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 concerns only 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 is simply a characteristic feature of each person.

What is this – Rhesus conflict?

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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 the unborn child inherits the Rh factor from him.

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 the mother’s vascular system, “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 mellitus, ARVI and influenza damage the villi, and, consequently, the chorionic vessels and the blood of the mother and the unborn baby mix.

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 an 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, has poor appetite, constantly regurgitates (see), has reduced reflexes, and 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, the woman’s early attendance at the antenatal clinic is of great importance, especially if this is the second, third, etc. pregnancy 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-Rhesus 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 the same purpose that specific immunoglobulin is administered after artificial and spontaneous termination of 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 the condition of his internal organs and brain (the 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.

Rh conflict is an immunological incompatibility between the blood of a pregnant woman and the unborn child. Such a pregnancy requires careful monitoring and additional examination. Why is Rh conflict so dangerous and what needs to be done to avoid complications?

Such a pregnancy, as a rule, occurs with various complications, to prevent which it is important to prevent the immune conflict in time with the help of How is this dangerous?

What are the complications of Rhesus conflict?

• threat of miscarriage;
• fetal hypoxia;
• gestosis;
• intoxication syndrome;
• premature birth;
• hemolytic disease;
• intrauterine fetal death.

What is hemolytic disease and why is it dangerous? One of the dangerous complications of incompatibility of the blood of mother and child according to the Rh factor or blood group is hemolytic disease of the fetus and newborn. Hemolytic disease occurs in 3-6% of cases among immunoconflict pregnancies. In this disease, the mother's blood mixes with the blood of the fetus. Antibodies that are formed in a woman’s body enter the fetal blood through the placenta and destroy red blood cells, which leads to intoxication of the child with hemoglobin breakdown products.

Hemolytic disease of newborns has three forms:

• icteric- increased bilirubin, which appears as a result of the destruction of red blood cells, can cause damage to brain cells, deafness, cerebral palsy and developmental delays in the child. This happens if bilirubin rises to critically high levels. This form of HDN manifests itself as yellowness of the skin and mucous membranes of the newborn. This is the most common form of hemolytic disease.

• anemic- indicates a low level of hemoglobin and hematocrit. It manifests itself as excessive pallor of the skin of the newborn. Occurs in 10-20% of cases.

• edematous- the most dangerous form of HDN, has the highest percentage of deaths. This form of HDN is indicated by anemia, dropsy (accumulation of fluid in the abdominal cavity), pleural effusions (accumulation of fluid in the pleural cavity).

Why is Rh conflict dangerous for a woman? Rh conflict poses virtually no danger to the female body, the only thing is that complications can arise in the event of intrauterine fetal death, this is fraught with inflammatory processes.

Treatment and prognosis. Treatment and course of the disease depend on the form and severity of HDN. In mild and moderate forms, after treatment, children grow and develop in the same way as their peers. With a bilirubin level of 257-342 μmol/l or more, 1/3 of children may have deviations in neuropsychic development. Anemia may persist for several months. Children with disorders of the central nervous system require careful medical supervision by a neurologist, ophthalmologist and pediatrician. Newborns with hemolytic disease are not vaccinated in the maternity hospital.

Prevention. To prevent Rh-conflict during pregnancy, it is mandatory to determine the blood type and Rh during registration.

When registering a woman with negative Rh, it is necessary to find out:

• whether there has been a previous blood transfusion;
• were there any abortions or miscarriages;
• Have any children been born with this disease?

A woman who is Rh negative, in case of miscarriage or abortion, must be given an injection of anti-Rhesus immunoglobulin within 72 hours.

In addition, pregnant women regularly undergo blood tests for Rh antibodies. If they increase rapidly, the woman requires treatment using anti-D-globulin (anti-Rhesus).

Also be sure to find out about

Immunological incompatibility of the Rh factor in the blood of a Rh-negative mother and a Rh-positive fetus, characterized by sensitization of the maternal body. The cause of Rh conflict is the transplacental penetration of fetal red blood cells carrying a positive Rh factor into the bloodstream of a Rh-negative mother. Rh conflict can cause intrauterine fetal death, miscarriage, stillbirth and hemolytic disease of the newborn.

General information

Rh conflict can occur in women with negative Rh during pregnancy or during childbirth if the child has inherited a positive Rh father. The Rh factor (Rh) of human blood is a special lipoprotein (D-agglutinogen) in the Rh system, located on the surface of red blood cells. It is present in the blood of 85% of the human population who are Rh-positive Rh (+), and 15% who do not have the Rh factor belong to the Rh-negative group Rh (-).

