The vast majority of young expectant mothers have little idea of ​​what is meant by the concept of “Rh factor” and why this parameter is so important.

Rhesus is a protein found on the surface of red blood cells. It is present in approximately 85% of the planet's inhabitants.

How does Rh conflict arise?

The main reason for the development of Rh conflict is the discrepancy between these characteristics of the blood of the mother and the unborn child, i.e. if the baby's blood is positive and his mother's is negative. In this case, there is no Rh conflict between blood groups.

The mechanism for the development of this phenomenon is as follows. At the moment when fetal red blood cells with rhesus proteins enter the blood of the expectant mother through the vessels of the placenta, they are perceived as foreign. As a result, the pregnant woman’s immune system is activated, which is accompanied by the production of antibodies that are designed to destroy fetal blood cells that do not correspond to the mother’s cells.

Due to the fact that the baby's red blood cells are periodically destroyed, his spleen and liver, as a result of increased blood cell production, increase in size.

As a result, the baby’s body cannot cope, and severe pain sets in, which can lead to death.

In what cases is Rh conflict possible?

In order to avoid such a situation, a girl should know the Rh factor of her lover even before marriage. A violation occurs in cases where the wife has no rhesus protein, but the husband has it. In such a situation, in 75% of cases there is a discrepancy.

Therefore, in order to prevent the development of Rh conflict, a table was compiled on the likelihood of disorders occurring during pregnancy.

What are the signs of this disorder?

There are no clinical signs of the development of Rh conflict during pregnancy, i.e. A pregnant woman is unable to independently determine the disorder. This is done using ultrasound.

So, symptoms of this disorder may include:

• the development of swelling, which is accompanied by the accumulation of fluid in the body cavities;
• increase in fetal body size;
• “Buddha” pose (the baby’s legs are moved to the side, due to the strong increase in the abdomen);
• enlargement of the spleen and liver of the fetus;
• swelling and thickening of the placenta.

Is pregnancy possible for

Do not despair if a girl has Rh-negative blood, and her chosen one has positive blood. As a rule, the first pregnancy proceeds normally. This is explained by the fact that the woman’s body encounters Rh-positive blood for the first time, and few antibodies are produced. In cases where there were a lot of blood cells with rhesus protein entering the mother’s body, so-called memory cells remain in her blood, leading to conflict during the second pregnancy.

How is rhesus conflict prevented?

During pregnancy, special attention is paid to the prevention of Rh conflict.

So, first of all, they check whether this protein is present in the mother’s blood. If it is not there, then the father undergoes a similar procedure. If it contains Rhesus, then the blood of the expectant mother is carefully examined for the presence of antibodies in it. At the same time, constant monitoring of the level of these formations in the blood of the pregnant woman is carried out. So, up to 32 weeks, the analysis is carried out once a month, and in the period 32-35 weeks - 2 times every 30 days.

After the baby is born, his blood is taken and Rh is determined. If it is positive, then within 3 days the mother is injected with serum - immunoglobulin, which prevents the occurrence of conflict during the next pregnancy.

What are the consequences of Rh conflict?

A Rh conflict detected in time, as a rule, does not have negative consequences. However, this does not always happen. If a miscarriage occurs, then sensitization (production of antibodies) occurs in only 3-4% of cases, during a medical abortion - 5-6%, after a normal birth - 15%. At the same time, the risk of sensitization increases with placental abruption and cesarean section.

Human blood has two main indicators - group and Rh factor. For a pregnant woman, it is the second indicator that is extremely important: if the Rh blood of the woman and the fetus are incompatible, a conflict may arise.

Rh conflict is dangerous because it leads to blood pathology - hemolysis, which can develop in the prenatal period or after the birth of the baby. This disease leads to the rapid death of red blood cells, which, in turn, causes hypoxia in the child and leads to intoxication of his body, especially increasing the load on the liver.

Why and how does a conflict arise between the blood of the mother and the fetus?

The reason that Rh conflict between mother and fetus develops is the incompatibility of their Rh factors. Blood consists of plasma in which red and white cells circulate. The first of them are called red blood cells. They contain hemoglobin, which is responsible for transporting oxygen and carbon dioxide. The outer shell of red blood cells is covered with protein compounds, including Rh0(D) - the Rh factor.

