. This method allows you to significantly reduce the level of bilirubin in the blood, after which the general condition improves and the effect of bilirubin intoxication on the brain decreases. Usually 2-6 sessions are performed, and in some severe cases 11-12 procedures are required.

And at present, the question of the possibility and advisability of breastfeeding babies with the development of tension-type headache cannot be considered completely resolved. Some experts consider it completely safe, others are inclined to stop breastfeeding in the first week of a baby’s life, when the baby’s gastrointestinal tract is most permeable to immunoglobulins and there is a danger of additional maternal antibodies entering the baby’s bloodstream.

If Rh antibodies are found in your blood...

It is advisable to know your blood type and Rh factor before pregnancy. During pregnancy, at the first visit to the antenatal clinic, the blood type and blood type of the pregnant woman are determined. All pregnant women with Rh-negative blood and in the presence of Rh-positive blood of the husband should be regularly examined for the presence of antibodies in the blood serum. If Rh antibodies are detected, it is necessary to contact specialized medical centers for further observation.

Specialized modern perinatal centers are equipped with the necessary equipment to monitor the condition of the fetus and promptly diagnose the development of hemolytic disease of the fetus. The list of necessary studies in women with Rh sensitization includes:

• periodic determination of the level of antibodies (antibody titer) - carried out once a month,
• periodic ultrasound examination,
• if necessary, intrauterine interventions: amniocentesis, cordocentesis (procedures carried out under ultrasound control, during which a needle pierces the anterior abdominal wall and penetrates into the cavity during amnocentesis or into the umbilical cord vessels during cordocentesis); These procedures allow you to take amniotic fluid or fetal blood for analysis.

If a severe form of hemolytic disease of the fetus is detected, intrauterine treatment is carried out (under the control of ultrasound, the required amount of red blood cells is injected into the umbilical cord vessel through the anterior abdominal wall of the mother), which improves the condition of the fetus and prolongs pregnancy. Regular monitoring of pregnant women with Rh sensitization in specialized centers allows you to choose the optimal timing and methods of delivery.

How to avoid the appearance of Rh antibodies

Family planning plays an important role in the prevention of Rh sensitization. A guarantee of the birth of a healthy child in an Rh-negative woman (in the absence of previous sensitization during blood transfusion) is the continuation of the first pregnancy. For specific prevention, a drug is used - anti-Rhesus immunoglobulin. This drug is administered intramuscularly once after childbirth if a Rh-positive child is born; after artificial or spontaneous termination of pregnancy, after surgery performed in connection with an ectopic pregnancy. It should be remembered that the drug must be administered no later than 48 hours after birth (preferably within the first two hours), and in the case of artificial termination of pregnancy or ectopic pregnancy - immediately after the end of the operation. If the timing of administration is not observed, the effect of the drug will be ineffective.

If you have a negative Rh, and the unborn baby is positive, or if the father’s Rh is unknown, there is no way to establish it, then if there are no antibodies until the end of pregnancy, you should take care that, if necessary, if the child is determined to have a positive Rh, there are there was anti-Rhesus immunoglobulin. To do this, it is advisable to find out in advance whether the maternity hospital you have chosen is provided with this drug. If immunoglobulin is not available, you must purchase it in advance.

A program for the prevention of Rh sensitization during pregnancy is currently being developed. To achieve this, it is proposed to administer anti-Rh immunoglobulin to Rh-negative mothers who do not have antibodies detected in the middle of pregnancy.

Anastasia Khvatova
obstetrician-gynecologist, Russian State Medical University

Comment on the article "Rh-conflict: problem and solution"

Hello! I have blood type 4, Rh factor, Rh negative. My husband is 2 positive. My pregnancy was terminated at 21 weeks of pregnancy because I was found to have a very large amount of antibodies - titer 1:256. The fetus has severe ascites, hemolytic disease of edematous form. At the age of 13 I had sepsis and received a blood transfusion. The first pregnancy was stupidly terminated at 6 months of pregnancy, after which I had 2 medical abortions in the early stages. And I was never immunized. But I had no idea that it would all lead to this. Can I have children with such a high number of antibody titers in the future? And what is the probability of carrying a child to term?