Causes of Rh conflict

Isoimmunization and Rh conflict are caused by the entry of Rh-incompatible blood of the child into the mother’s bloodstream and largely depend on the outcome of the first pregnancy in an Rh (–) woman. Rh conflict during the first pregnancy is possible if the woman has previously received a blood transfusion without taking into account Rh compatibility. The occurrence of Rh conflict is facilitated by previous terminations of pregnancy: artificial (abortions) and spontaneous (miscarriages).

The entry of the baby's umbilical cord blood into the mother's bloodstream often occurs during childbirth, making the mother's body susceptible to the Rh antigen and creating the risk of Rh conflict in the next pregnancy. The likelihood of isoimmunization increases with delivery by cesarean section. Bleeding during pregnancy or childbirth due to abruption or damage to the placenta, manual separation of the placenta can provoke the development of Rh conflict.

After invasive prenatal diagnostic procedures (chorionic villus biopsy, cordocentesis or amniocentesis), Rh sensitization of the maternal body is also possible. A pregnant woman with Rh (-), suffering from preeclampsia, diabetes, who has had influenza and acute respiratory infections, may experience a violation of the integrity of the chorionic villi and, as a result, activation of the synthesis of anti-Rhesus antibodies. The cause of Rh conflict may be long-standing intrauterine sensitization of a Rh(-) woman, which occurred at birth from an Rh(+) mother (2% of cases).

The mechanism of development of Rh conflict

The Rh factor is inherited as a dominant trait, therefore, in an Rh (-) mother with homozygosity (DD) Rh (+) father, the child is always Rh (+), which is why the risk of Rh conflict is high. In the case of heterozygosity (Dd) of the father, the chances of having a child with positive or negative Rh are the same.

The formation of fetal hematopoiesis begins from the 8th week of intrauterine development; at this period, fetal red blood cells can be found in small quantities in the mother’s bloodstream. In this case, the fetal Rh antigen is foreign to the mother’s Rh (–) immune system and causes sensitization (isoimmunization) of the maternal body with the production of anti-Rh antibodies and the risk of Rh conflict.

Sensitization of Rh (–) women during the first pregnancy occurs in isolated cases and the chances of pregnancy during Rh conflict are quite high, since the antibodies formed during this process (Ig M) have a low concentration, penetrate the placenta poorly and do not pose a serious danger to the fetus.

The likelihood of isoimmunization during delivery is greater, which can lead to Rh conflict in subsequent pregnancies. This is due to the formation of a population of long-lived immune memory cells, and in the next pregnancy, upon repeated contact with even a small volume of Rh antigen (no more than 0.1 ml), a large number of specific antibodies (Ig G) are released.

Due to their small size, IgG is able to penetrate into the fetal bloodstream through the hematoplacental barrier, causing intravascular hemolysis of Rh (+) erythrocytes of the child and inhibition of the hematopoietic process. As a result of Rh conflict, a severe, life-threatening condition for the unborn child develops - hemolytic disease of the fetus, characterized by anemia, hypoxia and acidosis. It is accompanied by damage and excessive enlargement of organs: liver, spleen, brain, heart and kidneys; toxic damage to the child’s central nervous system - “bilirubin encephalopathy.” Without timely preventive measures, Rh conflict can lead to intrauterine fetal death, spontaneous miscarriage, stillbirth, or the birth of a child with various forms of hemolytic disease.

Symptoms of Rh conflict

Rh conflict does not cause specific clinical manifestations in a pregnant woman, but is detected by the presence of antibodies to the Rh factor in her blood. Sometimes Rh conflict can be accompanied by functional disorders similar to gestosis.

Rh conflict is manifested by the development of hemolytic disease of the fetus, which, with early onset, can lead to intrauterine death from the 20th to 30th week of pregnancy, miscarriage, stillbirth, premature birth, as well as the birth of a full-term child with an anemic, icteric or edematous form of this disease. Common manifestations of Rh conflict in the fetus are: anemia, the appearance of immature red blood cells in the blood (reticulocytosis, erythroblastosis), hypoxic damage to important organs, hepato- and splenomegaly.

The severity of the manifestations of Rh conflict can be determined by the amount of anti-Rh antibodies in the mother’s blood and the degree of maturity of the child. An edematous form of hemolytic disease of the fetus can be extremely difficult in case of Rh conflict - with an increase in the size of the organs; severe anemia, hypoalbuminemia; the appearance of edema, ascites; thickening of the placenta and increased volume of amniotic fluid. With Rh conflict, hydrops fetalis, edematous syndrome of the newborn, and an increase in the child's weight by almost 2 times can develop, which can lead to death.

