Group conflict with a child. Hemolytic disease of the newborn - physiological jaundice

The fact that there is a contradiction between the Rh factors of the father and mother, which can adversely affect the fetus and the very course of pregnancy, is well known to all expectant mothers. But for many, the information that there is a risk of a blood type conflict in pregnancy is a shock. This occurs when the unborn child inherits blood from his father that does not match well with the mother's blood type.

The immunological contradiction between the blood of the mother and the fetus is called the conflict ofblood group. This phenomenon is noted if the fetus receives a paternal blood type that does not match the maternal and conflicts with it. Most often this happens if the mother has I blood group, and the fetus has II or III blood groups, but there may be other combinations.

The severity of incompatibility is not as great and dangerous for the fetus and mother as with violations of the combination of the Rh factor, however, in some cases it can harm the health of both.

Despite the fact that the direct mixing of the blood of the fetus and the mother does not occur, but a small amount of it still enters the mother's circulatory system. Her immunity perceives the ingress of fetal blood with a different group as a foreign protein and attacks it.

In the mother's body, they begin to be produced to the blood of the fetus, that is, there is a threat that the mother's body can reject the pregnancy, and the fetus risks suffering by getting hemolytic disease of the newborn.

In contrast to the conflict of Rh factors, with incompatibility of blood groups, the first pregnancy is the least risky, since in its process the body only adapts to "foreign" blood, its sensitization occurs. Therefore, the first child from one husband is the least threatened, but with subsequent pregnancies from the same man, the risk level constantly increases. Such pregnant women need constant monitoring.

Causes of the problem

A blood group conflict occurs when conflicting O± and OI antibodies and A and B antigens occur in the blood of the mother and fetus.

In a healthy pregnancy, the blood of the mother and child does not combine due to the flawless functioning of the placental barrier. It is located between two layers of the placenta - fetal and maternal. In a normal state, the placental barrier serves as a faithful guardian of the health and safety of the fetus. But with various pathologies, for example, with, the blood of the mother and fetus is mixed.

In the mother's body, fetal blood cells are formed, they enter the fetal bloodstream and cause the destruction of its blood cells. During their decay, toxins are formed that affect the vital organs - the brain, and.

Dropsy of the brain is also possible, since when blood cells are destroyed, a large amount of “excess” fluid appears. A characteristic manifestation of the conflict is also. But such serious consequences are still more the exception than the rule.

The possibility of incompatibility is detected during, especially if the woman has risk factors in the form of previous blood transfusions, miscarriages, or children born with hemolytic disease of the newborn, jaundice, or various pathologies.

A blood test detects the presence of antibodies, the pregnant woman is closely monitored, and, if necessary, sent for treatment to a hospital.

If you fall into the high-risk category, a woman should be regularly tested for antibody titers. But the presence of a potential threat does not at all mean a mandatory defeat. In most cases, with a successful pregnancy, the conflict does not manifest itself or does not give dangerous consequences.

Danger to the fetus

The greatest danger to the fetus is a blood group conflict in the following cases:

Mother with group I or II - fetus with group III.
Mother with group I or III - fetus with group II.
Mother with group I, II or III - fetus with group IV.

The most risky form is the combination of the first blood group in the mother and the second or third in the child. After the first pregnancy in subsequent children, the risk of hemolytic disease increases significantly.

We can say that women with blood type I are more at risk of getting an immunological problem when conceiving a child from a man with any other blood type. In this case, the Rh factor does not play a decisive role. Women with other blood types are well compatible with carriers of their own and group I.

Even if no signs of incompatibility were found during the entire course of pregnancy, this does not mean that the fetus is not at risk of getting newborn hemolysis.

During childbirth, the placental barrier ceases to operate and ceases its protective function. The placenta separates, and the mother's blood can easily mix with the fetal blood, provoking a conflict. If the birth proceeds quickly, the disease in the newborn may manifest itself in a weak form or not at all affect his condition and health.

