During pregnancy, the absence of various diseases is extremely important. They become the reason for birth not healthy child with serious pathologies. This is the Rhesus conflict between mother and fetus.

What is Rh conflict between mother and fetus?

Rh blood group incompatibility occurs when the mother and fetus have different Rh blood factors.

This leads to the fact that the mother’s body begins to actively produce antibodies that adversely affect the development of the future person.

When does Rhesus conflict occur?

It occurs when a piece of the baby’s red blood cells enters the mother’s body through the placenta. As a result, some chemical processes begin to cause harm. fetus, lead to miscarriage, stillbirth or to.

At the same time, such an outcome can only be prevented if it is detected in time.

When does Rhesus conflict occur?

If there are disorders in the immune system. By itself, Ph+ or Ph- does not have a serious impact on development. But it is an individual feature for everyone.

Causes

In the course of medical research, it was discovered that such a disease occurs due to injuries in the uterine area.

These include:

• abortions;
• past transfusions;
• spontaneous childbirth (miscarriage);
• congenital pathology;
• genetic problems;
• mechanical damage to the uterus.

There is a theory according to which the disease can manifest itself without the points described above, but it has not been proven. Similar cases have occurred in the history of medicine, but they were rare.

Additional insurance and careful diagnostics will never be superfluous during such a crucial period.

In some cases, progression begins during labor, when the placenta is separated manually rather than naturally.

In such a situation, the child’s blood, which is contained in this layer of skin, can reach the mother and cause the appearance of antigens.

Also one of the reasons is, since during this procedure the internal organs will suffer.

There is an increased risk of infection if you have the following diseases:

• (chronic);

A separate case is if at birth the girl has ph(-), and the mother has ph(+), and at the same time an intrauterine imbalance may arise, which doctors may not even detect.

It does not lead to visible changes and does not cause death, but can subsequently lead to this disease.

Symptoms

Symptoms of Rh conflict practically do not appear; women do not experience:

Therefore, there is a constant need to conduct a medical examination in case of suspicion to identify the presence or absence of antibodies. Otherwise, it is practically impossible to find out about the disease. This means that there is a possibility of fetal death.

Blood type conflict between mother and child causes serious health problems. In some situations, deterioration in the functioning of organs in a pregnant woman has been recorded. There is a possibility of death.

Diagnostic methods

The first step is to contact the clinic before pregnancy, or in the first trimester with the father.

If both parents Rh negative, then the probability of hemolytic disease occurring is 0%, there is no reason for concern.

In the opposite situation, doctors conduct an examination. They take it with help modern equipment count possible risks. At the same time, specialists are obliged to notify those who contacted them about the results.

After this procedure, several of the following are carried out:

Below is a table of Rh conflict during pregnancy, with which you can know in advance about possible troubles. To do this, you only need information about the parents, which can be taken from the medical record.

It is very important to prevent Rh blood group conflict.

Consequences

As a rule, the main health problems arise in the unborn child. His immune system is practically absent and cannot produce special antigens.

This leads to impaired blood circulation and nutrition.

Why is Rh conflict dangerous for a child?

In almost all cases, jaundice and swelling appear at birth, which cause severe pain, and can only be eliminated through long-term therapy.

Intrauterine symptoms of Rh conflict between mother and fetus:

In most cases, doctors do not have the ability to cure pathology during pregnancy, but it can be successfully corrected. However, immediately after birth, the baby and his mother are given the required dose of medication. Unfortunately, if Rh conflict is not diagnosed in a timely manner, the disease can cause irreparable harm to the fetus.

The consequences of Rh conflict can also affect a woman’s health, greatly weakening her body.

Treatment

The only way to recover is to perform a serious operation on the fetus through the umbilical cord artery.

However, such a procedure will not be enough. Mom is prescribed special medications and plasmapheresis. Together, they help reduce the concentration of antigens to normal safe blood cells.

After a successful birth, the baby is given a second blood transfusion. In some cases, oxygen therapy is prescribed.

Prevention of Rh conflict during pregnancy is a mandatory procedure even at an early stage in order to ensure a healthy and happy future for the future person.

How does childbirth proceed?

The main problem of active Rh conflict during childbirth is, due to which there is a need to carry out additional surgical intervention.

This causes congenital pathologies and serious diseases of the central nervous system.

In medical practice, there were exceptions when childbirth proceeded normally and the baby was born absolutely healthy. But such an outcome occurs with a probability of 1-2%.

In some cases, specialists independently decide on a caesarean section. If further pregnancy can cause death.

It is worth noting that this method is the safest. The level of training of surgeons to perform such an operation is quite high.

Early forecast

There are special technologies that can be used to determine in advance the possibility of developing a predisposition to Rh conflict. You don't need to spend extra money to do this. Since these are common procedures and tests, they can detect the development of the disease in time.

How to warn

Preventive measures are necessary even in cases where relatives have a negative blood type. Even so, there are health problems that have similar symptoms.

The main measure is a constant analysis of the body for the presence of antibodies. If there are any, then this indicates possible problems ah in the future. That is, there is a need for a special approach to a pregnant woman.

With help medicine containing immunoglobulin, you can get rid of harmful red blood cells. Thereby reducing the threat to a minimum.

This medication is administered intramuscularly under the supervision of the attending physician. The course of prophylaxis lasts several weeks with provisions for increasing it if necessary.

Planning your birth in advance will help you avoid a wide range of possible problems, so there are special courses that cover such important topics.

Video: Rhesus conflict between mother and fetus

How much various factors affect the course of pregnancy, and all of them simply need to be taken into account. Many women have heard something about such a sad phenomenon as Rh conflict during pregnancy. However, not all of them understand what it is and what this phenomenon is connected with. And misunderstanding quite naturally gives rise to fear, and even panic.

Therefore, it is very important to know what a conflict of Rh factors is during pregnancy, and what the Rh factor is in general.

What is the Rh factor?

Naturally, we should start with the very concept of Rh factor. This word refers to a special protein that is located on the surface of red blood cells. This protein is present in almost all people, but is absent in only 15% of people. Accordingly, the former are considered Rh-positive, and the latter – Rh-negative.