03/03/2017 17:22:44, Lyazzat

Hello. I have rh(-)1 husband, rh(+)1, two children died. The second child who died was tested and an expert was done, as a result they showed that the causes were Rh conflict. The first child was born in 2010. the second after 2 months, but had an abortion because I had a miscarriage. When I found out that I had rh(-)1, they did anti-Rhesus immunogloblin rogam. After 9 months, I became pregnant. I assessed that the pregnancy was good. I did antibody tests once; nothing came of it. The time has come, 2012, February 17. but there were no contractions, they made a background because of varicose veins, the doctor did a cesarean section. The child was Rh negative. Again they did anti-Rhesus immunogloblin, the child died 3 days after the first baby died. Now I’m pregnant by accident. pregnancy 3-4 weeks. I don’t know what they’re doing. I really need your help, I live in Azerbaijan. Sincerely, Fidan

11/14/2012 01:01:41, fidan

My mother has 2 "-" and my father has 1 "+", they gave birth to 4 healthy children. There wasn't even an ultrasound in those days. So the presence of a difference in Rh factors is normal, give birth to your health)))

08/21/2008 08:44:50, Eva

Total 13 messages .

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Negative Rh factor. Intrauterine growth retardation. ...protein in the urine, edema, long-term increased tone of the uterus with the threat of premature birth, abnormal development of the uterus Rhesus - a conflict during pregnancy. Negative Rh factor.

Not so long ago, negative Rh blood factor during pregnancy was a serious threat to its course. Doctors predicted that the expectant mother, especially if she was pregnant with her second or third child, would experience a whole range of negative consequences for the baby. If a woman, having a negative Rh factor, for some reason decided to artificially terminate pregnancy, an abortion could cause further childlessness.

Today the situation has changed dramatically. Modern diagnostic and therapeutic methods make it possible to minimize the risks of negative indicators of this parameter in the mother.

What is the Rh factor?

The blood of humans and animals contains red blood cells, on the surface of which there is an antigen or protein called the Rh factor. This is a constant indicator and cannot change during life. Sometimes there is evidence that after medical manipulations in a person this blood parameter changes. But it has been scientifically proven that changing it is impossible. The answer to the question of why such information appears is the erroneous results of determining the presence of an antigen before or after medical manipulation.

If a person’s red blood cells have this antigen, the Rh factor is called positive; if it does not, it is called negative. More than 85% of the world's population are Rh positive carriers. Information about whether a person has an antigen or not is necessary when giving a blood transfusion, providing emergency medical care, or surgical intervention. These parameters are sometimes used to determine the sex of the unborn child, but there is no data confirming the accuracy of such methods.

It is reliably known that the discovery of a negative Rh factor du in a patient means that, if necessary, he is given a blood transfusion only with a negative indicator.

During pregnancy, the Rh factor is very important. If the mother is negative and the husband is positive, the baby may inherit the father's antigen. This is fraught with the development of Rh conflict, which the mother’s body will fight with the active production of antibodies, perceiving the growing baby as a foreign body. If measures are not taken, the course of such a pregnancy will end negatively.

The compatibility of Rh factors and blood groups with each other is determined using a special table.

(Table picture)

When both spouses have the same positive or negative Rh factor, they have nothing to worry about. It is necessary to take measures during pregnancy only if young parents have different values ​​of this indicator.

Features of pregnancy with negative Rhesus

If parents have different antigen levels, and there is a possibility of Rh conflict during pregnancy, this is not a reason for frustration. Close supervision by specialists and regular testing, as well as knowledge of how to give birth with a negative Rhesus, will help you get through this stage without risks for the child.

During the first pregnancy

Only during pregnancy does a woman encounter unfamiliar, foreign antigens for the first time. There is a high probability that the production of antibodies against antigens will not begin at all. During the first pregnancy, the process of their production (if it has begun) proceeds slowly. A decrease in immunity due to changes in hormonal levels and the slowness of white blood cells contribute to the fact that the Rh conflict either does not begin at all or is mild.

During the second and subsequent pregnancies

When faced with foreign antigens, the body acquires “cellular memory”. This means that the next time it encounters a foreign antigen, the formation of antibodies in the female body will occur much faster. With each subsequent time, the speed of the process increases, increasing the inevitability of the development of Rh conflict.

Memorization occurs not only after a successful pregnancy, but also after a miscarriage, abortion, or medical intervention involving a blood transfusion.

If a Rh conflict has developed in the body of a young mother, modern medical methods can correct the situation in time. She is advised to constantly be under the supervision of specialists.

Consequences of negative Rh factor during pregnancy

A pregnant woman with negative Rh is required to take an antibody test every month. The obstetrician-gynecologist pays close attention to accompanying pregnancy with such an anamnesis. Until the thirty-second week, a venous blood test for the presence of antibodies is carried out every month. After the thirty-second week, it should be taken every couple of weeks. From 35 weeks - weekly.

Otherwise, bearing a baby by a mother with negative Rh is no different from the course of a normal pregnancy. The rapidity of antibody development determines whether immunoglobulin will need to be administered to the expectant mother.