A small degree of pathology is observed in the anemic form of hemolytic disease; the icteric form is expressed by icteric discoloration of the skin, enlargement of the liver, spleen, heart and lymph nodes, and hyperbilirubinemia. Bilirubin intoxication during Rh conflict causes damage to the central nervous system and is manifested by the child's lethargy, poor appetite, frequent regurgitation, vomiting, decreased reflexes, convulsions, which can subsequently lead to a delay in his mental and mental development, and hearing loss.

Diagnosis of Rhesus conflict

Diagnosis of Rh conflict begins with determining the Rh affiliation of a woman and her husband (preferably before the onset of the first pregnancy or at its earliest stage). If the expectant mother and father are Rh negative, there is no need for further examination.

To predict Rh conflict in Rh (-) women, important are data on past blood transfusions without taking into account Rh-relatedness, previous pregnancies and their outcomes (presence of spontaneous miscarriage, medical abortion, intrauterine fetal death, birth of a child with hemolytic disease), which may indicate possible isoimmunization.

Diagnosis of Rh conflict includes determining the titer and class of anti-Rh antibodies in the blood, which is carried out during the first pregnancy for women who are not sensitized for Rh - every 2 months; sensitized - up to 32 weeks of gestation every month, from 32 -35 weeks - every 2 weeks, from 35 weeks - weekly. Since there is no direct relationship between the degree of damage to the fetus and the titer of anti-Rhesus antibodies, this analysis does not give an accurate picture of the condition of the fetus in case of Rh-conflict.

To monitor the condition of the fetus, an ultrasound examination is performed (4 times in the period from 20 to 36 weeks of pregnancy and immediately before birth), which allows one to observe the dynamics of its growth and development. In order to predict Rh conflict, ultrasound evaluates the size of the placenta, the size of the fetal abdomen (including the liver and spleen), and identifies the presence of polyhydramnios, ascites, and dilation of the umbilical cord veins.

Carrying out electrocardiography (ECG), fetal phonocardiography (FCG) and cardiotocography (CTG) allows the gynecologist caring for pregnancy to determine the degree of fetal hypoxia in case of Rh conflict. Important data are provided by prenatal diagnosis of Rh conflict using amniocentesis (study of amniotic fluid) or cordocentesis (study of umbilical cord blood) over time under ultrasound control. Amniocentesis is carried out from the 34th to the 36th week of pregnancy: the titer of anti-Rhesus antibodies, the sex of the unborn child, the optical density of bilirubin, and the degree of maturity of the fetal lungs are determined in the amniotic fluid.

Cordocentesis, which helps determine the fetal blood type and Rh factor from the umbilical cord blood of the fetus, can accurately determine the severity of anemia in case of Rh conflict; levels of hemoglobin, bilirubin, serum protein; hematocrit, reticulocyte count; antibodies fixed on fetal red blood cells; blood gases.

Treatment of Rhesus conflict

To alleviate the Rh conflict, all Rh (–) pregnant women at 10-12, 22-24 and 32-34 weeks of gestation are given courses of nonspecific desensitizing therapy, including vitamins, metabolic agents, calcium and iron supplements, antihistamines, and oxygen therapy. At a gestation period of more than 36 weeks, in the presence of Rh-sensitization of the mother and satisfactory condition of the fetus, independent delivery is possible.

If a severe condition of the fetus is noted during Rh-conflict, a planned cesarean section is performed at 37-38 weeks. If this is not possible, the fetus, under ultrasound control, undergoes an intrauterine blood transfusion through the umbilical vein, which makes it possible to partially compensate for the phenomena of anemia and hypoxia and prolong pregnancy.

In case of Rh conflict, it is possible to prescribe plasmapheresis to a pregnant woman in the second half of gestation in order to reduce the titer of antibodies to Rh (+) fetal red blood cells in the mother’s blood. In case of severe hemolytic damage to the fetus, immediately after birth, the child undergoes a replacement transfusion of single-group Rh-negative blood or plasma or red blood cells of group I; begin treatment for hemolytic disease of the newborn.

Within 2 weeks after birth, breastfeeding a child with signs of hemolytic disease is not allowed, so as not to worsen the baby’s condition. If the newborn has no symptoms of this disease during Rhesus conflict, then after injection of anti-Rhesus immunoglobulin into the mother, breastfeeding is carried out without restrictions.