In fact, the Rh factor is just one of the immunological properties of blood, and does not affect human health in any way. Blood with a positive Rh factor is considered stronger.

This property of blood was discovered by two scientists: Landsteiner and Wiener in 1940 while studying rhesus monkeys, who gave the name to this phenomenon. The Rh factor is denoted by two Latin letters: Rp and plus and minus signs.

What is Rh conflict between mother and child? When positive and negative red blood cells come into contact, they stick together, which does not lead to anything good. However, stronger Rh-positive blood easily tolerates such intervention. Consequently, in women with a positive Rh factor, no conflict can arise on this basis.

However, in women with a negative Rh factor, pregnancy will most likely proceed normally. If the father of the child is also Rh negative, then there is no basis for conflict. When does Rh conflict occur? When a positive Rh factor is detected in the husband, the child’s blood will also have Rp + with some degree of probability. This is where a Rhesus conflict may arise.

It is possible to determine a child’s Rp without an intervention dangerous to his health only approximately based on the parents’ indicators. This is clearly shown in the table. Rhesus conflict during pregnancy occurs extremely rarely, in only 0.8%. However, this phenomenon is fraught with very serious consequences, which is why so much attention is paid to it.

What are the causes of Rh conflict? Positive blood of a baby for a mother with negative Rp is a serious threat, and in order to cope with it, the woman’s body begins to produce antibodies, and accordingly, they react with the red blood cells of the fetus and destroy them. This process is called hemolysis.

Maternal and fetal blood occurs in the space between the uterus and placenta. It is in this place that exchange occurs: oxygen and nutrients enter the baby’s blood, and waste products of the fetus enter the mother’s blood. At the same time, some of the red blood cells seem to change places. This is how positive fetal cells end up in the mother’s blood, and her red blood cells end up in the fetal blood.

In the same way, antibodies enter the baby’s blood. By the way, obstetricians have long noticed that Rh conflict is much less common during the first pregnancy.

What is this connected with? Everything is quite simple: at the first “meeting” of the blood of the mother and fetus, IgM type antibodies. The size of these antibodies is quite large. Rarely and in very small quantities they enter the child’s blood, and therefore do not cause problems.

Rp inheritance table

Father	Mother	Child	Possibility of blood type conflict
0 (1)	0 (1)	0 (1)	No
0 (1)	A (2)	0 (1) or (2)	No
0 (1)	AT 3)	0 (1) or B(3)	No
0 (1)	AB (4)	A (2) or B (3)	No
A (2)	0 (1)	0 (1) or A(2)	50/50
A (2)	A (2)	0 (1) or A(2)	No
A (2)	AT 3)		50/50
A (2)	AB (4)	B(3), or A(2), or AB(4)	No
AT 3)	0 (1)	0(1) or B(3)	50/50
AT 3)	A (2)	Any (0(1) or A(2), or B(3), or AB(4))	50/50
AT 3)	AT 3)	0(1) or B(3)	No
AT 3)	AB (4)	0 (1) or B(3), or AB(4)	No
AB (4)	0 (1)	A(2) or B(3)	Yes
AB (4)	A (2)	B(3), or A(2), or AB(4)	50/50
AB (4)	AT 3)	A(2), or B(3), or AB(4)	50/50
AB (4)	AB (4)	A(2) or B(3), or AB(4)	No

Rh conflict during the second pregnancy is much more likely, since upon repeated contact with Rh-negative blood cells, the woman’s body produces antibodies of another type – IgG. Their size allows them to easily pass through the placenta into the baby’s body. As a result, the process of hemolysis continues in his body, and the toxin bilirubin, a product of the breakdown of hemoglobin, accumulates in the body.

Why is Rh conflict dangerous? Fluid accumulates in the baby's organs and cavities. This condition leads to disruption of the development of almost all body systems. And the saddest thing is that after the birth of a child, antibodies from the mother’s blood continue to function in his body for some time, therefore, hemolysis continues and the condition worsens. It is called hemolytic disease of newborns, abbreviated as GBN.

In acute cases, miscarriage is possible due to Rh conflict. In a number of cases, this phenomenon becomes the cause of miscarriage. That is why women with negative Rp need to be very careful about their condition and not miss scheduled visits to the gynecologist, tests and other studies.

Symptoms of Rh conflict

How does Rh conflict manifest itself? Unfortunately, there are no external manifestations visible to the naked eye. For the mother, all the processes occurring in her body and associated with Rh conflict are completely harmless and have no symptoms.

Symptoms of Rh conflict can be seen in the fetus during ultrasound examination. In this case, you can see the accumulation of fluid in the cavities of the fetus, swelling; the fetus, as a rule, is in an unnatural position: the so-called Buddha pose. Due to the accumulation of fluid, the abdomen enlarges, and the baby’s legs are forced to spread apart. In addition, it is observed double circuit heads, this also occurs due to the development of edema. The size of the placenta and the diameter of the vein in the umbilical cord also change.

Rhesus conflict in newborns can result in one of three forms of the disease: icteric, edematous and anemic. Edema the form is considered the most severe and most dangerous for the child. After birth, these babies often require resuscitation or a stay in the intensive care unit.

The second most difficult form is icteric. The degree of complexity of the course in this case is determined by the amount of bilirubin in the amniotic fluid. Anemic The most mild form of the disease occurs, although the severity also largely depends on the degree of anemia.

Antibody test during pregnancy

One way to determine the very presence of Rh conflict is an antibody test. This analysis is performed on all women with suspected Rh conflict. To determine the risk group at the beginning of pregnancy, everyone is tested for the Rh factor, and the father of the child must also undergo the same procedure. If the combination of Rh factors in a particular case is dangerous, the woman will be tested once a month for Rh conflict, that is, for the number of antibodies.

Starting from the 20th week, if the situation is threatening, the woman antenatal clinic will be transferred for observation to a specialized center. Starting from 32 weeks, a woman will be tested for antibodies 2 times a month, and after 35 weeks - once a week until the onset of labor.