Long, protracted labor increases the risk of incompatibility, and the baby may get sick some time after birth, so a thorough examination and careful monitoring of the condition of both the mother and the child is required. Immediately after birth, a blood sample is taken from the newborn. If a hemolytic problem is identified, action will be taken immediately.

More information about what is Rhesus conflict can be found in the video:

Severe manifestations of the disease are quite rare, within one case per 200-250 births in risky pregnancies. In order to timely identify a potential risk, not only the expectant mother, but also the father donates blood for antibodies and blood type.

Throughout pregnancy, a woman needs to be wary of various interventions that can lead to the connection of the blood of the fetus and mother. Puncture of the fetal bladder to conduct a sample of amniotic fluid or draw blood from an unborn baby can lead to a sharp increase in antibodies.

Treatment, possible consequences and prognosis

Modern medicine has not yet been able to fully cope with or prevent a blood type conflict, but there are ways to reduce the dangerous manifestations of the disease in newborns. Timely determination of the presence allows you to quickly start treatment, start cleaning the mother's blood. She is prescribed an intake of activated charcoal, Enterosgel.

During childbirth, a child is carried out and, in the presence of antibodies, phototherapy is immediately carried out - they are placed under a special lamp, the radiation of which contributes to a rapid decrease in the level. If the antibody titer is very high and the level of bilirubin rises rapidly, then even timely phototherapy may not help. In such a situation, one has to resort to blood transfusion, hemosorption or plasmapheresis in order to improve the condition of the newborn. A sharp increase in bilirubin levels leads to a negative effect on cells and the development of jaundice, an enlarged spleen and. To avoid this, prescribe drugs that can bind bilirubin and remove it from the body, enterosorbents and choleretic agents.

In the event of a potential blood conflict, breastfeeding is not recommended to avoid passing antibodies from the mother to the baby.

Previously, this was not known or practiced, and now in modern maternity hospitals they are not allowed to feed a newborn colostrum, since it also contains antibodies, and in large enough quantities to intensify or provoke conflict. In cases of a severe picture of the lesion, breastfeeding can be canceled altogether, immediately after birth, choosing a special diet for the baby that provides him with nutrients without risk to health.

Since severe manifestations of hemolytic disease with a blood conflict are much less common than with incompatibility of Rh factors, the prognosis for a normal, unproblematic development of pregnancy is positive. The risk is minimal, and with proper control, dangerous consequences can be stopped at the earliest stages. It can't harm the baby in any way. In rare cases, a newborn may develop jaundice or anemia, some other diseases that, if treated in time, will not adversely affect the child's health.

When the initial stages of hemolysis are detected, the newborn is placed under a blue lamp, and this simple action is often enough to lower the level of bilirubin and avoid severe intoxication. In the future, the blood picture and the state of other systems and organs are balanced and the newborn develops in the same way as all other babies of his age. In a critical situation, the baby is saved by a transfusion or blood purification.

An analysis for the blood type and Rh factor is included in the list of mandatory studies during pregnancy. Often, expectant mothers assume that only a mismatch between the Rh factors in the mother and father causes complications when carrying a child. However, a conflict in blood type can also lead to illness in the unborn baby.

By checking the blood type and Rh factor in pregnant women and future fathers, doctors not only make a note in the documents in case of an emergency blood transfusion, but also predict the course of pregnancy and the specifics of caring for a newborn.

It is known that Rhesus conflict before the invention of immunoglobulin therapy often led to miscarriage. Rh-negative women were urged not to terminate the pregnancy, as this could interfere with future plans for healthy offspring.

This is probably why society is so well aware of the impact of the Rh factor on pregnancy. However, antibodies are also produced if the blood type does not match.

When transfusing blood from a donor to a recipient, doctors must take into account whether the Rh factor also matches. During pregnancy, the red blood cells of the mother and the future baby are also found in the process of intrauterine development, as well as with the introduction of donor material. If the types of blood cells do not match, the mother's body "turns on" the protective reaction of immunization.

