A negative Rh factor and Rh conflict during pregnancy are not a death sentence. Rh conflict during pregnancy - symptoms, consequences, treatment and prevention Does the presence of antibodies always indicate that the child will be born sick?
What does the concept of Rh conflict mean? It is a special protein located on the surface of red blood cells. All people except 15% of the planet's inhabitants have it. Therefore, most of them are called Rh positive, the rest are called Rh negative.
The Rh factor is an immunological quality of blood that has absolutely no effect on health. Only Rh-positive blood is considered stronger.
Conflict of blood between mother and child during pregnancy
Having come into contact with each other, positive and negative red blood cells stick together. This process has virtually no effect on Rh-positive blood. Pregnant women with negative Rhesus will also have a normal pregnancy. Especially if the father has the same Rh.Rh conflict during pregnancy occurs when the father is found to be Rh positive, then most likely the child will also have Rp+. In this case, Rh conflict is possible.
It is possible to establish Rp in a baby in a safe way only approximately, based on the parents’ coefficients.
Rhesus conflict occurs infrequently - only in 0.8% of cases. However, this can have serious consequences. Why? A positive Rp baby for a mother with negative blood is a serious danger. In order to cope with it, the female body begins to produce antibodies that react with the child’s red blood cells and destroy them. This action is called hemolysis. In the space between the placenta and the uterus, the blood of mother and child meets. And then an exchange occurs: oxygen and vital components enter the blood of the fetus, and the products of its vital activity enter the mother’s body. At the same time, some of the red blood cells change places, as a result of which positive fetal cells enter the mother’s blood, her red blood cells, and therefore antibodies, enter the child’s blood.
During the second pregnancy, the occurrence of an Rh conflict is much more likely, because the woman’s body, having second contact with Rh-negative blood cells, begins to produce other antibodies - IgG. They freely enter the child's body through the placenta. As a result, hemolysis continues there, and the breakdown product of hemoglobin, the toxin bilirubin, accumulates in the body.
Table of Rh conflict by blood group during pregnancy and inheritance by child
| Father | Mother | Child | Probability of conflict |
|---|---|---|---|
| 0 (1) | 0 (1) | 0 (1) | No |
| 0 (1) | A (2) | 0 (1) or A (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% chance of conflict |
| A (2) | A (2) | 0 (1) or A (2) | No |
| A (2) | AT 3) | 25% chance of conflict | |
| A (2) | AB (4) | 0 (1) or A (2) or AB (4) | No |
| AT 3) | 0 (1) | 0 (1) or B (3) | 50% chance of conflict |
| AT 3) | A (2) | any 0 (1) or A (2) or B (3) or AB (4) | 50% chance of conflict |
| 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) | 100% chance of conflict |
| AB (4) | A (2) | 0 (1) or A (2) or AB (4) | 66% chance of conflict |
| AB (4) | AT 3) | 0 (1) or B (3) or AB (4) | 66% chance of conflict |
| AB (4) | AB (4) | A (2) or B (3) or AB (4) | No |
Why is Rh conflict dangerous?
Fluid accumulates in the child’s organs and cavities, which disrupts the development of almost all body systems. Even after the baby is born, antibodies from the mother’s blood still act in his body for some time, which means hemolysis continues, resulting in the so-called hemolytic disease of the newborn. Sometimes a miscarriage occurs due to Rh conflict. This phenomenon is often the cause of miscarriage.Symptoms
There are no clear signs. At least from my mother. They can be seen in the fetus. On an ultrasound, you can see abnormalities in the fetus - accumulated fluid in the cavities, swelling; unnatural fetal position; the stomach is enlarged, the legs are spread apart; double head contour; changed placenta size and umbilical vein diameter.There are three forms of the disease: icteric, edematous, anemic.
Edema is the most severe and dangerous for the baby. After giving birth, they often end up in intensive care. In case of icteric form, the amount of bilirubin in the amniotic fluid is determined. The anemic form is the mildest.
How to determine the presence of Rh conflict
Antibody testing is one of the methods for determining the presence of Rh conflict. To determine the risk group, it is given to all pregnant women and fathers too. The earlier it is detected, the more complications such a pregnancy promises, because the Rh conflict accumulates. Fetal damage: how to determine its degree?
First of all, from the 18th week of pregnancy it is an ultrasound. Doctors pay attention to the child’s posture, the condition of the tissues, placenta, etc.Using the Doppler procedure, cardiac activity is assessed and the speed at which blood flow moves in the blood vessels of the placenta and baby is determined.
CTG is used to determine the degree of reactivity of the cardiovascular system and the presence of hypoxia.
There are two invasive ways to assess fetal position. Amniocynthosis - when the amniotic sac is punctured and amniotic fluid is taken for analysis. This makes it possible to determine the level of bilirubin, and at the same time to very accurately assess the condition of the fetus.