The Rh0(D) compound appears on embryonic erythrocytes already in the first weeks of gestation. It is found in 85% of people who are Rh positive. The remaining 15% are Rh negative because they do not have this substance. Expectant mothers with this feature may develop Rh conflict with the fetus. Mismatch of Rh factors often leads to serious pregnancy complications, including miscarriage.

Why might this happen? The mechanism of conflict between the blood cells of a pregnant woman and her baby has a complex scheme. It occurs when a woman lacks the Rh0(D) compound, but the baby has it.

Information about the presence of the Rh factor is transmitted to the fetus through the father's genes. If the father has a positive Rh factor, the chance that the child will not have Rh0(D) and a conflict will not arise is very small. At the same time, it also happens that an Rh-positive father gives birth to a child with Rh-. It depends on the genetic characteristics of the father and mother.

Conditions that increase the likelihood of conflict

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Conflict between a child with positive Rh and a mother with negative almost never appears during the first pregnancy. Each subsequent child is harder for the “negative” mother.

With negative Rh, the female body begins to perceive the fetus as something dangerous, and an immune reaction appears. This happens only if the fetal body fluids enter the mother’s body.

During the normal course of pregnancy, the substances of the mother and child’s bodies do not mix. However, in some cases, if the integrity of the placenta is disrupted, fetal cells containing the Rh0(D) protein enter the mother's body and cause a rejection reaction. Conditions that may increase the likelihood of Rh conflict during pregnancy are:

• ectopic pregnancy;
• medical termination of pregnancy or spontaneous abortion;
• chorionic villus biopsy, biochemical analysis of amniotic fluid, examination of fetal blood taken from the umbilical cord;
• various pathologies of the placenta;
• any obstetric operations.

Blood type conflict: table for determining probability

A conflict of incompatible Rhesus genes can sometimes develop when the mother and child have different blood groups. The causes of problems in this case lie in the reaction of the female body to protein compounds in the child’s blood group. If group incompatibility occurs, the only treatment is intrauterine blood transfusion to the fetus. The table for the possibility of conflict by group looks like this:

Rh factor conflict

The occurrence of a conflict between mother and fetus regarding Rh occurs more often than with blood group incompatibility. This probability can be calculated taking into account the genetic characteristics and Rh blood of the partner with whom the expectant mother is married or in an intimate relationship. If the baby has a protein that is not in the woman’s red blood cells, her body gives an immune reaction, starting an attack on the baby’s body.

Rh conflict during gestation usually occurs when the mother's blood is Rh negative and the father's blood is positive. The danger is reduced if the father is homozygous and carries the DD genotype. In Rh-positive men with the Dd genotype, the chance of having a baby with the same blood characteristics is reduced to 50%.

There is a special table that allows you to provide for the possibility of Rh incompatibility. However, determining a man’s genotype is extremely rare in practice, so doctors rarely turn to such a table. Instead of approximate calculations for an accurate diagnosis, they prefer data that can be obtained using special blood testing methods.

Analysis for the presence of conflict by blood group or Rh factor

Prevention of Rh incompatibility in patients with negative Rh is performed in two approaches. The first is an analysis for signs of conflict between her red blood cells and the foreign protein Rh0(D). The second approach involves searching for traces of hemolytic abnormalities in a patient carrying a baby, and calculating the titer - the height of the antibody concentration D.

Since Rh incompatibility can have very unpleasant consequences, Rh-negative patients, after being registered for pregnancy, are carefully examined for the likelihood of developing a conflict. The biggest danger in such a situation is the threat of spontaneous abortion or premature birth.

When the Rh blood of the mother and fetus are incompatible, the child often develops various congenital diseases - from hepatitis to cerebral palsy. The likelihood of such complications is especially high during a second pregnancy. Fortunately, the achievements of modern medicine make it possible to avoid all these dangers if you resort to examination and treatment in a timely manner.

Indications for research

The main indication for additional research is the presence in the expectant mother's history of pathologies that increase the possibility of developing Rh incompatibility during pregnancy. The need for strict control may arise when symptoms of Rh incompatibility appear during a second pregnancy.

A woman should begin taking biomaterial to search for antibodies in the body at the 6th week of gestation. After this, she needs to undergo the same examinations every 4 weeks. If the number of antibodies increases, after 20 weeks the woman will be prescribed additional tests. She may even need to go to a hospital, where the rise or fall in the concentration of antibodies in the blood will be easier to observe.

Preparing to submit material

Before going to the laboratory to donate blood for antibodies, no special preparation is required. The material for the study is taken from a vein. You should come to the clinic on an empty stomach, early in the morning. Before this, you are allowed to drink only a little water.