Red blood cells contain A or B antigens, and plasma contains α or β antibodies. The blood of the first group does not contain antigens, the fourth - antibodies. Antigens and antibodies are distributed as follows:

group I (O) - antibodies α, β, antigens are absent;
second II (A) - antigen A, antibodies β;
third III (B) - B and α;
fourth IV (AB) - A and B, no antibodies.

Antigens and antibodies named with the same letter (A and α, B and β) should not be together. The combination of antibodies and antigens of the same name leads to the destruction of erythrocytes, disrupting the system of oxygen transfer to tissues. This is a blood type conflict (or ABO conflict).

Is the mismatch of blood types of future parents dangerous?

In accordance with the laws of inheritance, when the blood types of the parents are the same, this type of hemolytic disease either does not develop or has a low probability of manifestation. An ABO conflict is most likely if the mother's body is characterized by the first blood type, and the baby inherits a different variant from the father. In such a situation, antigens found in the blood of the fetus, placental blood and amniotic fluid cause a response in the body of the pregnant woman.

Antibodies are produced in the blood that destroy foreign red blood cells, releasing hemoglobin (the process of hemolysis). Most often, the main “hit” occurs during childbirth, but occasionally blood hemolysis can begin directly during pregnancy.

The fight against excess hemoglobin is the function of the liver. Hemoglobin is converted into bilirubin and excreted from the body. If there is too much bilirubin, the liver is stressed, unable to cope with the cleaning function, and other organs of the child may be affected.

To check for the presence of antibodies, the doctor may prescribe tests starting at 30 weeks of pregnancy, repeating them every month until delivery. Symptoms are also being studied, indicating the consequences of an immunological mismatch of blood groups. When assessing the condition of the baby and the feto-placental complex on ultrasound, the doctor pays attention to the presence of placental edema, an increase in the size of the child's abdomen that does not correspond to age norms, physical activity, and tone.

Similar changes in development may indicate other diseases. Therefore, to diagnose an ABO conflict, procedures such as amniocentesis (taking amniotic fluid to calculate the amount of bilirubin) or cordocentesis (removal of blood from the umbilical cord under ultrasound control) can also be performed. After birth, one or a series of tests are performed on the newborn to track the dynamics of bilirubin production.

A positive difference between the ABO conflict and the Rh factor: in the following states of expectation of a baby, the chances of developing a disease do not increase, but decrease.

The most common manifestation of ABO conflict is expressed in hemolytic (or physiological) jaundice in a newborn. Its symptoms are manifested by staining the skin and sclera of the eyes in yellow, and sometimes affect the neurological status. Children become restless, noisy or, conversely, inactive, lethargic, sleep more than they should by age.

In severe cases, the bilirubin attack affects the brain and other vital organs of the newborn. But most often, physiological jaundice disappears in 2-3 weeks with little support (and constant monitoring) of a neonatologist and pediatrician.

The main treatment is to help the body. As during pregnancy, if a high titer of group antibodies is detected, the doctor may prescribe intravenous infusions (or supplementation from a bottle) of glucose, taking vitamin complexes designed to facilitate the process of cleaning the blood by the liver. If a child has a high bilirubin content, do not resist the appointment of additional nutrition or medical procedures. As a rule, this does not interfere with breastfeeding, and timely assistance to the baby will alleviate his condition and help him grow and develop properly.

If necessary, the doctor may prescribe other medications, including those with the condition of hospitalization. If jaundice begins to affect the brain cells, treatment is carried out under constant medical supervision.

Recently, there has been much talk about the benefits of late cord cutting after childbirth. The tying of the umbilical cord is postponed until its pulsation stops, which allows the child to receive nutrients after birth. This is exactly the procedure that is prohibited if the mother's blood type is different from the father's blood type. Even if the chance that the baby has inherited the mother's blood type is greater than the possibility of blood type conflict, the cord should be cut immediately after birth. This will save the baby from possible problems.

However, the main thing with neonatal jaundice is prevention. During pregnancy, the mother does not feel discomfort from immunological incompatibility. Therefore, if there is a possibility of a conflict in the blood group, it is necessary to undergo research in a timely manner, plan the conduct of labor with a doctor and remember the importance of a healthy lifestyle.