Prevention of Rhesus conflict

To avoid very serious consequences for the child during an Rh-incompatible pregnancy, the primary task in gynecology is to prevent the development of Rh immunization and Rh conflict. Of great importance for the prevention of Rh conflict in an Rh (-) woman is taking into account Rh compatibility with the donor during blood transfusion, mandatory preservation of the first pregnancy, and the absence of a history of abortions.

An important role in preventing Rh conflict is played by pregnancy planning, with examination of the woman for blood type, Rh factor, and the presence of anti-Rh antibodies in the blood. The risk of developing a Rh conflict and the presence of antibodies to Rh in a woman’s blood are not a contraindication to pregnancy or a reason to terminate it.

A specific prevention of Rh conflict is an intramuscular injection of anti-Rhesus immunoglobulin (RhoGAM) from donor blood, which is prescribed to women with Rh (-) who are not sensitized to the Rh antigen. The drug destroys Rh (+) red blood cells that may have entered the woman’s bloodstream, thereby preventing her isoimmunization and reducing the likelihood of Rh conflict. For high effectiveness of the preventive action of RhoGAM, it is necessary to strictly adhere to the timing of drug administration.

Administration of anti-Rhesus immunoglobulin Rh (-) to women to prevent Rh conflict is carried out no later than 72 hours after transfusion of Rh (+) blood or platelet mass; artificial termination of pregnancy; spontaneous miscarriage, surgery associated with ectopic pregnancy. Anti-Rhesus immunoglobulin is prescribed to pregnant women at risk of Rh conflict at 28 weeks of gestation (sometimes again at 34 weeks) to prevent hemolytic disease of the fetus. If a pregnant woman with Rh (-) experienced bleeding (due to placental abruption, abdominal trauma), invasive manipulations were performed with the risk of developing an Rh conflict, anti-Rh immunoglobulin was administered at the 7th month of gestation.

In the first 48–72 hours after birth, in the case of the birth of an Rh (+) child and the absence of antibodies to Rh in the mother’s blood, the RhoGAM injection is repeated. This allows you to avoid Rh sensitization and Rh conflict in the next pregnancy. The effect of immunoglobulin lasts for several weeks and with each subsequent pregnancy, if there is a possibility of the birth of an Rh (+) child and the development of Rh conflict, the drug must be administered again. For Rh (-) women already sensitized to the Rh antigen, RhoGAM is not effective.

Since I’m reading a lot on this topic now, trying to understand what happened in my body and what’s happening now with my child, I’ll share it with you. Especially with mothers who have a different Rh factor with their child

Rh factor is a concept that was introduced into scientific use in 1940. It refers to the presence or absence of antigens (red blood cells) on the surface of red blood cells. It is the “plus” or “minus” sign that plays a decisive role in the manifestation of Rh conflict. Rh conflict occurs when antibodies from Rh positive blood enter “negative” blood. They are perceived by the body as foreign, so antibodies begin to be produced that perform a protective function. The onset of Rh conflict is possible in two cases. The first of these is blood transfusion. It is important to know that Rh-negative people can only be transfused with Rh-negative blood, and vice versa, Rh-positive people can only be transfused with Rh-positive blood. The second - the most common - . The danger of Rh conflict appears if the expectant mother is Rh negative and the father is Rh positive. All other combinations do not pose a threat. Often women and girls have a vague idea of ​​the Rh conflict and believe that the difference in the Rhesus of their partners puts an end to dreams of children. I hasten to reassure you: timely diagnosis and constant medical monitoring will help the birth of a healthy and strong baby. I propose to lift the veil over a “problematic” pregnancy. To begin with, a pregnant woman with a negative Rh factor must be examined for sensitization, that is, for the presence of antibodies in the blood that interfere with the positive blood antigen. The level of sensitization increases in a number of cases: with the transfusion of Rh-positive blood into Rh-negative, with an ectopic pregnancy of 7-8 weeks, abortion, miscarriage, trauma in a pregnant woman, chorionic villus biopsy (manipulation of the membranes). Also, sensitization can occur even before birth if red blood cells from a Rh-positive mother enter the blood of an Rh-negative girl who has not yet been born. The lowest level of sensitization occurs after an ectopic pregnancy, then after a miscarriage, abortion, and the highest after a normal birth (up to 10-15%). It all depends on how many red blood cells enter the mother’s bloodstream. The first pregnancy of an Rh-negative woman usually proceeds without complications, since antibodies have not yet been developed. But each of us needs to know the most important moments of a problematic pregnancy. The presence of antibodies to red blood cells in the blood of a Rh-negative mother will not affect her well-being in any way, but can harm the fetus. The breakdown of red blood cells leads to disruption of the liver, kidneys, and brain of the unborn baby, as well as to the development of hemolytic disease of the newborn child. The disease develops rapidly after birth, which is caused by the entry of a large number of antibodies into the child’s blood if the integrity of the placental vessels has been compromised. After birth, external signs of hemolytic disease are clearly expressed: jaundice, anemia. There is also a risk of disruption of brain activity, as well as the functioning of the nervous system, and developmental delays. Rhesus conflict is also dangerous due to the possibility of miscarriage or stillbirth.