Two to three days before donating blood, you should make changes to the menu, excluding fatty, spicy and smoked foods. It is also undesirable to drink strong tea or coffee. If you need to take any medications, you need to notify your doctor, who will interpret the analysis.

Decoding the results

Reading an antibody test is a fairly simple process in which even a very young doctor is unlikely to make a mistake. If a blood test for antibodies during pregnancy gives a negative result, then there is no conflict.

If the serum produces a titer of 1:2 or 1:4, then there is little risk of conflict. At higher rates, the risk of complications increases, so expectant mothers are prescribed an antibody test again after a week. A steadily growing titer indicates the danger of complications. To reduce the negative impact that Rh conflict has during a second pregnancy, doctors prescribe special treatment for patients with this diagnosis.

Symptoms of conflict and its consequences for mother and fetus

Doctors try to especially carefully monitor the presence and concentration of antibodies in the blood of an expectant mother with negative Rh in a situation where the patient begins to complain of symptoms of a conflict pregnancy. In the early months these happen:

• constant feeling of lethargy and extreme fatigue;
• pain in the lumbar region;
• the appearance of swelling in the legs even in cases of lack of exercise and other factors that cause disruption of fluid circulation in the body;
• tachycardia or surges in blood pressure;
• severe toxicosis with debilitating vomiting.

All of the above symptoms are also characteristic of other diseases, so in the early weeks of gestation it is very difficult to determine the presence of a conflict based on different blood rhesus levels. At a later stage, ultrasound helps to identify pathology. Signs of Rh incompatibility during the 1st and subsequent pregnancies are:

• Finding the baby in the Buddha pose. This position is completely unusual for the fetus and is explained by the accumulation of fluid in its abdominal cavity, which prevents the baby from connecting the legs together.
• Double contour of the baby's head. It appears due to the abundant accumulation of fluid between the skull and scalp.
• Increased size of the fetal liver and spleen. This is explained by the high load on these organs.
• Enlargement of the umbilical vein, increase in the number of large vessels in the placenta. Due to poor blood flow that occurs during a conflict pregnancy, the fetus experiences vasodilation and swelling.

The results of Rh conflict during the period of bearing a baby can be various deviations after birth. One of the most likely diseases is hemolytic disorder in a newborn. Other possible pathologies include:

• enlarged spleen and liver;
• jaundice;
• anemia;
• hypoxia;
• low weight, weakness, lethargy.

In the blood of a newborn, bilirubin can greatly increase, poisoning the entire weak body of the baby. A high concentration of liver pigment can provoke encephalopathy, the consequences of which are often cerebral palsy, liver dysfunction and kidney infarction.

Health care

When a patient with Rh negative has a high titer of conflict, she is prescribed a certain treatment. The main therapeutic goal that the doctor sets for himself is to level out the aggressive reaction of the mother’s body to the Rh0(D) protein, as well as reduce the consequences of this disorder.

One of the areas of therapy in such a case is oxygen therapy, which involves the prevention of fetal hypoxia. The expectant mother is also prescribed antihistamines, vitamin preparations, and products containing iron and calcium.

Quite often, in patients with conflict pregnancies, labor occurs earlier than expected. In the absence of pronounced pathologies in the fetus, doctors decide on natural delivery. If the condition of mother and baby continues to deteriorate steadily, a caesarean section will be performed at 37 weeks. The postpartum woman will be prescribed immunoglobulins.

After birth, the baby is given an emergency blood transfusion, a course of body-cleansing therapy is given, and the baby is prescribed warming under an ultraviolet lamp. In the hospital, the newborn is closely monitored by neonatologists. Most often, the baby is discharged 7–9 days after birth. In especially severe cases, the baby is placed in the intensive care unit.

Prevention of conflict based on blood type and Rh factor

Pregnant women with negative Rh who are married or have intimate relationships with Rh-positive partners are at risk for conflict and need to prevent the development of complications. The main modern measure to prevent problems with bearing a baby in such women is the intramuscular injection of donor anti-Rhesus immunoglobulin. This procedure is performed in pregnant women in the following cases:

• with placental abruption;
• if the woman was injured during gestation;
• there was a need to analyze the amniotic fluid, placenta or fetal blood.