Cordocentosis - when the umbilical cord is pierced and blood is taken for analysis. This method is even more accurate. It is used to give a blood transfusion to the fetus.
Like amniocentesis, this method is quite unsafe. It also leads to complications and poses a risk of developing a hematoma on the umbilical cord.
How to treat Rh conflict during pregnancy
Blood transfusion to a child is the only effective method of treating Rh conflict during pregnancy. This is a rather dangerous operation, but it significantly improves the condition of the fetus.The vast majority of young expectant mothers have little idea of what is meant by the concept of “Rh factor” and why this parameter is so important.
Rhesus is a protein found on the surface of red blood cells. It is present in approximately 85% of the planet's inhabitants.
How does Rh conflict arise?
The main reason for the development of Rh conflict is the discrepancy between these characteristics of the blood of the mother and the unborn child, i.e. if the baby's blood is positive and his mother's is negative. In this case, there is no Rh conflict between blood groups.
The mechanism for the development of this phenomenon is as follows. At the moment when fetal red blood cells with rhesus proteins enter the blood of the expectant mother through the vessels of the placenta, they are perceived as foreign. As a result, the pregnant woman’s immune system is activated, which is accompanied by the production of antibodies that are designed to destroy fetal blood cells that do not correspond to the mother’s cells.
Due to the fact that the baby's red blood cells are periodically destroyed, his spleen and liver, as a result of increased blood cell production, increase in size.
As a result, the baby’s body cannot cope, and severe pain sets in, which can lead to death.
In what cases is Rh conflict possible?
In order to avoid such a situation, a girl should know the Rh factor of her lover even before marriage. A violation occurs in cases where the wife has no rhesus protein, but the husband has it. In such a situation, in 75% of cases there is a discrepancy.
Therefore, in order to prevent the development of Rh conflict, a table was compiled on the likelihood of disorders occurring during pregnancy.
What are the signs of this disorder?
There are no clinical signs of the development of Rh conflict during pregnancy, i.e. A pregnant woman is unable to independently determine the disorder. This is done using ultrasound.
So, symptoms of this disorder may include:
- the development of swelling, which is accompanied by the accumulation of fluid in the body cavities;
- increase in fetal body size;
- “Buddha” pose (the baby’s legs are moved to the side, due to the strong increase in the abdomen);
- enlargement of the spleen and liver of the fetus;
- swelling and thickening of the placenta.
Is pregnancy possible for
Do not despair if a girl has Rh-negative blood, and her chosen one has positive blood. As a rule, the first pregnancy proceeds normally. This is explained by the fact that the woman’s body encounters Rh-positive blood for the first time, and few antibodies are produced. In cases where there were a lot of blood cells with rhesus protein entering the mother’s body, so-called memory cells remain in her blood, leading to conflict during the second pregnancy.
How is rhesus conflict prevented?
During pregnancy, special attention is paid to the prevention of Rh conflict.
So, first of all, they check whether this protein is present in the mother’s blood. If it is not there, then the father undergoes a similar procedure. If it contains Rhesus, then the blood of the expectant mother is carefully examined for the presence of antibodies in it. At the same time, constant monitoring of the level of these formations in the blood of the pregnant woman is carried out. So, up to 32 weeks, the analysis is carried out once a month, and in the period 32-35 weeks - 2 times every 30 days.
After the baby is born, his blood is taken and Rh is determined. If it is positive, then within 3 days the mother is injected with serum - immunoglobulin, which prevents the occurrence of conflict during the next pregnancy.
What are the consequences of Rh conflict?
A Rh conflict detected in time, as a rule, does not have negative consequences. However, this does not always happen. If a miscarriage occurs, then sensitization (production of antibodies) occurs in only 3-4% of cases, during a medical abortion - 5-6%, after a normal birth - 15%. At the same time, the risk of sensitization increases with placental abruption and cesarean section.
The time of bearing a child is one of the most beautiful times in a woman’s life. Every expectant mother wants to be calm about the baby’s health and enjoy the period of waiting for a new addition. But every tenth woman, 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 Rh conflict between mother and baby, and what the danger lies, we will tell you in this article.
What it is?
When a woman and her future toddler have different blood counts, immunological incompatibility may begin; this is what is called Rh conflict. Representatives of humanity who have a Rh factor with a + sign have a specific protein D, which is contained in red blood cells. A person with Rhesus does not have a negative value for this protein.
Scientists still don't know for sure why some people have the specific Rhesus monkey protein and others don't. But the fact remains that about 15% of the world’s population have nothing in common with macaques; their Rh factor is negative.
There is a constant exchange between the pregnant woman and the child through the uteroplacental blood flow. If the mother has a negative Rh factor, and the baby is positive, then protein D entering her body is nothing more than a foreign protein for the woman.