Therefore, taking all precautions is the main task of the expectant mother. Fortunately, the modern level of development of medicine can significantly facilitate pregnancy and reduce the risk of complications. In a special perinatal center, the expectant mother and her child are under the constant supervision of doctors. If it is possible to bring the pregnancy to 38 weeks, a cesarean section is performed, but if not, an intrauterine blood transfusion is performed: 20-50 ml of red blood cells are transfused into the fetus, penetrating the umbilical cord vein through the anterior abdominal wall of the mother. This helps prolong pregnancy and improve the condition of the fetus. This procedure is carried out under ultrasound control. And so, the child was born. This is all? It turns out not. As soon as possible - within 72 hours - a woman should be given anti-Rhesus immunoglobulin into her blood, which will prevent the development of Rh conflict in a subsequent pregnancy

For a happy, enjoyable pregnancy and, as a result, the birth of a healthy baby, a woman must arm herself with the necessary basic knowledge so that no myths or prejudices can throw her out of balance. Previously, pregnancy was considered incompatible and caused real fear among expectant mothers. To find out the truth, we must first understand what this Rh factor is?

The concept of the Rh factor arose only 35 years ago. This is a blood antigen (protein) that is located on the surface of blood cells and is determined through a blood test. People with negative Rhesus do not have this protein in their blood. According to statistics, approximately 20% of women in the world have this Rh factor, and many of them are happy mothers. Doctors say that Rh negative during pregnancy is not at all synonymous with infertility. What is dangerous is not the emerging Rh conflict, which happens only in isolated cases.

When is Rh negative during pregnancy dangerous?

Such cases include the moment when the Rh factor of the woman in labor does not coincide with the Rh factor of the child. What is the reason for the possible occurrence of Rh conflict? Our body has the ability to protect itself from foreign bodies. During infectious diseases, the body fights the virus, ensuring recovery. The same reaction of the body in Rhesus conflict. Aggressive antibodies, the purpose of which is to isolate foreigners (in this case, the child’s blood proteins), pose a threat to his full development. The penetration of antibodies through the placenta and their conflict with the red blood cells of the fetus can also lead to possible damage to the child’s brain and his hearing. The worst consequences are congenital hydrops of the fetus and even its death.

Thanks to the achievements of modern medicine, Rh negative during pregnancy is no longer as threatening as it used to be. There are many ways to successfully cope with the problem of Rh conflict between the blood of mother and child. A woman with a negative Rh factor feels no worse than other mothers. The only condition for preventing the consequences of a possible conflict is regular visits to the doctor and blood tests. If a conflict does arise, doctors sometimes have to provoke early labor and transfuse blood to the newborn. These procedures are happening quite successfully today, so you shouldn’t worry too much in advance.

It should be noted that Rh negative during pregnancy with the first child very rarely provokes conflict. A woman who has never come into contact with a positive Rh factor simply does not have antibodies that can harm the child. But during childbirth, the baby's protein may enter the mother's bloodstream. In this case, antibodies may appear. To prevent problems with subsequent pregnancy, the expectant mother is recommended to administer a drug called anti-Rh immunoglobulin. It binds aggressive antibodies and allows them to be removed from the body.

Therefore, if your first child had a positive Rh factor and you dream of having more children, so that if you have a negative Rh factor it will be successful, it would be advisable to introduce such a vaccine. It can be administered both during pregnancy itself and after childbirth.

Modern medicine deals with the treatment of Rh conflict quite successfully. Therefore, even when the result of your tests determines the Rh conflict, this is not yet a reason to panic. If you take a responsible and conscious approach to this problem and its solution, with the help of experienced doctors, you will soon find yourself in your arms with a healthy toddler, and you will become another happy mother.