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The Rh factor is a special protein that is found on erythrocytes - red blood cells. If it is not there, they talk about the negative Rh factor of the blood (Rh-), if it is - about the positive (Rh +). Problems during pregnancy can occur when a woman is Rh negative and the future dad is Rh positive. In this case the immune system women may not “accept” the child and begin to get rid of the “stranger.” This is the Rh conflict during pregnancy.

Coincidence

All expectant mothers need to know that only an Rh-negative woman can face Rh conflict. In addition, several other circumstances must coincide:

The husband must be Rh positive;

The child must inherit the father's Rh factor (the probability of this is 50%).

In most cases, this should not be the first pregnancy.

Rhesus conflict usually does not appear during the first pregnancy. The immune system does not have time to recognize the threat, since it encounters a foreign protein for the first time. Only cellular memory is formed. But having remembered the “stranger,” the next time he appears, the woman’s immune system will begin to defend itself and produce aggressive antibodies. When they reach an unborn child, they can destroy his red blood cells. Therefore, Rh-negative wives of Rh-positive husbands who have already given birth to an Rh-positive child automatically fall into the risk group. The likelihood of Rh conflict during the next pregnancy is also high in women whose previous pregnancy interrupted after 8 weeks, when cellular memory had already formed.

Rh conflict during pregnancy: table by blood groups

The table below shows the likelihood of Rh conflict during pregnancy depending on the Rh factor of the future parents.

Rh conflict during pregnancy: consequences for the child

There is no Rh conflict between mother and fetus for a woman’s body negative consequences does not have. He only threatens the unborn child. Antibodies destroy his red blood cells, hemoglobin breaks down and bilirubin is released. In large quantities, bilirubin is very toxic to all organs, but especially to the brain of the unborn child. A small amount of hemoglobin, that is, red blood cells, is fraught with hypoxia and anemia, because red blood cells supply the blood with oxygen.

Rhesus conflict during pregnancy: symptoms

Before the 20th week of pregnancy, the Rh conflict is very rare. As a rule, Rh conflict symptoms during pregnancy appear closer to the 28th week of gestation. Ultrasound determines the so-called ultrasound markers - polyhydramnios and placental thickness. If the placenta is thicker than expected for the duration of pregnancy, this may be a sign of an incipient hemolytic disease, that is, Rh conflict during pregnancy. The circumference of the abdomen of the unborn baby is also important, the presence in it abdominal cavity fluids, enlargement of the liver and spleen. If they are enlarged, these organs can begin to produce young red blood cells instead of destroyed ones. Another symptom is a decrease in blood flow speed in cerebral artery baby. This indicator is measured using Doppler ultrasound.

To prevent such serious complications, the first time a woman contacts a doctor about pregnancy, she is given a referral for a blood test to determine the Rh factor and blood type. If Rh is negative, and the expectant mother does not know her husband’s Rh factor, he will also have to be tested to determine the Rh factor and blood type. If Rh is positive, the woman will be taken under special control.

This means that simultaneously with determining the negative Rh factor, the laboratory will also determine the titer of antibodies in the woman’s blood - their amount in 1 ml of blood serum. The higher the titer, the more antibodies in the mother’s bloodstream. Only a titer above 1:16 matters. But even with a very high titer, fetal disease does not always manifest itself.

If an antibody titer is detected, the test is repeated once a month until the 20th week of pregnancy, and if it increases rapidly - once every 2 weeks. In this case, ultrasounds from the 20th week are done every 4 weeks to monitor the symptoms of hemolytic disease in the unborn child.

If at least one symptom of hemolytic disease is found in the unborn baby, the woman will be hospitalized in a specialized hospital. If the antibody titer increases rapidly, the woman will undergo a puncture of amniotic fluid to determine the severity of the hemolytic disease in the baby. At the same time, it is decided whether cordocentesis is needed - sampling cord blood to determine the level of hemoglobin in the child’s blood. If the level is low, an intrauterine blood transfusion is performed. Then the antibody titer will be determined once a week. Such measures alleviate the baby’s condition, but do not cure the disease. You can get rid of it only after birth.