The term "Rh factor" applies to one of 36 blood group systems. This is a lipoprotein protein on the surface of red blood cells. If it is present on the membranes of red cells, then the person is Rh positive; if not, he is Rh negative. When the Rh factors of the pregnant woman and the fetus do not match, hemolysis develops, leading to serious complications.

What role does the Rh factor play during pregnancy?

The presence of the Rh factor in itself does not in any way affect human health, including pregnant women. This is just one of the immunological properties of blood.

With a positive Rh factor, it is considered stronger. Only 15% of all people have a negative one. The Rh factor appears in the embryo early in pregnancy. Already at 8 weeks, maternal blood tests detect a small number of fetal red blood cells. The Rh factor of parents during pregnancy is important for predicting the further development of the child:

• If the parents have the same Rh factor, then the conception and development of the baby will be favorable.
• When the Rh factors of a woman and a man are different, Rh conflict may develop. If the fetus inherits Rh from its father, then it will be incompatible with its mother. This is very dangerous for the child. Miscarriage can occur at any stage of pregnancy.

The mechanism of occurrence of Rh conflict

In the case of Rh conflict, upon contact, the red blood cells of the fetus and the woman stick together, which leads to complications. It is worth noting that Rh-positive blood tolerates this more easily. For this reason, a woman with Rh+ does not experience a Rh conflict during pregnancy with a fetus with Rh–. The mother's blood does not react to the child's Rh, so protective antibodies are not formed.

A dangerous condition is a negative Rh factor in a woman during pregnancy with a Rh-positive fetus. This is observed when a baby inherits Rh from a father with Rh+.

In this case, the following processes occur:

1. The meeting of the blood of the mother and the fetus occurs in the space between the placenta and the uterus.
2. An exchange takes place there: nutrients and oxygen are supplied to the baby, and waste products are supplied to the mother.
3. Against this background, some of the positive red blood cells of the fetus enter the blood of the pregnant woman, and her negative red cells enter the blood of the child.
4. In the same way, antibodies penetrate the baby, which are produced in response to genetically foreign material - fetal red blood cells.

Regardless of how often a woman is pregnant, the entry of positive red blood cells from the fetus into the blood of a mother with negative Rh occurs in several other situations. Main cases:

• Pregnancy, which is accompanied by gestosis, threat of miscarriage or serious illness of the woman.
• Premature placental abruption or manual separation.
• Delivery by caesarean section.
• Cordocentesis, chorionic villus biopsy, amniocentesis are studies that are carried out during pregnancy.
• Mother's Rh-positive blood transfusion.
• Miscarriage, induced abortion or surgery for ectopic pregnancy.

How to determine the Rh factor in a child

Families with negative Rhesus should not worry, although this is rare. Only 3% of men have Rh-. According to the laws of genetics, inheritance comes from the father or mother. Rh transmission principles:

Symptoms

If there are no concomitant diseases, then the woman’s well-being, even with Rh conflict, does not change in any way. This deviation cannot be detected externally. The following studies are used to identify pathology:

Consequences

During the first pregnancy, the likelihood of Rh conflict is practically excluded. This is explained by the fact that the produced IgM immunoglobulins are large in size, which is why they cannot penetrate the placenta and enter the fetal blood.

In subsequent pregnancies, the number of such antibodies increases. In addition, their size decreases, which increases the likelihood of Rh conflict. If the fetus does not die at 20–30 weeks, then the following complications develop after birth:

• hemolytic disease of newborns;
• muscle flaccidity;
• regurgitation;
• feeding difficulties;
• cerebral palsy;
• abdominal enlargement;
• pallor or yellowness of the skin, borders of the lips, conjunctiva of the eyes;
• constant high-pitched crying, anxiety;
• opisthotonus - arching with spasms of the arm muscles.

Treatment methods

Rhesus conflict pregnancy requires special attention from doctors. If anti-Rhesus antibodies were detected in the woman’s blood or specialists established signs of hemolytic disease in the child, nonspecific treatment is carried out. Treatment regimen in this case:

There is also a specific treatment for Rh conflict. Unlike nonspecific measures, it has slightly different indications. This treatment is prescribed to all women with negative Rh in the following cases:

• after childbirth, miscarriages, abortions;
• after surgical treatment of ectopic pregnancy.

Specific therapy is the intramuscular administration of anti-Rhesus immunoglobulin immediately after childbirth or surgery. The injection should be given no later than 48–72 hours after medical procedures. Otherwise, the drug will not bring the desired effect. Anti-Rhesus immunoglobulin works as follows:

1. Destroys fetal red blood cells in a woman’s body that managed to enter her blood during childbirth or surgery.
2. As a result, antibodies do not have time to form.
3. During the next pregnancy, the risk of Rh conflict is minimized.