Impact on baby's health

If preventive measures are not taken, dangerous pathological processes are launched:

1. A decrease in the number of red blood cells in the fetus, which are responsible for transporting oxygen, which gradually develops oxygen starvation. First of all, it affects the development of the heart and brain.
2. The amount of bilirubin increases. It is produced when red blood cells are destroyed. An increasing amount of bilirubin causes serious intoxication of the fetus.
3. Increased production of red blood cells by the spleen and liver of the child, causing an enlargement of these organs and their pathological development.
4. The development of an imbalance in the composition of the blood, impaired production of blood particles, the development of pathologies in the development of the spinal cord, congenital hemolytic anemia. Hemolytic disease of the newborn (HDN) is manifested by pale skin and general weakness.

Methods for diagnosing problems with negative Rh factor during pregnancy

The presence of antibodies in a young mother is determined at the very beginning of pregnancy. Many women know about their Rh factor long before conception and the onset of an “interesting situation.” The obstetrician-gynecologist puts such a mother on special registration. Having identified a negative antibody test result, the doctor prescribes a monthly venous blood donation for the expectant mother to monitor the rate of antibody formation. The closer the due date, the more often the young mother has to undergo tests to control the situation.

In addition to blood tests, the pregnant woman is prescribed routine ultrasound examinations, during which close attention is paid to the condition of the baby’s liver and spleen, as well as the condition of the placenta.

If any pathologies are detected, cardiotocography (CTG) and Doppler ultrasound are additionally performed. These studies make it possible to evaluate the functioning of the child’s cardiovascular system, as well as whether a sufficient amount of oxygen is supplied to him through the uteroplacental bloodstream.

If the analysis for anti-Rhesus bodies shows their rapid growth, invasive diagnostic methods are used. This diagnostic method is dangerous due to leakage of water surrounding the fetus, the risk of infection, and the formation of a hematoma on the umbilical cord.

Analysis of amniotic fluid is the most reliable study, which indicates the exact amount of bilirubin produced by the baby, which allows us to assess the condition of the fetus. Taking material from the umbilical cord also provides reliable information about the composition of the fetal blood.

Specifics of childbirth

If the incompatibility of Rh factors did not lead to the rapid formation of antibodies and the pregnancy proceeded normally, without pathologies, the baby can be born naturally. During the process of delivery, the mother's body may intensify the production of antibodies due to the loss of a certain amount of blood. To do this, in the delivery room, the obstetrician-gynecologist must have on hand a portion of blood of the same type and Rh as that of the woman in labor. To eliminate the risk of pathologies during the birth process, the woman in labor is allowed to receive an injection of immunoglobulin.

In cases where the child inherited not the mother’s Rh, but the male, and a Rh conflict arose while carrying the baby, a decision is made to deliver by caesarean section. A problematic pregnancy is supported and maintained until 37-38 weeks, and upon reaching this period, a planned operation is performed.

In severe situations, a newborn baby is given a blood transfusion of the same type and Rh as the mother’s. In the first days, a newborn is fed not with breast milk, but with formula. This is due to the fact that breast milk still contains antibodies. If they enter the baby's body, they will begin to destroy the red blood cells of his blood.

Immunoglobulin is injected into the body of a young mother within 72 hours after birth. This will prevent the conflict from developing in subsequent pregnancies. The same measures should be taken after an abortion or miscarriage. It is extremely important to complete the injection within three days.

Even if the first birth and the period of gestation passed without complications and the woman is planning the next pregnancy from a man with positive Rh, memory cells will still be produced in her body, so for the next birth the injection drug will need to either be purchased independently or check its availability in the maternity hospital. home.

You can learn more about what Rh conflict is, why it is bad, and how pregnancy proceeds with such a history from the video:

Conclusion

A negative Rhesus in a mother is not a reason to give up motherhood, and incompatibility of Rhesus with a beloved man is not a reason to part with him. In the vast majority of cases, bearing a baby under such circumstances proceeds without pathologies. Rhesus conflict occurs in only ten percent of pregnant women. Serious problems with development and health are observed in only two or three children out of a thousand.

In this article:

Few people know what the Rh factor (Rh) is. This is due to the fact that during ordinary life its absence or presence does not affect a person in any painful way. However, if a man and woman have an incompatible Rh combination, then during pregnancy this can lead to a phenomenon called Rh conflict.

What is the Rh factor? It refers to a protein or antigen found on the surface of red blood cells. Positive Rh (Rh (+)) is the presence of this antigen, and negative (Rh (-)) is its absence. Most people are Rh positive, while only 15% are Rh negative.
This phenomenon occurs only in two cases. Firstly, when transfusing blood that is Rhesus incompatible. Secondly, if a pregnant woman with Rh (-) carries a fetus with Rh (+).