The article explains the risk of Rhesus conflict during pregnancy. Recommendations are given to future parents on the prevention of possible complications.

Having become pregnant, the woman becomes registered in the antenatal clinic. She has to go through a lot of examinations, take tests. An analysis will also be required, which will help determine the blood types of future parents and their Rh factors.

The Rh factor is a specific property of human erythrocytes, which is due to the presence of an antigen protein. Other group systems do not affect the presence of the Rh factor in the blood. Every person is born with a certain Rh factor. It remains unchanged until death and is inherited by children.

How is the Rh factor determined?

Rh factor in medicine is indicated by a combination of two Latin letters Rh. If Rh antigen is detected in red blood cells, then the blood of such a person is considered Rh-positive (Rh +). There are about 85% of such people in the world. The remaining 15% are carriers of Rh-negative blood

Rh-negative people do not experience any particular inconvenience and are not considered sick. But if a woman is going to become a mother, then she needs special attention.

If an antigen and an antibody of the same name are present in the blood, then their combination leads to a gluing reaction of erythrocytes

Glued together red blood cells are unable to carry out the function of delivering oxygen. Antigen and antibody of the same name do not occur in the bloodstream of healthy people.

Rh-conflict occurs when mixing Rh-positive blood with Rh-negative. The blood of the fetus becomes incompatible with the blood of the mother. All systems of the mother's body will fight against the foreign protein that has appeared in it.

This happens when the father's Rh is inherited, with immunological incompatibility of blood groups: maternal and child. With incompatibility of blood groups, the danger is less than with incompatibility of the Rh factor.

Rhesus affiliation is determined in several ways. It depends on whether special laboratory equipment is available. In its absence, express methods for determining the Rh factor are carried out:

using a universal reagent; tube does not heat up
on a white flat plate without heating the test tube

Rh-affiliation is determined by fresh, unclotting blood. It is taken from a finger or from a vein

For the express method, universal serum is used, which is suitable for all blood groups. Whey is prepared in a special way. It is used during the procedures of iso-immunization of pregnant women. The agglutination of red blood cells in a test tube indicates that there is an Rh antigen in the blood.

The body of a mother with a negative Rh perceives a fetus that has inherited a positive Rh father as foreign. As a result, antibodies are produced that attack and destroy the fetus.

Sometimes this affects the development, normal growth of the baby. But serious consequences are also possible: antigens present in the blood can cause intrauterine death of the fetus, miscarriage

Rh conflict symptoms

On her own, a woman cannot determine by her well-being that she is at risk of developing an Rhesus conflict. The main symptom is the presence of antibodies in her blood

the fetus develops a hemolytic disease, which is manifested by anemia, a violation of the activity of internal organs
baby has jaundice
there is a risk of hypoxic damage to the brain and heart that is deadly to the fetus

Cause of Rh conflict:

C-section
various complications, bleeding before or during childbirth caused by placental disorders or its detachment
performing various procedures such as chorionic biopsy, cordocentesis or amniocentesis
with preeclampsia, diabetes, after the flu or acute respiratory infections
after intrauterine sensitization of the expectant mother

A woman is at risk for the development of Rh-conflict in case of complications during pregnancy (toxicosis, jumps in blood pressure, infectious diseases). They will find out about possible sensitization after the woman passes all the tests and the Rh affiliation of future parents and their blood groups is determined

Rh factor blood test

It is impossible to independently find out that a couple does not match each other by blood. But if a woman does not become pregnant for a long time from a partner, or if miscarriages become the outcome of pregnancy, then you should seek help from doctors. An “infertile” couple, having passed all the necessary tests and following the recommendations, will be able to conceive a baby, and a woman will successfully endure it

The first step in the examination of a pregnant woman for the presence of antigens is to determine the Rh-affiliation of future parents. It is recommended to carry out such a diagnosis before conception, or at the beginning of pregnancy. With negative Rh of both partners, further research is not carried out, since the conflict is excluded.