Much depends on how long the Rh conflict was detected. The sooner this happens, the more problems such a pregnancy portends, since the effect of Rh conflict has the ability to accumulate. After 28 weeks, blood exchange between mother and child increases, and, consequently, the number of antibodies in the baby’s body increases. Starting from this period, the woman is given special attention.

Studies to determine the extent of fetal damage

The condition of the fetus can be determined using a number of studies, including invasive ones, that is, associated with a certain risk to the health of the fetus. From the 18th week, they begin to regularly examine the baby using ultrasound. Factors that doctors pay attention to are the position in which the fetus is located, the condition of the tissues, placenta, veins, and so on.

The first study is scheduled around 18-20 weeks, the next at 24-26, then at 30-32, another at 34-36 weeks and the last one just before birth. However, if the condition of the fetus is assessed as serious, the mother may be prescribed additional ultrasound examinations.

Another research method that allows you to assess the baby’s condition is Doppler ultrasound. It allows you to evaluate the work of the heart and the speed of blood flow in the blood vessels of the fetus and placenta.

CTG is also invaluable in assessing the child's condition. It allows you to determine the reactivity of the cardiovascular system and suggest the presence of hypoxia.

Separately worth mentioning invasive assessment methods condition of the fetus. There are only 2 of them. The first one is amniocentesis- puncture amniotic sac and collection of amniotic fluid for analysis. This analysis allows you to determine the amount of bilirubin. In turn, this allows you to very accurately determine the child’s condition.

However, puncture of the amniotic sac is a truly dangerous procedure, and in some cases it entails infection in the amniotic fluid, can provoke leakage of amniotic fluid, bleeding, premature placental abruption and several other serious pathologies.

The indication for amniocentesis is an antibody titer for Rhesus conflict of 1:16, as well as the presence of children born with a severe form of HDN.

The second research method is cordocentosis. During this test, the umbilical cord is pierced and a blood test is taken. This method even more accurately determines the bilirubin content; in addition, this is the method used to give a blood transfusion to a child.

Cordocentosis is also very dangerous and leads to the same complications as the previous research method, in addition there is a risk of developing a hematoma on the umbilical cord, which will interfere with the metabolism between mother and fetus. Indications for this procedure are an antibody titer of 1:32, the presence of previously born children with a severe form of HDN or deceased children due to Rh conflict.

Treatment of Rh conflict during pregnancy

Unfortunately, the only one really in an effective way Treatment of Rh conflict during pregnancy is a blood transfusion to the fetus. This is a very risky operation, but it provides a significant improvement in the condition of the fetus. Accordingly, this helps prevent premature birth.

Previously, other treatment methods were widely used, such as plasmapherosis during pregnancy, skin transplantation of the husband to the woman, and some others are considered ineffective or not at all effective. Therefore, the only answer to the question of what to do in case of Rh conflict is constant observation by a doctor and following all his recommendations.

Delivery in case of Rhesus conflict

In most cases, pregnancy that occurs with the development of Rh conflict ends in planned pregnancy. Doctors monitor the child’s condition in every available way and decide whether it makes sense to continue the pregnancy or whether it would be safer for the child to be born prematurely.

Natural childbirth with Rhesus conflict occurs rarely, only if the condition of the fetus is satisfactory and there are no other contraindications.

At the same time, doctors constantly monitor the baby’s condition, and if difficulties arise, they decide on further management of labor, often prescribing C-section.

However, most often birth in case of Rh-conflict occurs by caesarean section, since it is in this case considered more gentle.

The term “Rh factor” was introduced later, in the middle of the 20th century, when sufficient knowledge had already been accumulated. Blood with the presence of such a protein is called Rh-positive; if it is absent, it is called Rh-negative. To a greater extent, the Rh protein conflict is characteristic of Europeans; about 15% of fair-skinned residents do not have this protein. In everyday life, a person does not suffer at all from its absence, with the exception of extreme situations when a blood transfusion is urgently required. A person with a negative Rh factor is allowed an identical one, otherwise it can provoke the occurrence of blood transfusion shock with fatal. But the likelihood of such events is not high, and for example, many men do not even know whether they are the owners of this protein or not. But the negative one causes concern among women.

Danger to child

It is understood that every woman is a future mother, and if she has negative Rh blood, and the fetus is on the contrary, a conflict arises between the maternal blood and the Rh protein of the baby. A situation arises when the immune system of a pregnant woman perceives the Rh protein of the unborn child as a hostile agent, and produces proteins that can pass through placental barrier and kill his blood cells. As a result, it occurs during pregnancy in women.

What does a negative Rh factor affect in a woman during pregnancy? The child develops, possible pathology of the heart muscle, destruction of red blood cells, and with them hemoglobin, leading to the development of hemolytic disease and an increase in bilirubin, which also negatively affects the development of the fetus.

If untimely assistance is not given, Rh conflict during pregnancy leads to spontaneous abortion, stillbirth, and developmental pathology. The development of Rh conflict in a woman is directly proportional to the number of pregnancies; it is also important which genes the baby inherits.

Favorable and negative protein combinations

A woman registered with a gynecologist undergoes many tests, including the Rh factor, since a negative Rh factor in a woman during pregnancy is a direct threat to her baby.

Let's look at combinations and incompatibilities between mother and baby and the likely outcome:

• The most common combination is when both the mother and her baby exhibit an Rh-positive reaction.
• Pregnancy proceeds calmly for a mother with Rh negation, but the fetus does not have it.
• A woman with a positive Rh factor carries a negative baby without any problems.

Rh conflict occurs when the mother has no Rh, but the child, on the contrary, has Rh positive. For the first pregnancy, the risk of Rh conflict during pregnancy is only 1.5%, while with a second pregnancy it increases to 70-75%.

Dangers for the first pregnancy

A Rhesus conflict in a pregnant woman for the first time is possible only when the woman’s blood has come into contact with Rh-positive blood, or in case of exposure to blood that is unsuitable for the factor, for example, during previously performed medical procedures, or during some instrumental studies of the fetus. In this case, allerization occurs female body, and it triggers the antigen-antibody system.

