Rhesus conflict
Rhesus conflict is the incompatibility of the mother with the fetus, which is based on the protective reaction of the female body: the positive rhesus of the child’s blood cannot exist with the negative rhesus of the mother. This is a very serious phenomenon, since rhesus conflict leads to fetal fading, artificial termination of pregnancy and the birth of a stillborn child.
The content of the article:
What is Rh conflict during pregnancy?
Causes of Rh conflict
Symptoms of Rh-conflict during pregnancy
Symptoms of complicated Rh conflict during pregnancy
Diagnosis of rhesus conflict
Treatment of Rh-conflict during pregnancy
Prevention of Rh conflict during pregnancy
Rhesus conflict
The Rh factor of human blood is determined by the presence of D-agglutinogen in the Rh system. This special type of lipoprotein is located in the upper part of red blood cells. This element is present in the blood of 85% of the inhabitants of the planet, but 15% do not have such a lipoprotein, therefore they are a Rh-negative group. Specialists have developed a system for classifying the Rh factor depending on the blood type and its rhesus, the positive Rh factor is designated Rh (+), and the negative Rh (-).
Rh-conflict during pregnancy occurs exclusively in women with a negative Rh factor. A child can inherit a positive rhesus of his father’s blood, hence all subsequent problems. The mother’s body perceives the child as a virus and directs all its forces to fight it. Rh conflict of the mother and fetus is not observed when the patient has Rh (+), and the child and his father have Rh (—). The indicators of the maternal Rh factor of blood play a decisive role.
Rhesus conflict during the first pregnancy does not pose a great threat to the baby’s life, because maternal immunity does not produce enough atiresus bodies yet, but problems may arise in the later stages of pregnancy. With each subsequent conception of a child, the immune system will increase the number of antibodies against the Rh factor of the fetus. It is these antibodies that penetrate into the blood of the child and provoke such a phenomenon as Rh-conflict.
Today’s advances in immunology significantly reduce the risks associated with the incompatibility of a woman and her baby.
What is Rh conflict during pregnancy?
The process of adhesion of Rh-positive and Rh-negative erythrocytes is called agglutination. It is with this phenomenon that antibodies – immunoglobulins — connected with Rh-protein are fighting. These antibodies have only two types: IgM and IgG.
The contact of maternal antibodies with the red blood cells of the child is observed in the cavity between the placenta and the uterine wall. Initially, during a hematological collision, IgM-type antibodies are produced, which are large enough that they do not allow them to penetrate to the fetus through the placenta. Therefore, rhesus conflict during the first pregnancy is quite rare. But with the repeated ingestion of positive baby molecules into the woman’s blood, the active production of antibodies of the second type — IgG begins. Their size is much smaller, therefore they can easily seep through the placenta and destroy the baby’s red blood cells. The presence of such processes in the body causes the development of hemolytic disease of the newborn. Therefore, rhesus conflict during the second pregnancy poses a serious threat to the life of the child.
If the first pregnancy proceeded without complications, and immunoglobulin was injected into the body in time, then there should also be no problems with the second pregnancy. Do not be afraid ahead of time and worry about the negative Rh factor, since it is not a contraindication for conceiving a child. It’s just that Rh-conflict pregnancy should proceed under the supervision of specialists, and the expectant mother should be extremely careful in everything.
Causes of Rh conflict
The following factors can provoke this phenomenon:
The blood with a positive rhesus factor of the child enters the maternal blood of a negative rhesus at the time of birth of the child, which activates the further production of antibodies in the female body. Once formed, antibodies remain in the body for life.
The blood of the patient and fetus incompatible with Rh factors can connect with the pathological course of pregnancy: the development of a fertilized egg outside the uterus, surgery, spontaneous termination of pregnancy, bleeding, blood transfusion with positive Rh. All of the above factors are a possible cause of serious malting during the subsequent bearing of a child.
The production of antibodies in the female body is influenced by early prenatal tests: amniocentesis, chorionic biopsy. To obtain the test material, intrauterine intervention is necessary, which creates the likelihood of Rh-positive fetal blood entering the mother’s blood.
Experts also identify a group of risk factors unrelated to pregnancy and childbirth, which significantly increases the chance of Rh-conflict between mother and child:
production of antibodies during blood transfusion of positive Rh factor;
immunization with intravenous administration of narcotic substances with one needle at all.
Symptoms of Rh-conflict during pregnancy
Rh-conflict of mother and child has no clearly expressed symptoms. It is possible to detect the presence of hemolytic disease when undergoing ultrasound. During the examination, the doctor will be able to identify the accumulation of fluid in the abdominal cavity, which provokes an uncharacteristic increase in the tummy. There may also be an abnormal increase in vital organs: liver, spleen, heart. The manifestation of certain symptoms indicates the development of a certain form of hemolytic disease of the child. Experts distinguish three types of the disease: edematous, jaundice, anemic.
The development of this disease has serious consequences and can cause the death of a child in the womb from the 20th week of pregnancy.
Symptoms of complicated Rh conflict during pregnancy
The degree of complexity of hemolytic disease depends on the number of produced antiresus bodies with Rh (-) in the mother’s blood and on the level of fetal development. A serious complication is the formation of fetal dropsy, the development of edematous syndrome of the baby and a pathological increase in fetal weight, which leads to its death.
Diagnosis of rhesus conflict
Diagnosis consists in examining the female body and identifying risk factors for the possible development of hemolytic disease. Becoming registered, every pregnant woman and the father of the unborn child must pass a blood test that determines her group and Rh factor. If a woman has been found to have a negative Rh factor, and the father has a positive one, it is necessary to donate blood once a month to study antibodies and control their development.