Important: if the patient's pregnancy ended in a miscarriage or there were abortions, the fetus died in the womb, or the baby who was born had a hemolytic disease, then there is a high risk of an Rhesus conflict

To find out if the fetus suffers from a lack of oxygen during the Rhesus conflict, it is necessary to regularly undergo ultrasound diagnostics. Ultrasound is prescribed for the period of the 20th week of pregnancy and ending with the 36th week. The last time an ultrasound is prescribed before childbirth. This allows you to monitor the growth and development of the baby.

The development of the fetus is also judged by examining amniotic fluid (amniocentesis) and examining cord blood (cordocentesis). Diagnosis of this type is carried out in the last trimester of pregnancy. Cord blood analysis, how much anemia develops in terms of hemoglobin, bilirubin, and other indicators.

What do antibodies mean?

In the body of a pregnant woman, compounds of a protein structure - Rh antibodies - begin to be produced only by 7-8 weeks. Prior to this, there are no Rh antibodies in the mother's bloodstream that can harm the fetus.

The first pregnancy is characterized by the production of large antibodies. It is not easy for them to penetrate the placenta to the fetus. But in subsequent pregnancies, other antibodies against the Rh factor are produced.

There are fewer antibodies, but their presence is more detrimental to the baby, since it is easier for them to pass through the placenta and they are more aggressive. Therefore, the female immune system reacts during the subsequent gestation of the fetus to the Rh antigen faster and stronger.

Rhesus conflict in the second and subsequent pregnancies

If a woman is carrying a child for the first time, then the incompatibility of the blood types of future parents will not cause an Rh conflict, since the amount of antibodies produced is insignificant.

A second pregnancy increases the risk of conflict. This means that during childbirth, umbilical cord blood with protective antibodies - "memory cells" enters the mother's blood. Thus, the mother's body becomes susceptible to the Rh antigen. Antibodies cross the placental barrier and destroy fetal red blood cells.

Maximum risk for women

Rh sensitization does not threaten the mother's body. After a difficult pregnancy and childbirth, the mother's problems with the presence of a Rh conflict are exhausted. But the immunization that has occurred can affect the recurrence of the situation during a subsequent pregnancy.

Consequences of Rh conflict for the fetus

A child with a Rh conflict develops hemolytic disease, edema, jaundice appear, the spleen and liver increase. In the blood, the rate of bilirubin increases, which poisons a small organism.

Favorable prognosis: a newborn child is likely to develop mild hemolytic anemia. At the same time, jaundice and dropsy are absent.

In more severe forms, hemolytic anemia with jaundice occurs. But the most severe form of the disease is aggravated by both jaundice and dropsy. The baby can die in the womb

Treatment of Rh conflict

Doctors may decide to give the baby an intrauterine blood transfusion up to the 34th week of pregnancy, which improves the condition of the fetus. Transfusion is carried out through the umbilical cord. Thus, it is possible to avoid the development of anemia in the fetus.

In especially severe cases, a decision is made to stimulate preterm labor. A newborn child is treated for jaundice, a course of phototherapy is carried out (with laying out under special blue lamps). Multiple blood transfusions may be needed. In some cases, no treatment is required at all.

Video: about the Rh factor and the threat to the child

A blood type conflict during pregnancy occurs most often when a woman has the first blood type 0 (I), and the fetus has a second A (II) or a third B (III). Blood type incompatibility is not as severe as Rh incompatibility, but also leads to hemolytic disease of the newborn.

Although the blood of the mother and child does not mix, even with a healthy pregnancy, a small reflux of fetal blood (a tenth of a milliliter is enough) into the maternal circulation can occur, as a result of which an active immunological reaction occurs to produce antibodies to the child's blood. Thus, the female body is protected from the ingress of foreign protein.

Why is blood type conflict dangerous during pregnancy?