However, by the end of pregnancy, the amount of antibodies in the blood does not reach an alarming concentration, and even if they enter the child’s body, they do not cause significant harm, and the baby is usually born healthy.

The second baby being carried is at significant risk, since the antibodies developed during the first pregnancy continue to circulate in the mother’s blood. As soon as the mother’s immune cells recognize a foreign agent in the nascent body, the antigen-antibody system immediately comes into action. What is important is that the woman is not bothered by any symptoms, her health does not change.

In the mother's fetus, clear symptoms emerge during an ultrasound scan:

• gives unclear outlines of the head
• V chest and in abdominal cavity a large amount of liquid collects
• enlarged heart and liver
• the walls of the placenta are thickened, the supply veins are swollen.

How is the Rh factor determined in the fetus?

Not so long ago, in order to find out the Rh factor in a child and make a prognosis for Rh conflict, a rather risky and painful method of taking blood from the umbilical cord was used. In the present, this information can be obtained by taking it from your mother.

An analysis for determining Rh in a child is carried out by examining the child’s DNA, which circulates in the mother’s blood and allows us to determine the presence of Rh antigen. If the child has a positive test, the mother’s antibody levels are checked monthly, monitoring their growth.

Prevention and treatment

If a blood test to detect Rh protein in the fetus is positive, preventive measures are taken to give the child a real opportunity to develop normally and the woman to have healthy children.

It is important that a pregnant woman strictly follows the doctor’s instructions:

• An antibody test is carried out twice during the gestation period, but if necessary, much more often.
• Monitoring the child's condition through the method.
• According to the doctor's decision, an anitresus immunoglobulin drug is prescribed. Vaccination is given to women with no antibodies at 28 weeks of pregnancy. The same vaccination is carried out if the pregnancy ends in miscarriage or.
• If antibodies are detected in the blood of a pregnant woman, vaccination is pointless. And if there is a threat to the child’s condition, the question of premature birth is raised.

If the Rhesus conflict has already developed in a pregnant woman, vaccination is not able to help, just as the method once used is now recognized as ineffective. The only thing that can save the child is a complex procedure for the fetus, but if the timing allows, the best solution would be to terminate the pregnancy.

Conclusion

A negative Rh factor in the blood of women during their first pregnancy extremely rarely leads to an Rh conflict. The difference in the presence of Rh protein does not affect the child and ends in a successful delivery.

For a woman without the Rh factor, the first pregnancy has a decisive role.

A negative Rh factor in a woman during her second pregnancy is almost always a significant threat to the baby’s health even without medical care here, you can't get by.

But with the responsible attitude of the mother herself and the competent work of a specialist, the baby will be born healthy and on time. We hope you understand what a negative Rh factor can lead to in women during pregnancy for the first and second time.

Update: October 2018

Most women who are preparing to become mothers have heard about the “terrible and terrible” Rh conflict during pregnancy. But this problem applies only to those representatives of the fairer sex whose blood is Rh negative.

Rh conflict during pregnancy threatens only those pregnant women and those planning a pregnancy who have negative Rh blood, and even then, not in 100% of cases.

Let's understand the Rh factor

It is known that human blood consists of red blood cells or erythrocytes, which are responsible for the transport of oxygen, white blood cells - leukocytes, which guard the health of the body, platelets, which are responsible for blood clotting and many other cells and systems.

The Rh factor is a D protein, which is an antigen and is localized on the surface of red blood cells. A significant proportion of people have the Rh factor, then their blood is called Rh positive. For example:

• Among Europeans, there are 85% of Rh-positive people
• while for Africans this figure rises to 93%
• among Asians up to 99%

If D protein is not detected, then such people are called Rh negative. The Rh factor is determined genetically, just like hair or eye color, it remains for life and does not change. The presence or absence of the Rh factor does not bring any benefit or harm, it’s just characteristic feature each person.

What is this – Rhesus conflict?

Click to enlarge

It becomes clear that pregnancy with Rh conflict occurs in situations where the mother’s blood is Rh negative, and the father’s, on the contrary, is Rh positive, and unborn child inherits the Rh factor from it.

However, this situation occurs in no more than 60% of cases, and the occurrence of Rh conflict accounts for only 1.5%. The mechanism of Rh conflict while waiting for the birth of a baby is that the red blood cells of the fetus, which carry the D-antigen, meet the red blood cells of a Rh-negative pregnant woman and stick together, that is, agglutination occurs.

To prevent clumping, the mother’s immunity is activated, the immune system begins to intensively synthesize antibodies that bind to the antigen - the Rh factor and prevent clumping. These antibodies or immunoglobulins can be of two types, both IgM and IgG.

• Rh conflict during the first pregnancy

It almost never occurs, which is due to the production of type 1 immunoglobulins. IgM is very large and cannot cross the placenta to enter the fetal bloodstream. And in order for the red blood cells of the unborn child and antibodies to meet, they need to “collide” in the gap between the uterine wall and the placenta. The first pregnancy almost completely eliminates this situation, which prevents the development of a Rh conflict situation.

• If a woman becomes pregnant again with an Rh-positive fetus

In this case, his red blood cells, penetrating into vascular system mothers “trigger” an immune response, during which IgG begins to be produced. These antibodies are small in size, they easily cross the placental barrier, penetrate the baby’s bloodstream, where they begin to destroy his red blood cells, that is, cause hemolysis.

In the process of destruction of the red blood cells of the fetus, bilirubin is formed from them, which in significant quantities is a toxic substance for the child. Excessive formation of bilirubin and its action contributes to the development of such a formidable pathology as hemolytic disease of the fetus and newborn.

What leads to Rh conflict?

For the development of Rh conflict, two conditions are needed:

• Firstly, the fetus must have Rh-positive blood, which means it will inherit its Rh-positive father
• Secondly, the mother’s blood must be sensitized, that is, have antibodies to the D-protein.