The mother's immune system very quickly begins to react to the uninvited guest, and when protein concentration reaches high values, Rh conflict begins. This is a merciless war that the pregnant woman’s immune defense declares on the child as the 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, including the death of the baby in the mother’s womb, the death of the baby after birth, or the birth of a disabled child.
A Rh 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 occurs based on such an indicator as blood group, if a man and a woman 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 for families with the same negative Rhesus, but this coincidence does not happen often, because among the 15% of people with “negative” blood, the vast majority are representatives of the fair sex, men with such blood characteristics are only 3%.
Toddlers' own hematopoiesis begins in the womb at approximately 8 weeks of gestation. And from this moment on, in maternal blood tests, a small number of fetal red blood cells is determined in the laboratory. It is from this period that the possibility of Rh conflict arises.
Probability tables
From a genetic point of view, the probability of inheriting the main characteristics of blood - type and Rh factor from father or mother is estimated at 50%.
There are tables that allow you to assess the risks of Rh conflict during pregnancy. And timely weighed risks give doctors time to try to minimize the consequences. Unfortunately, medicine cannot eliminate the conflict completely.
By Rh factor
By blood type
Dad's blood type | Mom's blood type | Child's blood type | Will there be a 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) | Probability of conflict - 50% |
A (second) | A (second) | A (second) or 0 (first) | |
A (second) | B (third) | Any (0, A, B, AB) | Probability of conflict - 25% |
A (second) | AB (fourth) | ||
B (third) | 0 (first) | 0 (first) or B (third) | Probability of conflict - 50% |
B (third) | A (second) | Any (0, A, B, AB) | Probability 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) | Probability of conflict - 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 a Rh conflict greatly depends on how and how the woman’s first pregnancy ended.
Even a “negative” mother can quite safely give birth to a positive baby, since during the first pregnancy the woman’s immune system does not yet have time to develop a killer amount of antibodies to protein D. The main thing is that before pregnancy she is not given a blood transfusion, without taking into account the Rh factor, as sometimes happens in an emergency situations to save lives.
If the first pregnancy ended in miscarriage or abortion, then the likelihood of a Rh conflict during the second pregnancy increases significantly, since the woman’s blood already contains antibodies ready to attack at a very early stage.
In women who underwent a caesarean section during the first birth, the likelihood 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, and there was bleeding, then the likelihood of sensitization and conflict in a subsequent pregnancy also increases.
Diseases during pregnancy also pose a danger to an expectant mother with a negative Rh factor. Influenza, ARVI, gestosis, diabetes in the anamnesis can provoke a structural disorder chorionic villi, and the mother’s immunity will begin to produce antibodies that are harmful to the baby.
After childbirth, the antibodies that were developed during pregnancy do not disappear. They represent long-term immune memory. After the second pregnancy and childbirth, the number of antibodies becomes even greater, as well as after the third and subsequent ones.
Danger
The antibodies that maternal immunity produces are very small in size; they can easily penetrate the placenta into the baby’s bloodstream. Once in the baby’s blood, the mother’s protective cells begin to inhibit the fetal hematopoietic function.
The child suffers and experiences oxygen deficiency, since decaying red blood cells are the carriers of this vital gas.
In addition to hypoxia, hemolytic disease of the fetus may develop, and subsequently the newborn. It is accompanied by severe anemia. The fetus' internal organs enlarge - 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 take measures in time, the baby may die in utero, be born still, or be born with severe damage to the liver, central nervous system, and kidneys. Sometimes these lesions turn out to be incompatible with life, sometimes they lead to profound lifelong disability.
Diagnosis and symptoms
The woman herself cannot feel the symptoms of a developing conflict between her immunity and the blood of the fetus. There are no symptoms by which the expectant mother could guess the destructive process that is taking 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 the blood group and Rh factor of the father, takes a blood test from a vein to determine 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.
The antibody titer obtained as a result of laboratory testing indicates how severe the conflict is. The doctor also takes into account the degree of maturity of the fetus, because the older the baby is in the womb, the easier it is for him to resist an immune attack.
Thus, titer 1:4 or 1:8 at 12 weeks of pregnancy is a very alarming indicator, and a similar antibody titer at 32 weeks will not cause panic in the doctor.
When a titer is detected, the analysis is done more often to monitor its dynamics. In a severe conflict, the titer increases rapidly - 1:8 can turn into 1:16 or 1:32 in just a week or two.
A woman with antibody titers in her blood will have to visit the ultrasound diagnostic room more often. Using an ultrasound, it will be possible to monitor the development of the child; this research method provides fairly detailed information about whether the child has hemolytic disease, and even about what form it has.
In the edematous form of hemolytic disease of the fetus, an ultrasound will reveal an increase in the size of the internal organs and brain, the placenta thickens, and the amount of amniotic fluid also increases and exceeds normal values.