Rh conflict: consequences for the child after birth

Treatment for Rh conflict during pregnancy is carried out until 34-36 weeks of gestation. After this period, doctors will try to bring the baby closer to birth. It is believed that C-section in such cases the best way the birth of the baby, but it all depends on the condition of the child. Rhesus conflict in itself is not absolute indication to the operation.

After birth, the baby is treated for anemia and other manifestations of hemolytic disease. Bilirubin levels are also monitored daily.

Prevention of Rh conflict during pregnancy

If the blood is Rh negative expectant mother antibodies are not detectable, at the 28th-30th week of pregnancy she will be given an injection of anti-Rhesus immunoglobulin. If a Rh-positive baby is born, then during the first 48-72 hours after birth the mother is also given an injection of anti-Rhesus immunoglobulin. This will help prevent conflict in your next pregnancy. The same injection is also needed after a miscarriage or abortion after 8 weeks, as well as when ectopic pregnancy. It is also necessary after invasive diagnostics - chorionic villus biopsy, amniocentesis or cordocentesis, for abdominal injuries during pregnancy and bleeding or placental or chorionic abruption.

Blood type conflict

Rh conflict during pregnancy should not be confused with blood group conflict. In this case serious problems This usually does not affect the baby’s health. The table below shows the likelihood of such a conflict occurring. Group conflict manifests itself only after childbirth in the form hemolytic jaundice. Usually on the 5th day everything returns to normal. In contrast to the Rhesus conflict, the group conflict usually manifests itself after the first birth. After the second and subsequent births it occurs much less frequently.

Mother	Father	The child will inherit	Risk of group incompatibility
0 (I)	0 (I)	0 (I) probability 100%	No
0 (I)	A (II)	0 (I) or A (II) probability 25/75	75%
0 (I)	B (III)	0 (I) or B (III) probability 25/75	75%
0 (I)	AB (IV)	A (II) or B (III) probability 50/50	100%
A (II)	0 (I)	0 (I) or A (II) probability 25/75	No
A (II)	A (II)	0 (I) or A (II) probability 10/90	No
A (II)	B (III)	0 (I), A (II), B (III) or AB (IV) probability 10/20/20/50	70%
A (II)	AB (IV)	A (II), B (III) or AB (IV) probability 50/15/35	50%
B (III)	0 (I)	0 (I) or B (III) probability 25/75	No
B (III)	A (II)	0 (I), A (II), B (III) or AB (IV) probability 10/20/20/50	70%
B (III)	B (III)	0 (I) or B (III) probability 10/90	No
B (III)	AB (IV)	A (II), B (III) or AB (IV) probability 15/50/35	50%
AB (IV)	0 (I)	A (II) or B (III) probability 50/50	No
AB (IV)	A (II)	A (II), B (III) or AB (IV) probability 50/15/35	No
AB (IV)	B (III)	A (II), B (III) or AB (IV) probability 15 /35 /50	No
AB (IV)	AB (IV)	A (II), B (III) or AB (IV) probability 12/25/50	No

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

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

What is the Rh factor?

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

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

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

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

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

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

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

Maternal and fetal blood occurs in the space between the uterus and placenta. It is in this place that the exchange takes place: oxygen enters the baby’s blood and nutrients, into the mother's blood - the waste products of the fetus. At the same time, part of the erythrocytes, as it were, change places. This is how positive fetal cells end up in the mother’s blood, and her red blood cells end up in the fetal blood.

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

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

Rp inheritance table

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

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

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

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

Symptoms of Rh conflict

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

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

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

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

Antibody test during pregnancy

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

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

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

Studies to determine the extent of fetal damage

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

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

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

CTG is also invaluable in assessing the child's condition. It allows you to determine reactivity of cardio-vascular system and assume the presence of hypoxia.