The production of antibodies is mainly due to previous pregnancies, no matter how they ended. The main thing is that there was a meeting between maternal blood and fetal blood, after which IgM antibodies were developed. It could be:

• previous births (during the process of expulsion of the fetus, contact with its blood cannot be avoided by a woman)
• C-section
• ectopic pregnancy
• artificial termination of pregnancy (regardless of the method, both surgical and)
• spontaneous miscarriage
• separation of the placenta by hand.

It is also possible to develop antibodies after performing invasive procedures during gestation, for example, after cordocentesis or amniocentesis. And such a reason cannot be ruled out, although this is rather nonsense, like transfusion of Rh-positive blood to a woman in the past who has an Rh-negative factor.

Diseases of the woman who is carrying the baby are also important. , diabetes, ARVI and influenza damage the villi, and, consequently, the chorion vessels, and the blood of the mother and the unborn baby mixes.

But you should know that hematopoiesis in the fetus begins to form from the 8th week of embryogenesis, which means that abortions performed before 7 weeks are safe in terms of the development of an Rh conflict situation in the future.

Manifestations of Rh conflict

There are no external, that is, visible manifestations of Rh conflict. Incompatibility of maternal and fetal blood does not in any way affect the condition of the pregnant woman. As described above, the Rh conflict “ripens” during the second pregnancy, and with each subsequent pregnancy the risk of this condition increases.

Incompatibility of the blood of the child and the expectant mother according to the Rh factor has a very adverse effect on his condition and health in the future. To find out what devastating damage the Rhesus conflict has caused to the baby, an ultrasound scan of the fetus is performed. During ultrasound examination The following signs are clearly visualized:

• the contour of the head becomes double, which indicates edema
• the placenta and umbilical vein swell and increase in diameter
• Fluid accumulates in the abdominal cavity, heart sac, and chest
• the size of the fetal abdomen exceeds the norm
• splenohepatomegaly develops (increase in the size of the liver and spleen), the fetal heart is larger than normal
• the baby in the uterus takes a certain position in which the legs are spread apart due to the large belly - this is called the “Buddha pose”

All of these ultrasound signs indicate the development of hemolytic disease of the fetus, and after birth it will be called hemolytic disease of the newborn. This pathology has three forms:

• icteric
• edematous
• and anemic

The most unfavorable and severe is the edematous form. The icteric form ranks second in severity. A child who has high levels of bilirubin in the bloodstream after birth is very lethargic, apathetic, different poor appetite, constantly regurgitates (see), has reduced reflexes, he often has convulsions and vomiting.

Bilirubin intoxication negatively affects the child in utero, and is fraught with the development of mental and mental disability. In the anemic form, the fetus has a lack of red blood cells, which causes oxygen starvation (hypoxia) and immature red blood cells (erythroblasts, reticulocytes) are present in large quantities in the blood.

Diagnostics and dynamic control

In the diagnosis of the described pathology great importance has an early appearance of a woman at the antenatal clinic, especially if the pregnancy is second, third, and so on, and the pregnant woman has been diagnosed with either antibody sensitization in the past, or, which is much more unfavorable, a history of hemolytic disease of the fetus/newborn.

• When registering at a dispensary, all pregnant women, without exception, are determined to have their blood type and Rh status.
• If the mother is diagnosed with Rh-negative blood, in this case, determination of the group and Rh factor in the father is indicated.
• If he has a positive Rh factor, a woman up to 20 weeks of pregnancy is prescribed tests for antibody titer every 28 days.
• It is important to determine the type of immunoglobulins (IgM or IgG).
• After the pregnancy has reached the second half (after 20 weeks), the woman is sent for observation to a specialized center.
• After 32 weeks, a blood test for antibody titer is carried out every 14 days, and after 35 every 7 days.
• The prognosis depends on the gestational age (see) in which the antibodies were detected. The earlier the Rh factor immunoglobulins were diagnosed, the more unfavorable it is.

If antibodies are detected, especially if there is a second pregnancy and the chances of an Rh conflict increase, the condition of the fetus is assessed, which is carried out using both non-invasive and invasive methods.

Non-invasive ways to determine the condition of the unborn baby:

Ultrasound should be performed at 18, 24–26, 30–32, 34–36 weeks of gestation and on the eve of birth. The position of the child, swelling of the tissues, dilated umbilical veins, and how the baby grows and develops are determined.

• Doppler

The speed of blood flow in the placental vessels and in the unborn child is assessed.

• Cardiotocography (CTG)

Allows you to determine the state of the heart and vascular system in the fetus and diagnose the presence of a lack of oxygen (hypoxia).

Invasive methods:

• Amniocentesis

During amniocentesis, amniotic fluid is collected by puncturing the amniotic fluid and the bilirubin content in it is determined. Amniocentesis is prescribed when the antibody titer is 1:16 or higher and is performed at 34–36 weeks. The negative aspects of this procedure should also be taken into account. Carrying out amniocentesis is fraught with infection, leakage of amniotic fluid, premature rupture of water, bleeding and placental abruption.

• Cordocentesis

The essence of the procedure is to puncture the umbilical vein and take blood from it. A highly informative method for diagnosing hemolytic disease, in addition, it allows intrauterine blood transfusion to the fetus. Cordocentesis has the same negative aspects as amniocentesis, and the formation of a hematoma at the puncture site or bleeding from it is also possible. This manipulation is carried out when the antibody titer is 1: 32 and in the case of hemolytic disease of the fetus/newborn in the previous child or his death.

Methods for countering Rhesus conflict

Today, there is only one way to alleviate the condition of the fetus and improve its situation - this is intrauterine blood transfusion through cordocentesis. This method reduces the likelihood of premature birth and the development of severe hemolytic disease after birth. All other methods do not have a significant effect or are completely useless (desensitizing treatment, transplantation of a skin flap from the mother’s husband, etc.).

A woman usually gives birth ahead of schedule. Preference is given to abdominal delivery, since in this case the risk of complications is reduced. But in some situations (absence of hypoxia, gestational age more than 36 weeks, not the first birth) independent childbirth is also possible.

To prevent Rh conflict during the next pregnancy, a first-time mother is given anti-Rh immunoglobulin within 72 hours after the birth of the child, which will destroy the baby's red blood cells that enter the mother's blood, which will prevent the formation of antibodies to them.