Is it possible to prevent Rh conflict?

Prevention of Rh conflict is necessary for all Rh-negative women, especially if their partner is Rh-positive. Vaccination with anti-Rhesus immunoglobulin helps prevent this pathology. It is administered at 28 and 32 weeks of pregnancy. Other preventive measures:

• blood transfusion only taking into account group and rhesus compatibility;
• preservation of the first pregnancy in a woman with Rh–;
• vaccination with anti-Rhesus immunoglobulin in Rh-negative women after childbirth, abortion, miscarriages, ectopic pregnancies.

Video

Knowledge about the Rh factor can easily be called one of the most valuable knowledge acquired by man in the entire history of medicine. It allows you to avoid a huge number of serious relationships during blood transfusion, as well as during pregnancy and childbirth, in particular in cases where the child and mother have a so-called Rh conflict. So, what is the Rh factor, and what does it mean for expectant mothers?

Rh conflict: essence and mechanism

The Rh factor is a specific protein that is found on the surface of red blood cells in approximately 85% of the world's population. That is, those who have such a protein are called people Rh positive, and those who lack it - Rh negative. The Rh factor does not affect the health of the mother and the course of pregnancy, however, if a “negative” woman is pregnant by a “positive” man, in this case there is a possibility of a so-called Rh conflict.

Its essence lies in the fact that the red blood cells of the mother and child, having different signs, meet each other, as a result of which a specific reaction begins in the woman’s body, reminiscent of an allergy. Antibodies produced by the immune system begin to destroy the child’s red blood cells, which leads to the most disastrous consequences.

It should be noted that such complications are especially likely due to so-called sensabilization: a condition when the baby’s blood enters the pregnant woman’s blood, causing her body to begin producing antibodies. This happens in cases where the mother has a history of abortions, miscarriages, ectopic pregnancies, uterine bleeding and other complications during pregnancy. In addition, sensabilization can occur if there is any damage to the placenta due to infections, gestosis, abruption, as well as certain medical procedures (amniocentesis).

If there have been no similar situations in the past, and the woman is pregnant for the first time, then serious problems usually do not arise: the doctor carefully monitors the patient’s condition, and childbirth most often goes well. However, during the second and subsequent pregnancies, the mother will require special treatment, which can eliminate the occurrence of serious complications. In addition, in order to protect the baby, every woman needs to know about the possible risk of Rh conflict in each specific case.

Possibility of Rh conflict depending on the Rhesus of the parents

To determine the possibility of Rh conflict, you should remember the laws of genetics, according to which certain blood groups, as well as Rhesus, are inherited from parents. In particular, in At risk are families where the expectant mother is Rh negative and the father is Rh positive.

To determine this risk, you can use the following table.

Rh factor inheritance

Inheritance of blood groups

It must be remembered that it is impossible to determine the probability of a conflict with complete confidence using such tables; This will require blood tests from the father and mother, as well as a consultation with a doctor.

Diagnosis and symptoms

The danger of a Rhesus conflict is that it usually does not give any clinical manifestations that may alert a pregnant woman. In some cases, she may feel symptoms similar to those of gestosis, but it can be very difficult to clearly identify a hemolytic disorder.

That is why all women at risk must be strictly monitored gynecologists throughout pregnancy, and regularly undergo an ultrasound procedure. Symptoms of Rh factor conflict in the fetus include the following:

• severe swelling;
• accumulation of fluid in the body cavities (abdominal, thoracic), as well as in the area of ​​the pericardial sac;
• increase in abdominal size;
• the so-called “Buddha pose”: a large belly and limbs removed from it;
• enlargement of the spleen, liver and heart;
• “double contour” (soft tissue swelling) of the head;
• thickening of the veins of the umbilical cord and placenta.

To diagnose Rh conflict and prevent symptoms, it is very important to determine the group and Rh of both the expectant mother and the expectant father, regularly test for antibodies, and, if necessary, prescribe adequate treatment.

Possible consequences

In the event of a Rh conflict, the woman’s antibodies begin to attack the “foreign” red blood cells of the fetus, gradually destroying them, as a result of which bilirubin is released into the blood, which turns the skin yellow. In addition, the number of red blood cells in the baby's blood drops rapidly, leading to a deterioration in the ability to carry oxygen. Tissues and organs, including the brain, begin to experience severe oxygen starvation, which disrupts their development and leads to a variety of diseases.