If the expected weight of the fetus is 2 times higher than normal, this is an alarming sign- hydrops of the fetus is not excluded, which can lead to death in the mother’s womb.
Hemolytic disease of the fetus 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.
Damages to the central nervous system will become known only after the birth of the child; this form of hemolytic disease of the fetus can lead to developmental delays in the baby and hearing loss.
Doctors at the antenatal clinic will be involved in diagnostics from the very first day a woman with a negative Rh factor is registered. They will take into account how many pregnancies there were, how they ended, and whether children with hemolytic disease have already been born. All this will enable the doctor to assume the possible likelihood of a conflict occurring and predict its severity.
During the first pregnancy, a woman will have to donate blood once every 2 months, during the second and subsequent ones - once a month. After the 32nd week of pregnancy, the analysis will be done once every 2 weeks, and from the 35th week - every week.
If an antibody titer appears, which can occur at any time after 8 weeks, additional research methods may be prescribed.
In case of 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 control.
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 what blood type and Rh factor is inherited by the baby, how severely his red blood cells are affected, what is the level of bilirubin in the blood, hemoglobin, and with 100% probability determine the gender of the child.
These invasive procedures are voluntary and the woman is not forced to undergo them. Despite the current level of development of medical technologies, 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 is managing her pregnancy will tell the woman about all the risks when performing procedures or refusing them.
Possible consequences and forms
Rhesus conflict is dangerous both during the period of bearing a baby and after its birth. 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 that attacked the baby’s blood cells 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.
Edema
The most severe form of HDN is the edematous form. With it, the little one is born very pale, as if “bloated”, swollen, with multiple internal edema. Such babies, unfortunately, in most cases are born dead or die, despite all the efforts of resuscitators and neonatologists, they die in the shortest possible time from several hours to several days.
Jaundice
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 in common with the common physiological jaundice of newborns.
The baby's liver and spleen are slightly enlarged, and blood tests show anemia. The level of bilirubin in the blood increases rapidly. If doctors fail to stop this process, the disease can develop into kernicterus.
Nuclear
The nuclear variety of HDN is characterized by lesions of the central nervous system. The newborn may experience convulsions and may 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
Doctors are always very careful when making predictions for TTH, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the baby in the future.
Children undergo detoxification infusions in intensive care conditions; very often there is a need for a replacement transfusion of blood or donor plasma. If on the 5th-7th day the child does not die from paralysis of the respiratory center, then the forecasts change to more positive ones, although they are rather conditional.
After suffering from hemolytic disease of newborns, children suck poorly and sluggishly, they have decreased appetite, disturbed sleep, and have neurological abnormalities.
Quite often (but not always) such children experience a significant lag in mental and intellectual development, they get sick more often, and hearing and vision impairments may occur. Cases of anemic hemolytic disease end most successfully; after the level of hemoglobin in the baby’s blood can be raised, it develops quite normally.
A conflict that has developed not because of a difference in Rh factors, but because of a difference in blood groups, proceeds more easily and usually does not have such destructive 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; difficulties can arise only during the next pregnancy.
Treatment
If a pregnant woman has a positive antibody titer in her 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 pregnancy, 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, drugs that improve metabolism, and oxygen therapy.
If titers are not detected before 36 weeks of gestation, 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 titres are high and the child’s condition is serious, then delivery can be carried out ahead of schedule by cesarean section. Doctors try to support a pregnant woman with medications until the 37th week of pregnancy, so that the baby has the opportunity to “mature.”
Unfortunately, this possibility is not always available. Sometimes you have to decide on an earlier caesarean section in order to save the baby’s life.
In some cases, when the baby is clearly not yet ready to come into this world, but remaining in the mother’s womb is very dangerous for him, an intrauterine blood transfusion is performed to the fetus. All these actions are performed under the control of an ultrasound scanner; every 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 suturing a pregnant woman with a piece of her husband’s skin. The skin flap is usually implanted on the lateral surface of the chest.
While the woman’s immune system is putting all its effort into rejecting the foreign skin fragment (which takes several weeks), the immunological load on the child is somewhat reduced. There is ongoing scientific debate about the effectiveness of this method, but reviews from women who have undergone such procedures are quite positive.
In the second half of pregnancy, if a conflict has been established, the expectant mother may be prescribed plasmapheresis sessions, this will slightly reduce the number and concentration of antibodies in the mother’s body, and accordingly, the negative load on the baby will also temporarily decrease.
Plasmapheresis should not frighten a pregnant woman; there are not many contraindications to it. Firstly, it is an acute respiratory viral infection or another infection in the acute stage, and, secondly, there is a threat of miscarriage or premature birth.
There will be about 20 sessions. Approximately 4 liters of plasma are purified in one procedure. Along with the infusion of donor plasma, protein preparations are administered, which are necessary for both mother and baby.