Mechanism of development of Rhesus conflict

The reaction to the entry into the blood of a pregnant Rh-negative woman of fetal antigens with Rh (+) is the production of antibodies by her body (isoimmunization). The bulk of them penetrates to the fetus through the placenta. Thus, in the body of an unborn baby, red blood cells stick together (hemolysis), and this in turn provokes damage to various organs. Hemolysis most affects the brain and liver. This condition is called hemolytic disease of the newborn (HDN).

The comforting fact is that during the first pregnancy of a woman with the absence of the antigen, carrying a child with its presence, a Rh conflict between mother and child will not arise. At this stage, antibodies are produced, but during a second pregnancy it is extremely difficult to avoid.

If a mother who does not have the antigen carries a fetus with a similar Rhesus, then there will be no conflict. The situation is the same if the mother is Rh positive and the fetus is Rh negative, since the father’s blood he inherited does not contain antigens.

Symptoms

Symptoms of the development of the process in the fetus are noticeable during ultrasound examination. Water will accumulate in its cavities, resulting in swelling. The baby's position is usually unnatural; it is also called the Buddha pose. The mother's belly may become enlarged due to accumulated fluid, and the baby will be forced to spread his legs. The contour of the head may become double, and the diameter of the vein in the umbilical cord and the size of the placenta will be subject to changes.

As a result, a newborn may develop one of three forms of HDN disease: edematous, icteric or anemic. The edematous form is considered the most dangerous for the baby. Usually such babies are sent to the intensive care unit or intensive care unit. The degree of complexity of the icteric form is determined by analyzing the amniotic fluid for the amount of bilirubin. The anemic form depends on the severity of the anemia, but is the easiest to tolerate.

What reasons can cause Rh conflict?

Isoimmunization (Rh-sensitization), which occurs during pregnancy in an Rh (-) woman, is caused by the entry of Rh-incompatible blood of the child into her bloodstream. In many ways, this process depends on the outcome of the primary pregnancy. Sometimes Rh sensitization occurs during the first pregnancy. This is possible if the woman has previously received a blood transfusion without taking into account Rh compatibility. The risk also increases if the pregnancy was previously terminated spontaneously or artificially.

Most often, umbilical cord blood enters the mother's bloodstream during childbirth. Thus, the female body becomes susceptible to the child’s antigen, creating a risk of Rh sensitization during the second pregnancy. In addition, the risk increases after a cesarean section. Also at risk are women suffering from bleeding due to damage or abruption of the placenta, manual separation, and those who have undergone prenatal diagnostics - cordocentesis, chorionic villus biopsy, amniocentesis. In 2% of women with no antigen, the cause of Rh conflict may be intrauterine sensitization of the Rh (-) pregnant woman, which once occurred at birth from an Rh (+) mother. If an Rh (-) pregnant woman suffers from diabetes, gestosis, or has suffered from an acute respiratory infection or influenza, then the synthesis of anti-Rhesus antibodies may be activated in her body due to a violation of the integrity of the chorionic villi.

Rhesus conflict can even lead to miscarriage. In view of this, Rh negative mothers should be very careful about their situation. They need to follow all the recommendations of the pregnancy specialist.

Diagnosis

The first thing doctors do to determine whether a Rhesus conflict is developing is to test for the presence of antibodies. To determine whether women are at risk, an analysis is done in the first trimester of pregnancy to determine the Rh factor. The baby's father also undergoes this procedure. If there is a danger, then once a month the pregnant woman will have to take this test again.

If there is a threat, starting from the 20th week, the mother carrying the fetus goes from the antenatal clinic to a specialized center for observation. From 32 weeks she will be tested twice a month, and after 35 weeks until delivery - weekly. From the 28th week, blood exchange between the fetus and mother increases, which means the number of antibodies in the child’s body also increases. From this time on, the expectant mother will be under close supervision.

The first ultrasound is scheduled somewhere at 18-20 weeks, after that at 24-26, another one at 30-32, the penultimate one at 34-36 and the final one before childbirth. If the fetus's condition worsens, additional examination may be performed. To assess the speed of blood flow and heart function, Doppler measurements are performed. To determine the reactivity of the cardiovascular system and the possible presence of hypoxia, CTG is performed.