In the most difficult cases, due to severe tissue damage, the fetus develops hydrops; Unfortunately, in such cases, saving the child’s life is often impossible.

As for the mother, it does not pose a direct danger to her condition, however, if the first pregnancy was interrupted or occurred with complications (for example, with uterine bleeding), then the second and subsequent ones require special attention. This is due to the so-called immune memory: the mother’s body produces specific antibodies to the child’s red blood cells, which means the risk of problems and complications increases significantly. That is why so-called “negative” women are especially not recommended to have abortions.

How to prevent complications from developing

To completely eliminate the risk of complications due to Rh conflict, it is necessary even before conception, that is, at the stage of pregnancy planning, or at least in the earliest stages undergo a rhesus test. If Rh is negative, it will be necessary to conduct another study on the type of antibodies and their concentration (titer) in the woman’s blood, which can answer the question of how dangerous their amount is for the child. This test must be taken before 18-20 weeks, and if the pregnant woman has had cases in the past Rh conflicts, then the determination of antibody concentration is carried out earlier.

• Considered normal titer less than 1:4. In this case, the woman only needs regular monitoring of the condition of the fetus, and a repeat analysis is performed at week 28 (if no abnormalities are found in the fetus).
• If the amount of antibodies remains at this time at 1:4 level and mless, the pregnant woman is given a dose of a special vaccine (anti-Rhesus immunoglobulin), which can prevent possible complications.
• At titer more than 1:4, antibody testing should be carried out approximately once every one to two weeks, carefully monitoring their dynamics.

In any case, if even a minimal amount of antibodies is detected, the woman requires regular examinations (ultrasound, Doppler ultrasound, etc.). If the fetal condition worsens, it is necessary to carry out a blood transfusion procedure in utero, which will compensate for the lack of red blood cells in the fetal blood. In situations where such a solution is impossible, the question of urgent delivery is raised, since any delay may threaten the death of the fetus.

Anti-Rhesus immunoglobulin: prevention of Rh conflict

A vaccine against Rhesus conflict is a drug that can prevent sensabilization, that is, the production of specific antibodies in a woman’s body. The mechanism of action of anti-Rhesus immunoglobulin is as follows: it destroys “positive” red blood cells, preventing the mother’s immune system from launching a protective reaction.

It is believed that about 20 mcg of the drug neutralizes 1 ml of red blood cells, therefore, to “neutralize” “foreign” red blood cells of the child that accidentally enter the mother’s blood, approximately 300 mcg of the vaccine is needed.

The first dose of the drug is usually given to a woman between 28 and 34 weeks (preferably at 28 weeks) if there are no antibodies in her blood and the fetal blood type is unknown. The second dose must be administered within 3 days after delivery (if the child is Rh positive).

Also, the administration of anti-Rhesus immunoglobulin is strongly recommended for all “negative” women after abortions, ectopic pregnancies or miscarriages: this can protect them from serious problems in the future.

It should be noted that in most cases, anti-Rhesus immunoglobulin is well tolerated by women, however, like any other medical drug, it can cause various allergic reactions, including anaphylactic shock. Therefore, after administering the vaccine, a pregnant woman should wait at least 30 minutes. be under the supervision of doctors.

Typically, anti-Rhesus immunoglobulin is available in domestic perinatal institutions, but it can only be purchased by prescription. The average cost is 5 thousand rubles. The vaccine is a colorless or light yellow solution (a small sediment is allowed) for intramuscular administration. Before administration, the ampoule must be kept for approximately two hours at room temperature, and after opening, the drug must be used immediately for its intended purpose. The shelf life of anti-Rhesus immunoglobulin is three years.

Rh conflict between mother and child is caused by incompatibility of the Rh factor. This situation can lead to serious consequences during pregnancy. The Rh factor is a protein found in the membrane of red blood cells - erythrocytes. However, it is not present in the body of all people. If this substance is present, the Rh factor is positive, and if it is absent, it is negative. There are only 15% of people who do not have protein. The remaining 85% are Rh positive.

A positive Rh factor is dominant. The danger arises if a woman does not have a protein substance, but a man has it in his body. When pregnancy occurs, the child in the vast majority of cases inherits the father's Rh factor. As a result, a conflict arises between the body of the woman and the fetus.