At the initial detection of antibodies, it is necessary to determine their class of manifestation. After 20 weeks of pregnancy, the patient must be examined by a specialist, who will determine the method and term of the upcoming birth.
After the 18th week of pregnancy, the fetal condition is examined using ultrasound. It is possible to assess the condition of the child and the level of his development using the following methods:
Non-invasive:
ultrasound examination is performed for the presence of pathologies in the fetus, the size of its organs, the diameter of the umbilical vein, the thickness of the placenta are studied. In the normal course of pregnancy, ultrasound is performed 3 times: at 18-20 weeks, 30-32 weeks and just before childbirth 34-36 weeks. If the child’s condition does not correspond to the norm or a blood transfusion was carried out to the baby, then an ultrasound examination can be carried out every day;
dopplerometry; a method that evaluates the functionality of the heart muscle, indicators of blood supply to large vessels and the umbilical cord;
cardiotocography; aimed at examining the cardiovascular system, which also helps to determine the lack of oxygen in the fetus in time.
Invasive:
amniocentesis: intervention in the fetal bladder in order to obtain amniotic fluid material with its further study in the laboratory. To assess the general condition of the child, the presence of bilirubin present is studied. The method is very accurate, but, unfortunately, it carries a great danger: an infection can get into the fetal bladder, intervention can lead to premature birth, bleeding. Amniocentesis is prescribed to women whose previous births were accompanied by hemolytic disease of the baby.
cordocentesis: blood sampling, involving a puncture of the umbilical cord. This method is used in cases when it is necessary to make a blood transfusion to a child and find out the severity of hemolysis as accurately as possible. Complications after the procedure are the same as with amniocentesis, however, a hematoma may develop on the umbilical cord, and bleeding may occur at the site of the umbilical cord puncture. Cordocentesis is prescribed to women who had Rh-conflict during previous pregnancies. If symptoms of hemolytic disease were detected during ultrasound examination, and the number of antibodies produced exceeds the norm, then cordocentesis should also be performed.
Complications after the use of invasive methods for diagnosing Rh-conflict between mother and fetus can be very serious, so it is necessary to do everything possible to avoid intrauterine intervention. A woman must be consulted and explain the risk to which the fetus lends itself. The doctor cannot be responsible for the behavior of the female body and the successful conduct of the procedure, so often the patient gives her agreement in writing for the further application of the procedures.
Treatment of Rh-conflict during pregnancy
Modern therapeutic techniques make it possible to effectively and quickly eliminate the threat to life for the fetus, saving his life and maintaining normal pregnancy rates. The most effective method remains fetal blood transfusion, which is prescribed when a child develops anemia. The intervention takes place exclusively during inpatient treatment, and after the procedure, the woman remains on preservation for a long time, under the careful supervision of obstetricians. Blood transfusion improves the condition of the fetus and prevents premature birth, and the risks of developing hemolytic disease in a newborn are also significantly reduced.
Women whose antibodies were detected in the early stages or whose previous pregnancy was accompanied by Rh-conflict between mother and fetus belong to the group with an increased risk of complications. Up to 20 weeks, patients should regularly visit the women’s office, and after that they are sent for inpatient treatment.
Also, treatment can be based on the purification of maternal blood. For this, procedures such as plasmapheresis or hemosorption are used. It is possible to weaken the patient’s immunity with the help of desensitizing therapy and immunoglobulin treatment. However, statistics indicate the inefficiency of these methods, so they were actually completely abandoned.
It is possible to achieve normalization of the child’s condition only by stopping the access of antibodies of the maternal immune system, therefore, as soon as medical indicators allow the child to survive outside the mother’s womb, delivery is carried out. Rhesus-conflict pregnancy usually ends with premature birth, since in the last stages, antiresus bodies coming to the child are produced in greater quantities. The methods and timing of delivery depend on the individuality of the female body and the severity of the fetal condition. Cesarean section is considered the most gentle method, therefore it is the most common way of giving birth to a baby. If the patient has reached 36 weeks of pregnancy, then obstetricians can cause childbirth, which will take place naturally, but a little earlier than planned.
Prevention of Rh conflict during pregnancy
To prevent the development of hemolytic disease, the expectant mother is injected with antiresus immunoglobulin D. This is a very effective drug that has passed a number of studies and is produced at enterprises in the USA, France and the Russian Federation. The drug is administered at the twenty-eighth week of pregnancy, because it is at this time that there is an increase in the risk of rhesus conflict between mother and fetus. Repeated use of the drug should be carried out for three days after delivery.
The injection can be prescribed regardless of the initial result: childbirth, artificial termination of pregnancy, abortion, ectopic pregnancy, etc. If the patient has lost a large amount of blood during any of the operations, the dose of immunoglobulin should be increased.
When registering, a woman passes tests to determine the Rh factor of blood, if the results show that it is negative, then it is necessary to establish the Rh and the father of the child. If a man turns out to have a positive Rh factor, then the fetus can inherit his Rh, which can provoke a Rh conflict with the mother. In this case, the pregnant woman is regularly examined and the number of developed antiresus bodies is checked. If the antibodies are not detected, then the child is not in danger. Immediately after birth, the baby’s blood is taken for analysis and determination of the blood group and Rh factor. If the result indicates that the baby has blood with a positive Rh factor, then mothers are also injected with immunoglobulin D to prevent the possibility of Rh conflict during future pregnancies.
Most of the specialists are inclined to believe that it is also worth introducing immunoglobulin after a blood transfusion of a positive Rh factor or platelet mass, exfoliation of the placenta, injury to the expectant mother, chorion biopsy.