To assess the condition of the unborn baby, invasive examination methods may be needed. Sometimes amniocentesis is prescribed, for which the fetal bladder is punctured and amniotic fluid is collected, then analyzed. The procedure makes it possible to determine the amount of bilirubin, and this helps to determine the true condition of the fetus. Such a puncture is indicated only if the antibody titers are 1:16 or the woman has children with any form of HDN. Amniocentesis can have dangerous consequences. For example, infection of amniotic fluid, leakage, bleeding, may trigger the process of premature placental abruption, as well as other pathologies.

Cordocetosis is carried out if the antibody titer is 1:32, Rh conflict has caused the death of children, and there are those born with a severe form of HDN. Like the previous study, the procedure is very dangerous, as it can lead to the same consequences. To carry it out, the umbilical cord is pierced and blood is taken for analysis. Cordocetosis more accurately determines bilirubin levels than amniocentesis. Blood transfusions to the fetus are performed in the same way. The examination may lead to the development of a hematoma on the umbilical cord, which interferes with the metabolism between mother and fetus.

Treatment of isoimmunization

To weaken the effect of antibodies, all mothers with Rh (-) undergo desensitizing therapy for a period of 10 to 12 weeks, from 22 to 24, from 32 to 34. For this, women are prescribed vitamins, iron and calcium supplements, metabolic and antihistamines, oxygen therapy . After 37 weeks, if the baby is in normal condition, the pregnant woman can give birth on her own. To prolong pregnancy, an intrauterine blood transfusion can be performed, which helps compensate for anemia, hypoxia, and prolong the gestation process. To reduce the antibody titer, mothers may be prescribed plasmapheresis.

Most often, pregnancy, which proceeds along with the development of Rh conflict, ends in planned premature birth. Using all available methods, doctors monitor the baby’s condition. So, they can make an immediate decision regarding continuation of pregnancy or premature birth. It depends on what is safer for the baby. As practice shows in the development of such a phenomenon, natural childbirth is rarely allowed, and only if the condition of the fetus is satisfactory and there are no other contraindications. But even if childbirth is allowed, specialists continue to actively monitor the condition of the fetus. If complications occur, they may prescribe an immediate cesarean section.

Even if Rh sensitization does not occur in a Rh-negative mother during pregnancy, the baby’s blood should be tested immediately after birth. If the baby has Rh (+), then during the first 72 hours after birth the woman is administered anti-Rhesus immunoglobulin. The drug very quickly destroys the newborn’s red blood cells that enter the mother’s body. Due to this, the mother’s body does not have time to produce antibodies. This minimizes the possibility that Rh conflict will develop during subsequent pregnancies. The same drug is administered to an Rh-negative woman during the first 72 hours after a miscarriage, abortion, or in some other cases. At the moment, immunoglobulin is recommended to be administered to all pregnant women with Rh (-). It is administered at 28 and 34 weeks of pregnancy.

Responsibility lies with the mother

A woman, first of all, must understand the extent of her responsibility. This means that after conception, she must carefully follow all the doctor’s instructions and the timing of his monitoring. In addition, to determine the presence of antibodies, she needs to be tested regularly - at least once a month. The absence of antibodies indicates that the child is developing normally at this stage. But, the expectant mother must understand that the risk of their formation will be before the birth itself and even during the process.

An increase in antibody levels means that the immune system's activity against Rh(+) is increased. If all tests indicate that Rh conflict is developing, then the mother carrying the child should immediately go to the perinatal center for conservation. Here she will be prescribed and given the necessary treatment, and the woman and fetus will be constantly under close medical supervision. The expectant mother cannot resist the help offered, otherwise she risks giving birth to a child in serious condition or losing him altogether.

In severe forms of the lesion, immediately after birth, the newborn begins to be treated for tension-type headache. In order not to worsen the baby's condition, breastfeeding is prohibited during the first two weeks. If the baby develops normally, without symptoms, then the mother is simply given an injection of anti-Rhesus immunoglobulin, after which breastfeeding can begin. But even in this case, doctors did not come to a consensus regarding feeding.

Some specialists assess the condition of the newborn and, to ensure his safety, may prohibit feeding for several days. Others argue that there is no need to limit breastfeeding. But, since these studies do not have any confirmation, and the equipment of the clinics leaves much to be desired, it is better not to challenge the decisions made by doctors. They focus on their capabilities and the condition of the newborn. The main thing is that specialists are interested in the well-being of the baby and his mother.

So, Rh conflict is not a death sentence, and it is quite possible to bear a baby with such a diagnosis. The absence of antigens in the mother does not always mean that pregnancy will lead to isoimmunization. It is undeniable that this diagnosis can end in failure, but this is not a reason for despair. Only 0.8% of Rh-negative pregnant women face this problem.

Useful video about Rh conflict during pregnancy