Babies who have suffered hemolytic disease are advised to undergo regular examinations by a neurologist, massage courses in the first months after birth to improve muscle tone, as well as courses of vitamin therapy.
Prevention
A pregnant woman is given a kind of vaccination at 28 and 32 weeks - anti-Rhesus immunoglobulin is administered. The same drug must be administered to a woman in labor after childbirth no later than 48-72 hours after the birth of the baby. This reduces the likelihood of developing conflict in subsequent pregnancies to 10-20%.
If a 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 any cost.
Blood transfusion without taking into account the Rh affiliation of the donor and recipient is not permissible, especially if the recipient has his own Rh with a “-” sign. If such a transfusion occurs, the woman should be given anti-Rhesus immunoglobulin as soon as possible.
A complete guarantee that there will be no conflict can only be given by a Rh-negative man, preferably with the same blood type as his chosen one. But if this is not possible, you should not postpone pregnancy or refuse it just because a man and a woman have different blood. In such families, planning a future pregnancy plays an important role.
A woman who wants to become a mother needs to undergo blood tests to detect antibodies to protein D before the onset of an “interesting situation”. If antibodies are detected, this does not mean that the pregnancy will have to be terminated or that pregnancy cannot be achieved. Modern medicine does not know how to eliminate conflict, but it knows very well how to minimize its consequences for the child.
The introduction of anti-Rhesus immunoglobulin is important for women who do not yet have antibodies in their blood that are not sensitized. They need to get such an injection after an abortion, after even minor bleeding during pregnancy, for example, with a slight placental abruption, after surgery for an ectopic pregnancy. If you already have antibodies, then you shouldn’t expect any special effect from vaccination.
Common Questions
Is it possible to breastfeed a child?
If a woman with a negative Rh factor gives birth to a child 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 feed on breast milk for 2 weeks after the administration of immunoglobulin to the mother. In the future, decisions about breastfeeding are made by neonatologists.
In severe hemotylic disease, breastfeeding is not recommended. To suppress lactation, a woman after childbirth is prescribed hormonal drugs that suppress milk production in order to prevent mastopathy.
Is it possible to carry a second child without conflict if there was 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 period of gestation, and in a fairly high concentration. They will not affect a baby with Rh (-) in any way, and there is no need to 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 a particular blood characteristic.
Dad's Rh factor is unknown
When the expectant mother is registered at the antenatal clinic, immediately after her negative Rh is detected, the father of the future baby is also invited to the consultation to take a blood test. This is the only way the doctor can 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 resulted from IVF with donor sperm, then a woman will have her blood tested 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 a conflict if it occurs.
And the doctor’s offer to invite my 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 their wife’s pregnancy.
Is there an impact on fertility?
There is no such connection. The presence of 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, a burdened medical history, including a large number of abortions in the past.
Are medical or vacuum abortion safe for terminating a first pregnancy in an Rh-negative woman?
This is a common misconception. Moreover, unfortunately, such a statement can often be heard even from medical workers. The method of performing 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 abortion or miscarriage, how great 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 one percent accuracy 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:
- miscarriage at a short term - +3% to a possible future conflict;
- artificial termination of pregnancy (abortion) – +7% to the probable future conflict;
- ectopic pregnancy and surgery to eliminate it – +1%;
- delivery at term with a live fetus – + 15-20%;
- delivery by cesarean section – + 35-50% to a possible conflict during the next pregnancy.
Thus, if a woman’s first pregnancy ended in abortion, the second in a miscarriage, then while carrying the third, the risk is estimated at approximately 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 cesarean section, then more than 60%.
Accordingly, any woman with a negative Rh factor who is planning to become a mother again can weigh the risks.
Does the presence of antibodies always mean that a child will be born sick?
No, this doesn't always happen. 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 is sick with an infectious disease (even a common ARVI), if she takes medications without supervision from the attending physician, then the likelihood of a decrease in the protective functions of the placenta 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 defense, but with a second pregnancy, the antibodies are smaller, more mobile, fast and “evil”, so the immunological attack becomes more probable.
Does conflict occur during pregnancy, contrary to all forecasts and tables, in two negative parents?
This cannot be ruled out, despite the fact that all existing genetic tables and teachings indicate that the probability tends to zero.
One of the three mother-father-child may turn out to 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 the 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 issues of genetics has not yet been studied well enough, and any “surprise” can be obtained from nature.
History knows several cases when a mother with Rh (-) and a father with a similar Rh gave birth to a child with positive blood and hemolytic disease. The situation requires careful study.
For more information about the likelihood of Rh conflict during pregnancy, see the following video.
Many people know about the importance of the Rh factor during blood transfusion. But not everyone correctly assesses its significance for the baby, if it is negative for a woman and positive for a man. But in these circumstances, the baby may face serious illness and even death before birth. Signs of Rh conflict during pregnancy in the early stages will let you know about the danger. They are easily identified by specialists if a woman registers on time. Then the chances of a healthy baby being born increase.