Causes of the conflict:

• abortion;
• spontaneous termination of pregnancy;
• carrying out amniocentesis - a study in which a small amount of amniotic fluid is taken in order to identify certain diseases of the child;
• development of pregnancy outside the uterus. In some cases, the fertilized egg implants in the fallopian tube or abdominal cavity;
• study of chorionic villi. This test is performed early in pregnancy to diagnose certain abnormalities in the formation of the fetus;
• bleeding during pregnancy;
• transfusion of Rh-positive blood.

In the absence of the above factors, there is a high percentage of probability that incompatibility will not arise during the process of bearing the first child. If sensitization does occur, in the event of a second pregnancy, special treatment is carried out to prevent Rh conflict.

Symptoms of Rh conflict

Due to the absence of clinical manifestations of incompatibility, the woman does not observe changes in her well-being. Deviations can only be detected through ultrasound examination. The presence of pathology is indicated by swelling, accumulation of fluid in the baby’s chest, abdominal cavity and in the pericardial sac. As a result, the baby's tummy, spleen, liver and heart increase in size. Swelling of the soft tissues of the head leads to the appearance of a double contour. Due to the increase in the tummy, the baby spreads his limbs to the sides. The placenta is also subject to swelling, because it becomes thicker. The umbilical vein also increases in diameter.

Diagnostic methods

Modern medicine allows you to diagnose the problem through certain tests. All women whose pregnancy is suspected of having this problem undergo them. The baby's father must also get tested. If there is a high probability of incompatibility, the expectant mother needs to undergo appropriate examinations every month until 32 weeks. Starting from this period of pregnancy, tests should be taken once every two weeks, with the onset of the 36th week - once every 7 days. If there is a Rh conflict, antibodies will be detected in the mother's body.

Research methods are divided into two groups. The first includes non-invasive methods. These include:

• ultrasound diagnostics;
• cardiotocography;
• Doppler.

An ultrasound examination is one of the mandatory procedures. It is carried out four times in the period from the 18th week to the 36th. And one more study before childbirth. The doctor can refer the woman for this diagnosis, and more often if the child’s condition requires it. Based on the examination results, the specialist gets an idea of ​​the baby’s development and the presence or absence of deviations. The doctor examines the condition of the placenta and umbilical veins, the volume of amniotic fluid, and the size of the abdominal circumference.

Cardiotocography is carried out to monitor the activity of the baby’s cardiovascular system. If the fetus is suffering from oxygen deficiency, this test will help detect this. Doppler measurements give an idea of ​​the blood circulation in the umbilical cord and blood vessels of the child.

The second group of methods includes invasive types of research. This:

• cordocentesis;
• amniocentesis.

The first type of analysis involves collecting cord blood. Its study gives an idea of ​​the degree of hemolysis. This method also allows for intrauterine transfusion, which the child needs. But this procedure can have complications. In some cases, bleeding begins from the place where the puncture was taken. It is also possible for an umbilical cord hematoma to form or become infected.

Cordocentesis is performed if the following indications exist:

• the level of bilirubin in the amniotic fluid exceeds the permissible norm;
• The woman has children who have suffered severe HDP.

Amniocentesis is the collection of amniotic fluid to determine the concentration of bilirubin. Based on this information, the doctor gets an idea of ​​the severity of hemolysis. This method is recognized as one of the most accurate analyzes. But it also has disadvantages in the form of complications. These are premature discharge of amniotic fluid, infection, bleeding and placental abruption. Since both procedures are unsafe for the health of the woman and the fetus, the doctor must provide the expectant mother with complete information regarding the consequences of these studies.

Consequences of the conflict

Incompatibility of Rh factors harms the baby, but it will not affect the mother’s well-being. The processes occurring in the female body can be compared to an allergic reaction. The child's red blood cells, which have protein on their surface, penetrate into the woman's blood, where this substance is absent. The immune system begins to produce antibodies that perceive the baby's red blood cells as foreign elements and destroy them.

The consequence of this process is the development of hemolytic anemia of the baby, damage to his brain, heart, intrauterine death, and disruption of the central nervous system. The production by the female body of anti-Rhesus antibodies aimed at destroying the child’s red blood cells is called sensitization. As a result, the breakdown product of hemoglobin is released, which in turn provokes the appearance of toxic substances that affect almost all systems and organs of the fetus. But this situation does not always develop. The probability of incompatibility occurring is 0.8%. But if it is detected, this problem should be treated with special attention.