It is for this same purpose that specific immunoglobulin is administered after artificial and spontaneous interruption pregnancy. In addition, the administration of immunoglobulin after an ectopic pregnancy and for bleeding during the current period of gestation is indicated. For prevention purposes, administration of this immunoglobulin is indicated at 28 and 34 weeks.

Rhesus conflict and breastfeeding

There is no consensus on the issue of breastfeeding during Rh conflict. Doctors evaluate the baby’s condition and possible risks, and in some cases, immediately after birth, they do not recommend breastfeeding for several days, sufficient to remove antibodies from the mother’s body.

However, there is also the opposite opinion of doctors that such a restriction is not necessary. There are no proper studies in this area confirming this or that position yet.

What does rhesus conflict portend?

The consequences of pregnancy with Rh-conflict are very unfavorable. The presence of a huge amount of bilirubin in a child’s blood affects his condition. internal organs and brain (damaging effect of bilirubin).

Hemolytic disease of the newborn often develops, the baby has mental retardation, and his death is possible, both in the womb and after birth. In addition, Rh conflict is the cause of termination of pregnancy and recurrent miscarriage.

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

When is Rh conflict possible?

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

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

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

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

At the first meeting of the expectant mother's immune system with Rh-positive erythrocytes of the fetus, antibodies (immunoglobulins) of class M are produced, the structure of which does not allow them to penetrate the placenta; thus, these antibodies do not have any effect on the developing fetus. After this meeting, “memory cells” are formed in the mother’s immune system, which, upon repeated contact (occurring during subsequent pregnancies), produce antibodies (immunoglobulins) of class G, which penetrate the placenta and can lead to the development of hemolytic disease of the fetus and newborn (see below for more details). ). Once they appear, class G antibodies remain in a woman’s body for life. Thus, Rh antibodies in the body of a Rh-negative woman can appear during artificial or spontaneous termination of an intrauterine or ectopic pregnancy, after the first birth at the birth of a Rh-positive child. Rh sensitization is also possible if a woman has ever had a blood transfusion without taking into account the Rh factor. The risk of developing Rh sensitization increases with subsequent pregnancies, especially in the case of termination of the first pregnancy, bleeding during pregnancy and childbirth, manual separation of the placenta, and also during delivery by cesarean section. This is explained by the fact that in the above situations, a large number of Rh-positive erythrocytes of the fetus enter the mother’s bloodstream and, consequently. The mother's immune system responds by producing a large number of antibodies.

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

Hemolytic disease of the fetus

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

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

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

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

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

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

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

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

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

After surgical treatment or in the case of a milder course of HDN, solution transfusions are performed ALBUMIN, GLUCOSE, HEMODES. At severe forms intravenous administration has a good effect on the disease PREDNISOONE within 4-7 days. In addition, the same methods are used as for transient conjugative jaundice.

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

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

If Rh antibodies are found in your blood...

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

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

• periodic determination of the level of antibodies (antibody titer) - carried out once a month,
• periodic ultrasound examination,
• if necessary, intrauterine interventions: amniocentesis, cordocentesis (procedures carried out under ultrasound control, during which a needle pierces the anterior abdominal wall and penetrates into the cavity of the fetal bladder during amniocentesis or into the umbilical cord vessels during cordocentesis); These procedures allow you to take amniotic fluid or fetal blood for analysis. If a severe form of hemolytic disease of the fetus is detected, intrauterine treatment is carried out (under ultrasound control, a required amount red blood cell mass), which improves the condition of the fetus and prolongs pregnancy. Regular monitoring of pregnant women with Rh sensitization in specialized centers allows you to choose the optimal timing and methods of delivery.

How to avoid the appearance of Rh antibodies

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

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

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

Every woman who has a negative Rh factor, at some point begins to think about what complications it may entail during pregnancy. A very common one among them is Rh conflict, which occurs in 75% of cases when a woman is a carrier of negative Rh and a man is positive. In this case, the unborn child may inherit the father’s positive antigen and its Rh factor will not match the mother’s. The question is asked, what to do in such cases and what to be afraid of? Which risks are imaginary and which ones actually exist?

Rh conflict (Rh sensitization) is the entry of positive fetal antigens into the blood of a Rh-negative mother, causing the production of antibodies and immunization in her body during pregnancy. In the case of positive maternal antigens and negative fetal antigens, Rh conflict does not develop. During the first pregnancy, the risk of developing Rh conflict is low. This is due to the low immune response of the mother’s body to the Rh-positive blood of the fetus and the low activity of antibodies.