A blood type conflict during pregnancy is dangerous for the child, and not for the mother. Antibodies to A- and B-antigens penetrate into the baby's body, then they interact with the erythrocytes of the fetus, as a result of which hemolysis (destruction of red blood cells) and anemia (decrease in hemoglobin in the blood) occurs. Then indirect toxic bilirubin is formed, it dissolves in the cells of the baby's brain, liver and spleen. Therefore, an extremely severe degree of HDN (hemolytic disease of the newborn) is dropsy of the child, as if he is all filled with water. But severe cases of HDN with incompatibility of the blood type of the mother and child are very rare.

A distinctive feature of the isoserological conflict according to the ABO system is the late manifestation of hemolytic disease of the newborn, this can occur a few days after birth, the baby's skin becomes yellow, the so-called neonatal jaundice.

In modern medical centers, a woman in labor with a high titer of antibodies in the blood, when a child is born with HDN, is not allowed to put the baby to the breast for some time, or they may completely prohibit breastfeeding. The fact is that colostrum also contains antibodies, and the attack of the child's body continues.

First pregnancy with blood type incompatibility

More often, the first pregnancy with incompatibility of the blood of the fetus and mother is not dangerous, because during it sensitization occurs ( acquisition by the body of specific sensitivity to foreign substances - allergens) of the mother's body to blood that is foreign to her gradually and mainly during the birth itself. In the delivery room, they take the blood of a newborn for analysis and take the necessary measures in case of a conflict.

In most cases, pregnancy and childbirth go well, severe forms of hemolytic disease occur once in 200-256 births. It is also important in the first pregnancy to be registered at the clinic on time, take all the necessary tests, and monitor whether the antibody titer is growing. The baby's father must also donate blood to determine the group and Rh factor, because if he has blood 0 (I) - the first, then there will be no conflict in the blood group.

It is important for women with a possible blood type conflict during pregnancy to be very careful with invasive procedures (amniocentesis, cordocentesis). When the mother's abdomen is pierced to collect amniotic fluid or test the fetus's blood, then after these manipulations, the level of antibodies rises.

Nowadays, there are methods of treatment and prevention of hemolytic disease. If antibodies to A- and B-antigens in maternal blood increase, then doctors take the necessary measures, purify the blood, prescribe treatment, recommend taking enterosgel, activated charcoal.

How to identify a blood type conflict

Immunological incompatibility occurs more often when a woman has the first blood group 0 (I), and a man has a different group, but conflicts more often when the fetus inherited the second A (II) blood group. In this case, a blood test is taken from a woman to determine antibodies to erythrocytes according to the ABO system. This analysis determines:

complete anti-A antibodies;
complete anti-B antibodies;
incomplete anti-A antibodies;
incomplete anti-B antibodies;
natural antibodies alpha-hemagglutinins;
natural antibodies beta-hemagglutinins.

Natural antibodies alpha-hemagglutinins and beta-hemagglutinins are formed in early childhood, both of these types are found in people with the first blood group 0 (I), natural antibodies of alpha-hemagglutinins are present in people with the third blood group B (III), and, accordingly, natural antibodies beta-hemagglutinins are found in people with the second blood group A (II). The fourth group AB (IV) contains A and B antigens, so the natural antibodies described above are not formed. Such antibodies are Ig(M) immunoglobulins, they are "large" and do not pass through the placenta, so they do not harm the erythrocytes of the fetus.

Complete antibodies also belong to Ig (M) immunoglobulins, therefore they do not pass through the placenta, but with a small detachment of the placenta or other unpleasant situations, entering the fetal bloodstream block its red blood cells. Complete antibodies are stored in the female body due to immunological memory; they do not play a large role in the development of intrauterine hemolytic disease.

Incomplete antibodies are Ig(G) immunoglobulins, so they can cross the placental barrier. These antibodies are the cause of hemolytic disease. It is very important to monitor the antibody titer, although these figures cannot always reliably indicate the severity of sensitization. If the titer drops sharply without medical treatment, this may mean that there has been a massive penetration of antibodies into the fetal bloodstream.

It is interesting to know that incompatibility by blood and by the Rh factor is much better at the same time than separately. This is because the two incompatibilities "compete" with each other.

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

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

What it is?