Treatment for Rh conflict between mother and fetus

Therapy depends on the presence or absence of Rh antibodies. When they are detected, blood is transfused into the fetus through the umbilical cord vein. This procedure makes it possible to compensate for the deficiency of red cells damaged by the antibodies of the mother's body. And also stabilize the child’s condition, reduce the manifestations of hypoxia, anemia and prolong the pregnancy period.

In addition, treatment methods include oxygen therapy and medications. A woman is prescribed a vitamin complex that helps replenish calcium and iron in the body.

It is mandatory to take antihistamines. They suppress the process of the mother’s immune system rejecting the baby’s blood cells. Plasmapheresis is prescribed to reduce antibody levels. If the fetus is in a serious condition at 37-38 weeks, it is removed by caesarean section. It is not always possible to normalize the situation. Then there is only one way to stop the flow of antibodies to it - premature birth.

The baby is given a blood transfusion after birth. This allows damaged red blood cells to be replaced. Toxic substances are removed from the baby’s body using droppers. This procedure helps slow down the breakdown of red blood cells. Such a child is constantly under the supervision of neonatologists. In some cases, admission to the intensive care unit is required. For the first two weeks of a baby's life, a mother is not recommended to feed him breast milk.

If a woman is not sensitized, the doctor prescribes immunoglobulins for her. These drugs help prevent the development of antibodies. The expectant mother's body, under the influence of these medications, does not perceive the child's red blood cells as foreign. As a result, the production of antibodies does not occur.

Indications for the appointment of immunoglobulin are the following factors:

• the onset of the 28th week of pregnancy and the absence of sensitization;
• the birth of a child with a Rh-positive factor (Rh-conflict can arise as a result of labor).

Immunoglobulin is effective for 12 weeks. If the next pregnancy occurs, the woman must be administered this drug again.

Childbirth with a conflict of Rh blood

Quite often, with Rh conflict, labor begins ahead of schedule. Therefore, the efforts of doctors are aimed at prolonging the pregnancy period, during which specialists carefully monitor the formation of the fetus. In the presence of serious pathologies, when subsequent pregnancy poses a risk, premature delivery is performed. In the vast majority of cases this is a caesarean section.

Natural birth is possible if doctors assess the baby’s condition as satisfactory. But when there is a conflict of Rh factors, this rarely happens. Surgical delivery is the safest for the child and reduces the likelihood of a threat to his life. Such births require highly qualified medical specialists and the availability of the necessary equipment. The presence of a neonatologist is mandatory, as resuscitation measures may be necessary.

Rhesus conflict forecast

The prognosis is influenced by the diagnostic period, the rate of increase in antibody titer and its size. And also a form of fetal hemolysis. If antibodies are detected at an early stage of pregnancy (up to 10 weeks), the prognosis is negative. In this situation, the risk of miscarriage increases. The most unfavorable prognosis will be with the edematous form of hemolytic pathology. Such children require intensive care and replacement transfusions.

A favorable prognosis is made for the anemic type of hemolysis. If the disease takes on an icteric form, the bilirubin content is determined and conclusions are drawn based on the results. The higher the level of hemoglobin breakdown product, the higher the likelihood of damage to the child's central nervous system.

How to prevent Rh conflict during pregnancy

Incompatibility of Rh factors can lead to serious consequences for the baby. Therefore, special attention should be paid to preventive measures.

1. If a blood transfusion is necessary, the procedure should only be performed with a compatible donor.
2. Women with a negative Rh factor are recommended to continue their first pregnancy.
3. At 28 weeks, the expectant mother is given anti-Rhesus immunoglobulin. It is at this stage of gestation that the risk of contact of fetal red blood cells with antibodies is highest.
4. This procedure is repeated in case of bleeding during pregnancy and during certain studies.
5. If a woman is planning her next child, immunoglobulin is administered for prophylactic purposes after delivery within 72 hours. In case of blood loss, the dose of the drug is increased.

Conclusion

In case of Rh conflict, antibodies produced by the mother's body destroy the child's red blood cells. But modern treatment methods make it possible to stop this process and minimize its negative consequences for the fetus. Today, there are several types of diagnostics that make it possible to detect a problem in a timely manner. If necessary, delivery is carried out prematurely by surgery. And preventive measures will help avoid this situation during the next pregnancy.

Video: expert opinion