Read in this article
Briefly about Rhesus conflict
Part of the blood consists of red blood cells and plasma. When mixed, the former make it possible to replenish its volume in the body in case of need through transfusion. And during pregnancy, the woman’s blood serves as a source of nutrition for the embryo. Red blood cells contain substances that sometimes make a person’s biological fluid unacceptable to another due to lack of compatibility. These are agglutinins and the Rh factor. But not everyone has the latter. Blood containing these particles is Rh positive. Their absence makes it negative.
When the mother is a carrier of just such blood, and the father has Rh particles, the fetus can inherit the properties of his biological fluid. That is, incompatibility arises between the woman and the embryo. Her blood counters this discrepancy by producing anti-Rh agglutinins. Substances enter the placenta, blind red blood cells, making the existence of the fetus problematic. By these actions, the mother’s body protects itself from foreign particles of the embryo’s blood, pushing it to death.
Detection of signs of Rh conflict during pregnancy in the early stages makes it possible to neutralize it so that the danger to the existence and health of the future little person is minimized.
Signs of Rh incompatibility in an expectant mother
Both parents should know their own blood type and Rh status at the stage of pregnancy planning. Mothers with a negative indicator should treat this with special care. But even for women who have Rh particles in their blood, there is a possibility that after conception a similar conflict will arise.
If it is the first pregnancy, the woman’s blood produces a minimal amount of anti-Rhesus agglutinins. In this case, the risk to the fetus is low. Therefore, for women with Rh-negative blood, maintaining the first pregnancy is fundamentally important. This is the best way to give birth to a healthy child, since with each subsequent attempt, in case of blood incompatibility, the body produces more and more protective particles dangerous to the fetus.
The difficulty is also hidden in the fact that the Rhesus conflict during early pregnancy, the mother’s symptoms clinically almost do not indicate its presence. That is, she often does not feel anything special that would indicate this serious problem. A frequent but optional accompaniment of Rh conflict is. Then a woman can observe in herself:
- Increased heaviness and pain in the abdomen. They are also felt in the lower back;
- General weakness;
- Difficulty breathing due to a raised diaphragm;
- High blood pressure;
- in the absence of physical activity;
- Swelling of the legs;
- Characteristic gurgling sounds inside the abdomen;
- Stretch marks appearing on the skin;
- Abdominal size inappropriate for pregnancy.
But suspicious people can feel the same way, and self-confident people do not attach importance to these symptoms. In addition, polyhydramnios is caused by other reasons, not just the incompatibility of the blood elements of the mother and baby. Therefore, at an early stage of pregnancy, more reliable ones are needed.
How is the diagnosis carried out?
Rh conflict is determined by testing the mother's blood. It is required first when registering a pregnant woman. First, in fact, the blood type and Rh are established, that is, the possibility of the problem itself is studied. If the risk is determined, from the 8-10th week anti-Rhesus agglutinins can already be detected in the biological fluid.
A pregnant woman donates blood more than once to be tested for antibodies. A special protein is placed in the biological fluid, which is broken down in the presence of anti-Rhesus agglutinins in it. This reaction is clearly visible to a specialist; moreover, it is even possible to determine the amount of such substances. The blood is diluted with protein until it stops reacting. In this way, the volume of anti-Rhesus particles and the level of danger to the embryo are determined.
If a blood test of the expectant mother gives a positive result, it is repeated as the pregnancy progresses, and studied in other ways to monitor the situation and maintain it.
First signs in the fetus
Rhesus conflict can be reliably recognized by fetal indicators, which are determined using hardware tests. And the faster they are carried out, the more likely a successful outcome for the baby.
Symptoms of Rh conflict during pregnancy at an early stage are as follows:
- Incorrect position of the embryo in the uterus. The usual position for an unborn child is with the arms folded on the chest and the legs pulled up to the stomach. The embryo appears curled up into a ball. With Rh-conflict, his abdomen is enlarged due to swelling, and his limbs are spread apart. Doctors call the position the Buddha pose;
- Double outlines of the head on ultrasound. This is also caused by fluid retention in soft tissues;
- Increased size of the placenta and umbilical vein. They arise due to impaired blood flow caused by Rh conflict. The placenta has more blood vessels than normal and they become thicker;
- Enlargement of the liver and spleen. This is also due to impaired hematopoiesis and hypoxia.