When a woman and her future peanut have different blood counts, immunological incompatibility can begin, it is she who is called the Rh conflict. Representatives of mankind who have a Rh factor with a + sign have a specific protein D, which contains red blood cells. A person with Rh negative value of this protein does not have.

Scientists still don't know for sure why some people have a specific Rhesus macaque protein while others don't. But the fact remains - about 15% of the world's population have nothing in common with macaques, their Rh factor is negative.

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

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

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

The fetus suffers, the woman experiences sensitization, the consequences can be quite sad, up to the death of the baby in the womb, the death of the crumbs after the birth or the birth of a disabled child.

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

Much less often, incompatibility is formed according to such an indicator as a blood type, if the men and women have different groups. That is, a pregnant woman, whose own Rh factor has positive values, has nothing to worry about.

There is no reason to worry about families with the same negative Rh, but this coincidence happens infrequently, because among the 15% of people with "negative" blood - the vast majority of the fair sex, men with such blood characteristics are only 3%.

Own hematopoiesis in peanuts in the womb begins around 8 weeks gestation. And from that moment on, a small amount of fetal erythrocytes is determined in the laboratory in maternal blood tests. It is from this period that the possibility of an Rhesus conflict arises.

Probability tables

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

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

By Rh factor

By blood group

Dad's blood group	Mother's blood group	Child's blood group	Will there be conflict
0 (first)	0 (first)	0 (first)
0 (first)	A (second)	0 (first) or A (second)
0 (first)	B (third)	0 (first) or B (third)
0 (first)	AB (fourth)	A (second) or B (third)
A (second)	0 (first)	0 (first) or A (second)	Chance of conflict - 50%
A (second)	A (second)	A (second) or 0 (first)
A (second)	B (third)	Any (0, A, B, AB)	Chance of conflict - 25%
A (second)	AB (fourth)
B (third)	0 (first)	0 (first) or B (third)	Chance of conflict - 50%
B (third)	A (second)	Any (0, A, B, AB)	Chance of conflict - 50%
B (third)	B (third)	0 (first) or B (third)
B (third)	AB (fourth)	0 (first), A (second) or AB (fourth)
AB (fourth)	0 (first)	A (second) or B (third)	Conflict probability - 100%
AB (fourth)	A (second)	0 (first), A (second) or AB (fourth)	Probability of conflict - 66%
AB (fourth)	B (third)	0 (first), B (third) or AB (fourth)	Probability of conflict - 66%
AB (fourth)	AB (fourth)	A (second), B (third) or AB (fourth)

Causes of the conflict

The likelihood of developing an Rhesus conflict is highly dependent on how and how the woman's first pregnancy ended.

Even a “negative” mother can quite safely give birth to a positive baby, because during the first pregnancy, the woman’s immunity does not yet have time to develop a killer amount of antibodies to the D protein. life saving situations.

If the first pregnancy ended in a miscarriage or abortion, then the likelihood of a Rh conflict during the second pregnancy increases significantly, since the woman's blood already has antibodies ready for attack at the earliest possible date.

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

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

Diseases during the period of bearing a baby are also dangerous for a future mother with a negative Rh factor of blood. Influenza, SARS, preeclampsia, diabetes in history can provoke a violation of the structure chorionic villi, and mother's immunity will begin to produce antibodies that are detrimental to the baby.

After childbirth, the antibodies that were developed in the process of bearing the crumbs do not disappear anywhere. They represent the long-term memory of the immune system. After the second pregnancy and childbirth, the amount of antibodies becomes even greater, as after the third and subsequent ones.

Danger

The antibodies that maternal immunity produces are very small, they can easily cross the placenta into the bloodstream of the baby. Once in the blood of the child, the protective cells of the mother begin to inhibit the hematopoietic function of the fetus.

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

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

If doctors do not start taking measures in time, then the baby may die in utero, be born dead, be born with severe damage to the liver, central nervous system, and kidneys. Sometimes these lesions are incompatible with life, sometimes they lead to deep lifelong disability.