Facts about Rhesus conflict

1. Rhesus conflict and upcoming pregnancy. Many women believe that having a negative Rh factor reduces their chances of getting pregnant, but this is not the case. The chances of getting pregnant are the same in all cases; if there is a possibility of developing a Rhesus conflict, you only need to worry about the fact of pregnancy. Rhesus conflict pregnancy does not develop in all cases of mismatch of erythrocyte antigens between mother and child.
2. Abortion during Rh-conflict pregnancy. Despite the achievements of modern medicine regarding the elimination of Rh conflict during pregnancy, interrupting it in this case remains an equally risky undertaking. The method of abortion, be it medication, vacuum or classical abortion, does not play any role. In particular, this includes spontaneous abortion or miscarriage. In the first Rh-conflict pregnancy, the chances of bearing a healthy child are much greater than in subsequent ones. Therefore, getting rid of the fetus during the first pregnancy is extremely dangerous and irrational. Such actions can lead to complications in subsequent pregnancy, and even to infertility.
3. Second and subsequent Rh-conflict pregnancies. Antibodies produced in the mother’s body during the first pregnancy are very large and inactive. With the second pregnancy, everything changes - they become small and active, and pass through the placenta to the fetus without difficulty. Therefore, each subsequent pregnancy increases the risk of developing congenital pathologies of the fetus and miscarriage, which is fraught with its spontaneous termination even in later stages. If not properly managed and taken, the pregnancy may become frozen.
4. Preparing for pregnancy with the risk of developing Rh conflict. If the expectant mother and her husband are carriers of different Rhesus (in the case of the mother - negative), one should prepare for any pregnancy. Also, when it occurs, it is necessary to undergo a series of tests, including a study that determines the presence of antibodies to the foreign Rh factor. At 28 weeks, when carrying a fetus with positive Rh, the woman is given an injection of immunoglobulin. If the outcome of the first pregnancy is favorable, blood is taken from the fetal umbilical cord for analysis, after which, if the rhesus is positive, the woman in labor is also given an injection to prevent the development of sensitization in subsequent pregnancies.
5. Statistics on Rh factors and Rh conflicts. According to statistics, only 15% of people do not have protein on the surface of red blood cells, and are carriers of the so-called negative Rh factor. The remaining 85% have positive antigens, therefore, the risk of developing Rh conflict in a pregnant woman is quite high. The probability of developing a conflict during pregnancy in an Rh-negative mother from an Rh-positive father is 50%. Regarding the carrying of subsequent pregnancies, the statistics are as follows: with a spontaneous miscarriage in the first pregnancy, the risk of further development of the conflict increases in 3-4% of cases, with an abortion performed on an outpatient basis - in 5-6%, with an ectopic pregnancy - in 1%, with a normal outcome pregnancy and childbirth - in 10-15%. The risk of developing a conflict during subsequent pregnancy greatly increases after cesarean section and placental abruption.
6. Real risks for the fetus in Rh-conflict pregnancy. Sensitization can lead to complications for the fetus. First of all, this is anemia, swelling of internal organs and tissues, in particular the brain. In complex cases, erythroblastosis and hepatitis may develop. The child may develop a dangerous hemolytic disease. Particularly difficult cases include the development of dropsy and edema syndrome, which can lead to missed abortion or stillbirth. To avoid such consequences, the expectant mother needs to be constantly monitored by a doctor.
7. Treatment of hemolytic disease of the fetus in Rhesus conflict. To identify the development of sensitization, the mother is prescribed ultrasound, Doppler ultrasound and cardiotocography. To treat hemolytic disease of the fetus, which can be dangerous in the form of intoxication, intrauterine blood transfusion, immunoglobulin injections, blood purification and plasma immunosorption are used.
8. Symptoms of Rh conflict. Rh sensitization on the part of the maternal organism is usually not expressed. Detection of the conflict occurs only through testing for the presence of antibodies. Symptoms and signs may be observed from the fetus and detected through ultrasound. These include hemolytic disease, anemia, hypoxia, reticulocytosis and erythroblastosis, hepatomegaly.

A pregnant woman just needs to know exactly what her Rh factor is in her blood. If positive, there are no concerns about the compatibility of her body with the body of the unborn baby. But if it is negative, you will have to undergo a number of additional examinations and tests and be constantly under the close supervision of doctors.

This is explained by the fact that in this case, a Rh conflict may well arise during pregnancy, which can threaten the life and health of the baby. Every woman who is going to become a mother and has a negative Rh factor in her blood must clearly understand what this phenomenon is, what it entails and what will be required of her in order to avoid undesirable consequences.

What is Rh conflict?

Most people have a positive Rh blood factor (about 85% of all whites). But there are also those (the remaining 15%) who live with the negative. With positive Rhesus, red blood cells (blood cells) are covered with a protein film, and with negative Rhesus, they do not have this coating. This phenomenon does not affect human health in any way in its normal state, but not in the case of pregnancy.

If a pregnant woman has a negative Rh factor, and her unborn baby has a positive one, biological incompatibility of their organisms arises. During the first pregnancy, no complications usually occur, because the mother’s body still reacts very weakly to a new condition for it - pregnancy, and her blood is unfamiliar with the child’s blood. It simply does not have time to produce antibodies in response to the appearance of blood of a completely different composition.

But in all subsequent pregnancies, the mother’s body’s immune response to the child’s blood will be stronger, more active and more powerful each time, thereby posing a serious threat to the baby. The pregnant woman's body begins to produce antibodies to the fetal blood. They have the ability to penetrate first into the placenta, and then into the baby’s blood. There they begin to destroy hostile and dissimilar protein-coated red blood cells, which are the main transporters of oxygen.

As a result, the fetus begins to develop oxygen deficiency which doctors call hemolytic disease. The amount of dangerous bilirubin (bile pigment) in the baby’s blood increases. The consequences of such introduction of maternal antibodies into the blood of the fetus can be the saddest:

• in the early stages - miscarriage;
• at later times - premature birth, stillborn child;
• already after birth, the newborn is diagnosed with jaundice, disturbances in brain activity (damage to the organs of hearing and speech), heart pathologies, anemia, enlargement of the liver, spleen, lymph nodes, swelling, large body weight up to dropsy - all this can subsequently manifest itself in physical and mental insufficiency.

Biological incompatibility of Rh factors in the blood of mother and child gives rise to Rh conflict during pregnancy, which is so dangerous for the baby during secondary pregnancy. To protect your baby from such terrible consequences, future mom must understand the seriousness of the situation and constantly be under the closest supervision of a doctor. The success of such observation will largely depend on identifying the causes of Rh conflict.

Why in some cases does Rhesus conflict not occur, and in some cases the entire pregnancy is in jeopardy due to this phenomenon?

The main reason for the development of Rh conflict during pregnancy is the mixing of biologically incompatible blood of mother and child. It is in this case that the mother’s body begins to intensively produce antibodies that kill hostile red blood cells.

The body has a so-called immune memory, and when, during a subsequent pregnancy, a new life with a different Rh blood factor begins to develop in the womb, the maternal body reacts instantly by producing these antibodies. Mixing of blood can occur in the following cases:

• ectopic pregnancy, miscarriage, abortion, or blood transfusion;
• when a pregnant woman is prescribed invasive prenatal tests (collecting fetal cells through the abdominal wall, vagina or cervix);
• during the birth itself.

However, the risk of developing a Rh conflict even during the first pregnancy can be triggered by a woman’s diseases: gestosis, influenza, diabetes and even simple acute respiratory infections.