Over time, the features of the signs of Rh conflict during pregnancy in the early stages become more distinct:
- Anemia. Antibodies produced by a woman’s blood reach the placenta, where they interact with the red blood cells of the embryo. The latter are destroyed, which makes it difficult to supply the tissues of the unborn baby with oxygen;
- Reticulocytosis. Instead of mature red blood cells, particles that lack a nucleus are formed in excessive quantities. This occurs due to an acute lack of oxygen;
- Erythroblastosis. The formation of another early form of red blood cells, also anucleate and unable to support the normal formation of the fetus;
- Increased bilirubin. Occurs due to a malfunction of the liver of the unborn baby.
Methods for identifying signs of blood incompatibility based on embryonic parameters
What symptoms of Rh conflict occur during early pregnancy are identified using:
- Ultrasound. The screen shows areas of swelling of the internal organs of the fetus, which in these circumstances are enlarged;
- Doppler. This method will detect increased blood viscosity. It occurs in the embryo due to the destruction of red blood cells, which makes the blood flow slow;
- Cardiotocography. The study is aimed at identifying deficiencies in the formation of the cardiovascular system, which, in case of Rh conflict, makes these organs enlarged due to edema.
Identified signs of Rh conflict during early pregnancy are a chance of having a healthy baby. Modern medicine is able to neutralize the factors that interfere with its prenatal development and in a later period. But for this purpose, detection and treatment methods are used, which themselves can cause placental abruption, the introduction of infections into the embryo’s body, leakage of amniotic fluid, premature birth and many other complications.
Knowledge about the Rh factor can easily be called one of the most valuable knowledge acquired by man in the entire history of medicine. It allows you to avoid a huge number of serious relationships during blood transfusion, as well as during pregnancy and childbirth, in particular in cases where the child and mother have a so-called Rh conflict. So, what is the Rh factor, and what does it mean for expectant mothers?
Rh conflict: essence and mechanism
The Rh factor is a specific protein that is found on the surface of red blood cells in approximately 85% of the world's population. That is, those who have such a protein are called people Rh positive, and those who lack it - Rh negative. The Rh factor does not affect the health of the mother and the course of pregnancy, however, if a “negative” woman is pregnant from a “positive” man, in this case there is a possibility of a so-called Rh conflict.
Its essence lies in the fact that the red blood cells of the mother and child, having different signs, meet each other, as a result of which a specific reaction begins in the woman’s body, reminiscent of an allergy. Antibodies produced by the immune system begin to destroy the child’s red blood cells, which leads to the most disastrous consequences.
It should be noted that such complications are especially likely due to so-called sensabilization: a condition when the baby’s blood enters the pregnant woman’s blood, causing her body to begin producing antibodies. This happens in cases where the mother has a history of abortions, miscarriages, ectopic pregnancies, uterine bleeding and other complications during pregnancy. In addition, sensabilization can occur if there is any damage to the placenta due to infections, gestosis, abruption, as well as certain medical procedures (amniocentesis).
If there have been no similar situations in the past, and the woman is pregnant for the first time, then serious problems usually do not arise: the doctor carefully monitors the patient’s condition, and childbirth most often goes well. However, during the second and subsequent pregnancies, the mother will require special treatment, which can eliminate the occurrence of serious complications. In addition, in order to protect the baby, every woman needs to know about the possible risk of Rh conflict in each specific case.
Possibility of Rh conflict depending on the Rhesus of the parents
To determine the possibility of Rh conflict, you should remember the laws of genetics, according to which certain blood groups, as well as Rhesus, are inherited from parents. In particular, in At risk are families where the expectant mother is Rh negative and the father is Rh positive. To determine this risk, you can use the following table.
Rh factor inheritance
Inheritance of blood groups
| Father | Mother | Fetus | Probability of conflict |
| Group I (0) | Group I (0) | Group I | 0 |
| Group I | Group II (A) | I/II group | 0 |
| Group I | III group (B) | Group I/III | 0 |
| Group I | IV group (AV) | II/III group | 0 |
| Group II (A) | Group I | I/II group | probability 50% |
| Group II | Group II | I/II group | 0 |
| Group II | III group | All 4 groups | probability 25% |
| Group II | IV group | I/II/IV group | 0 |
| III group (B) | Group I | Group I/III | probability 50% |
| III group | Group II | All 4 groups | probability 50% |
| III group | III group | Group I/III | 0 |
| III group | IV group | I/III/IV group | 0 |
| IV group (AV) | Group I | II/III group | probability 100% |
| IV group | Group II | I/II/IV group | probability 66% |
| IV group | III group | I/III/IV group | probability 66% |
| IV group | IV group | II/III/IV group | 0 |
It must be remembered that it is impossible to determine the probability of a conflict with complete confidence using such tables; This will require blood tests from the father and mother, as well as a consultation with a doctor.
Diagnosis and symptoms
The danger of a Rhesus conflict is that it usually does not give any clinical manifestations that may alert a pregnant woman. In some cases, she may feel symptoms similar to those of gestosis, but it can be very difficult to clearly identify a hemolytic disorder.