Diagnosis and symptoms

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

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

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

In this way, a titer of 1:4 or 1:8 at 12 weeks of gestation is a very alarming indicator, and a similar antibody titer for a period of 32 weeks will not cause panic in the doctor.

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

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

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

If the estimated weight of the fetus is 2 times higher than normal, this is an alarming sign.- dropsy of the fetus is not excluded, which can be fatal even in the mother's womb.

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

Damage to the central nervous system will become known only after the birth of a child; this form of hemolytic disease of the fetus can lead to a developmental delay in the baby, to hearing loss.

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

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

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

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

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

During cordocentesis, blood is taken from the umbilical cord.

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

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

The obstetrician-gynecologist who leads her pregnancy will tell the woman about all the risks during the procedures or refusing them.

Possible consequences and forms

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

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

edematous

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

icteric

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

The baby has a slightly enlarged liver and spleen, blood tests show the presence of anemia. The level of bilirubin in the blood rises rapidly. If doctors fail to stop this process, the disease can turn into kernicterus.

Nuclear

The nuclear type of HDN is characterized by lesions of the central nervous system. The newborn may have seizures, he can involuntarily move his eyes. The tone of all muscles is reduced, the child is very weak.

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

Forecast

In prognosis for HDN, doctors are always very careful, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the crumbs in the future.

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

After hemolytic disease of newborns, children suckle poorly and sluggishly, their appetite is reduced, sleep is disturbed, and there are neurological abnormalities.

Quite often (but not always) such children have a significant lag in mental and intellectual development, they get sick more often, hearing and vision impairments can be observed. Cases of anemic hemolytic disease end most safely, after the level of hemoglobin in the blood of the crumbs can be raised, it develops quite normally.

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

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

Treatment

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

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

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

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

If the titers are high, the child's condition is severe, then delivery can be carried out ahead of time by caesarean section. Doctors try to support the pregnant woman with medications until the 37th week of pregnancy so that the baby has the opportunity to “ripen”.

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

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

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

While the woman's immunity throws all its strength into rejecting a skin fragment that is foreign to itself (and this is several weeks), the immunological load on the child is somewhat reduced. Scientific disputes do not subside about the effectiveness of this method, but the reviews of women who have gone through such procedures are quite positive.

In the second half of pregnancy, with an established conflict, plasmapheresis sessions can be prescribed for the expectant mother, this will slightly reduce the number and concentration of antibodies in the mother's body, respectively, the negative burden on the baby will also temporarily decrease.

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

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

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

Prevention

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

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

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

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

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

The introduction of anti-Rhesus immunoglobulin is relevant for women whose blood does not yet have antibodies that are not sensitized. They need such an injection after an abortion, after even a slight bleeding during pregnancy, for example, with a slight placental abruption, after surgery for an ectopic pregnancy. If you already have antibodies, then you should not expect a special effect from vaccination.

Common Questions

Is it possible to breastfeed a child?

If a Rh-negative woman has a baby with a positive Rh factor, and there is no hemolytic disease, then breastfeeding is not contraindicated.

Babies who have experienced an immune attack and were born with hemolytic disease of the newborn are not recommended to eat breast milk for 2 weeks after the introduction of immunoglobulin to their mother. In the future, the decision to breastfeed is made by neonatologists.

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

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

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

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

Dad's rhesus unknown

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

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

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

Is there a fertility effect?

Such a connection does not exist. The presence of a negative Rh does not mean that it will be difficult for a woman to get pregnant.

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

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

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

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

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

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

Thus, if a woman's first pregnancy ended in an abortion, the second - in a miscarriage, then during the gestation of the third, the risks are estimated at about 10-11%.

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

Accordingly, any woman with a negative Rh factor who has decided to become a mother once again can weigh the risks.

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

No, this is not always the case. The child is protected by special filters that are in the placenta, they partially restrain aggressive maternal antibodies.

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

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

Is there a conflict during pregnancy, contrary to all forecasts and tables, in two negative parents?

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

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

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

There are several cases in history when a mother with Rh (-) and a father with a similar Rh had a child with positive blood and hemolytic disease. The situation requires careful study.

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