If these factors are avoided, absolutely all subsequent pregnancies can proceed normally, even if the child’s mother has different Rh factors. However, it is worth taking into account the individual characteristics of the mother’s body, which can begin to produce antibodies even without mixing blood. There is no need to worry if both the father and mother have a negative Rh blood factor: in this case, a conflict is excluded.

Symptoms of Rh conflict during pregnancy

If there is a danger of developing a Rh conflict during pregnancy, you need to warn your doctor in advance about the characteristics of your blood, tell him about all your previous diseases and very carefully monitor what is happening in the body. The symptoms of this phenomenon are difficult because the woman herself will not feel it. It can only be detected through tests or after birth based on the condition of the newborn. The presence of Rh conflict is indicated by:

• blood tests who detected antibodies to a positive Rh factor in the mother’s blood;
• Ultrasound, identifying hemolytic disease of the fetus by its anemia and impaired functioning of some internal organs;
• child, born in conditions of Rh conflict, is usually icteric and edematous, lethargic, with poor appetite, convulsions, pronounced anemia, and decreased reflexes.

To identify the danger of Rh conflict during pregnancy at the most early stages, the doctor conducts a complete examination of the pregnant woman. The prognosis of Rh conflict is given by ultrasound: based on its results, the doctor assesses the size of the fetal abdomen and placenta, identifies the presence of ascites, polyhydramnios, dilation of the umbilical cord veins - all those factors that may indicate the onset of antibody production. In addition to ultrasound, a pregnant woman needs to tune in to a number of additional studies: ECG, FCG, cardiotocography, amniocentesis and cordocentesis. All these procedures are carried out with one goal - to assess the condition of the woman and the fetus and maintain the health of the baby even in the presence of Rh conflict during pregnancy.

If there is a risk of Rh conflict during pregnancy, a woman should know about the preventive measures that reduce the risk of its occurrence:

• avoid abortion if possible;
• be sure to save the first pregnancy;
• see a doctor regularly;
• in cases of miscarriage, blood transfusion, abortion, an injection of immunoglobulin is necessary.

The most important thing is to remain calm so as not to provoke a premature termination of pregnancy. Modern medicine can cope even with such a danger as Rhesus conflict. The doctor, for his part, will do everything to protect the child’s health from the destructive effects of antibodies in the mother’s blood. Treatment includes a variety of procedures:

• oxygen therapy;
• therapy with vitamins, metabolic agents, calcium and iron supplements, antihistamines;
• blood transfusion;
• plasmapheresis (plasma purification).

If damage to the fetus by antibodies does occur, a cesarean section is performed. A child with hemolytic disease is prescribed a blood transfusion and complex therapy, and breastfeeding is prohibited during the first two weeks. But this is only if the disease is confirmed. In the absence of symptoms of hemolytic disease, the mother can feed the baby, but only after administering the same immunoglobulin.

You cannot be negligent about your health while carrying a child if you are a carrier of negative Rh blood factor. This provokes the risk of Rh conflict during pregnancy between your blood and the blood of the child. In this case, you need to be under the constant supervision of doctors, follow all their instructions and think, first of all, about the health of your unborn baby.

When can Rh conflict occur?
When a man with an Rh-positive factor marries a woman with an Rh-negative factor, it is more often possible to conceive an Rh-positive fetus. In this case, there is a threat of Rh conflict. All other combinations of Rh-affiliation of spouses are safe in this regard. The cause of Rh conflict can also be the transfusion of Rh-positive blood to patients with a negative indicator.

In what cases is conflict most likely?
Usually, the first pregnancy of an Rh-negative woman with an Rh-positive fetus ends normally. With subsequent similar pregnancies, the risk of conflict increases.

With an Rh-incompatible pregnancy, much depends on how it ended. After a miscarriage, sensitization, i.e. the formation of antibodies in the blood, occurs in 3-4% of cases, after a medical abortion - in 5-6%, after an ectopic pregnancy - in approximately 1% of cases, and after a normal birth - in 10-15 %. The risk of sensitization increases after cesarean section or if there has been placental abruption. That is, it all depends on how many fetal red blood cells penetrate into the mother’s bloodstream.

What is hemolytic disease?
During pregnancy, the Rh factor with the red blood cells of the Rh-positive fetus enters the blood of the Rh-negative mother and causes the formation of antibodies to the Rh factor in her blood (harmless to her, but causing the destruction of the fetal red blood cells). The breakdown of red blood cells leads to damage to the liver, kidneys, brain of the fetus, and the development of hemolytic disease of the fetus and newborn. In most cases, the disease develops quickly after birth, which is facilitated by the entry of a large number of antibodies into the baby’s blood when the integrity of the placental vessels is disrupted.

What can be the risk of Rh conflict between mother and fetus?
At birth, a baby with hemolytic disease may be icteric, anemic, or suffer from damage to the brain and central nervous system, which can cause mental retardation, hearing loss, and cortical paralysis. With early manifestations of the disease, Rh conflict can cause premature birth or miscarriages, as well as stillbirth child.

What examinations do pregnant women undergo if they have a possible Rh conflict?
At the antenatal clinic, a pregnant woman must be checked for the Rh factor. If there is a risk of Rh conflict, a woman’s blood is tested repeatedly during pregnancy for the presence of Rh antibodies. This is especially important if you have had a history of abortions, miscarriages, or blood transfusions. If no antibodies are detected, it means that the woman is not sensitized and there will be no Rh conflict during this pregnancy.

What to do if Rh conflict develops?
If a woman has Rh antibodies in her blood and their titer increases, this indicates the beginning of a Rh conflict. In this case, treatment is necessary in a specialized perinatal center, where both the woman and the child will be under constant supervision. If it is possible to bring the pregnancy to 38 weeks, a planned caesarean section is performed. If not, they resort to intrauterine blood transfusion: they penetrate the umbilical cord vein through the anterior abdominal wall of the mother and transfuse 20-50 ml of red blood cells into the fetus. The procedure is carried out under ultrasound control. This operation improves the condition of the fetus and allows you to prolong pregnancy.