That is why all women at risk must be strictly monitored gynecologists throughout pregnancy, and regularly undergo an ultrasound procedure. Symptoms of Rh factor conflict in the fetus include the following:
- severe swelling;
- accumulation of fluid in the body cavities (abdominal, thoracic), as well as in the area of the pericardial sac;
- increase in abdominal size;
- the so-called “Buddha pose”: a large belly and limbs removed from it;
- enlargement of the spleen, liver and heart;
- “double contour” (soft tissue swelling) of the head;
- thickening of the veins of the umbilical cord and placenta.
To diagnose Rh conflict and prevent symptoms, it is very important to determine the group and Rh of both the expectant mother and the expectant father, regularly test for antibodies, and, if necessary, prescribe adequate treatment.
Possible consequences
In the event of a Rh conflict, the woman’s antibodies begin to attack the “foreign” red blood cells of the fetus, gradually destroying them, as a result of which bilirubin is released into the blood, which turns the skin yellow. In addition, the number of red blood cells in the baby's blood drops rapidly, leading to a deterioration in the ability to carry oxygen. Tissues and organs, including the brain, begin to experience severe oxygen starvation, which disrupts their development and leads to a variety of diseases.
In the most difficult cases, due to severe tissue damage, the fetus develops hydrops; Unfortunately, in such cases, saving the child’s life is often impossible.
As for the mother, it does not pose a direct danger to her condition, however, if the first pregnancy was interrupted or occurred with complications (for example, with uterine bleeding), then the second and subsequent ones require special attention. This is due to the so-called immune memory: the mother’s body produces specific antibodies to the child’s red blood cells, which means the risk of problems and complications increases significantly. That is why so-called “negative” women are especially not recommended to have abortions.
How to prevent complications from developing
To completely eliminate the risk of complications due to Rh conflict, it is necessary even before conception, that is, at the stage of pregnancy planning, or at least in the earliest stages undergo a rhesus test. If Rh is negative, it will be necessary to conduct another study on the type of antibodies and their concentration (titer) in the woman’s blood, which can answer the question of how dangerous their amount is for the child. This test must be taken before 18-20 weeks, and if the pregnant woman has had cases in the past Rh conflicts, then the determination of antibody concentration is carried out earlier.
- Considered normal titer less than 1:4. In this case, the woman only needs regular monitoring of the condition of the fetus, and a repeat analysis is performed at week 28 (if no abnormalities are found in the fetus).
- If the amount of antibodies remains at this time at 1:4 level and mless, the pregnant woman is given a dose of a special vaccine (anti-Rhesus immunoglobulin), which can prevent possible complications.
- At titer more than 1:4, antibody testing should be carried out approximately once every one to two weeks, carefully monitoring their dynamics.
In any case, if even a minimal amount of antibodies is detected, the woman requires regular examinations (ultrasound, Doppler ultrasound, etc.). If the fetal condition worsens, it is necessary to carry out a blood transfusion procedure in utero, which will compensate for the lack of red blood cells in the fetal blood. In situations where such a solution is impossible, the question of urgent delivery is raised, since any delay may threaten the death of the fetus.
Anti-Rhesus immunoglobulin: prevention of Rh conflict
A vaccine against Rhesus conflict is a drug that can prevent sensabilization, that is, the production of specific antibodies in a woman’s body. The mechanism of action of anti-Rhesus immunoglobulin is as follows: it destroys “positive” red blood cells, preventing the mother’s immune system from launching a protective reaction.
It is believed that about 20 mcg of the drug neutralizes 1 ml of red blood cells, therefore, to “neutralize” “foreign” red blood cells of the child that accidentally enter the mother’s blood, approximately 300 mcg of the vaccine is needed.
The first dose of the drug is usually given to a woman between 28 and 34 weeks (preferably at 28 weeks) if there are no antibodies in her blood and the fetal blood type is unknown. The second dose must be administered within 3 days after delivery (if the child is Rh positive).
Also, the administration of anti-Rhesus immunoglobulin is strongly recommended for all “negative” women after abortions, ectopic pregnancies or miscarriages: this can protect them from serious problems in the future.
It should be noted that in most cases, anti-Rhesus immunoglobulin is well tolerated by women, however, like any other medical drug, it can cause various allergic reactions, including anaphylactic shock. Therefore, after administering the vaccine, a pregnant woman should wait at least 30 minutes. be under the supervision of doctors.
Typically, anti-Rhesus immunoglobulin is available in domestic perinatal institutions, but it can only be purchased by prescription. The average cost is 5 thousand rubles. The vaccine is a colorless or light yellow solution (a small sediment is allowed) for intramuscular administration. Before administration, the ampoule must be kept for approximately two hours at room temperature, and after opening, the drug must be used immediately for its intended purpose. The shelf life of anti-Rhesus immunoglobulin is three years.