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

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

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

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

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

Treatment of Rh conflict during pregnancy

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

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

Delivery in case of Rhesus conflict

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

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

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

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

Prevention of Rhesus conflict

Prevention of Rh conflict during pregnancy, fortunately, is possible. For this purpose, the woman is injected with a special substance - immunoglobulin. Immune globulin is usually given within 72 hours of the completion of labor, abortion, miscarriage, bleeding, or blood transfusion to the baby.

Immunoglobulin will help not only when planning pregnancy after Rhesus conflict. In some cases, it is also administered during pregnancy for a period of about 28 weeks, but only with the consent of the patient.

Breastfeeding with Rhesus conflict

A separate issue is breastfeeding with Rh conflict. This issue is very sensitive and there is no consensus on it. First of all, doctors assess the child’s condition, possible risks and after that they may recommend abstaining from breastfeeding until all antibodies are removed from the mother's body.

According to other sources, there is no need to limit feeding. However, all these studies have not yet been fully confirmed, and the equipment of our clinics still leaves much to be desired. Therefore, it is not worth arguing with the opinion of doctors, because they are guided both by the condition of your child and their capabilities in case of any complications.

It can be summed up: the Rhesus conflict of the mother and fetus is not a sentence, and it is quite possible to bear a child with such a diagnosis. Moreover, Rp- in the mother does not mean at all that pregnancy will lead to Rhesus conflict. Of course, the consequences of the Rhesus conflict can be very deplorable, but this is not a reason to despair. After all, only 0.8% of pregnant women with Rp- experience this problem.

Most people (about 85%) have a specific antigen attached to their red blood cells called the Rh factor (Rh). Rh conflict occurs during the growth of the fetus in the event that the mother has Rh negative, then this antigen is not present. If red blood cells with an antigen from the body of the fetus enter the body of a woman, her immune system begins to produce antibodies against this antigen, and since it is attached to the red blood cells, they die.

For this reason, a number of pathological changes occur in the fetal body, hypoxia occurs ( oxygen starvation), and the organs responsible for the processing of dead red blood cells cannot cope with this function in the proper amount. With time hematopoietic organs, despite a significant increase in their size, they can no longer reproduce red blood cells in the required volume, due to which the lack of oxygen increases. Rhesus conflict is dangerous because it is often the cause Very serious violations in fetal formation and even his death.

A Rh factor conflict during pregnancy may not appear immediately. Firstly, Rh can be inherited from both the father and mother, so there is some chance that the child will also be Rh negative (the probability of this is 1 in 4, since the presence of the antigen is a dominant trait).

Secondly, even if the child’s Rh is positive and the woman’s is negative, Rh sensitization (this is the production of antibodies by the mother’s body) does not occur immediately. During gestation without complications, the fetal blood does not mix with the woman’s blood, and even with mixing, the production of antibodies requires the launch of certain immune processes, which takes quite a long time, or may not happen at all.

Third, if the baby's blood cells have entered the female body in small quantities, the formation of “memory cells” that contribute to the accelerated production of antibodies does not occur, and even with further pregnancy, sensitization may not occur.

The Rh conflict by blood group is not divided in any way, since Rh is not related to the blood group and does not depend on its type.

What are the symptoms of Rh conflict?

Pronounced clinical picture Rhesus conflict does not cause conflict in pregnant women; it can only be determined using a special test for the presence of antibodies in the blood of a negative mother to the child’s antigen. External manifestations it does not have, but can manifest itself in a fetus with characteristic symptoms lack of red blood cells and oxygen starvation.

• On early may cause miscarriage or premature birth, stillbirth child;
• If the baby is full-term, he may have all the signs of damage to the liver and spleen: swelling, yellowish color skin, pathological changes organs, liver and spleen are significantly increased in size;
• Sometimes edema develops throughout the body of the fetus with a significant accumulation of fluid in all cavities of its body, this often causes the death of the child or irreversible damage to him internal organs;
• Detachment or a significant increase in the placenta and the amount of water may develop;
• A child's body produces large amounts of bilirubin as a result of the death and breakdown of a large number of red blood cells. A high percentage of bilirubin in the blood can lead to hepatitis and serious damage nervous system. Because of this, the child is lethargic and reflexes are reduced, which in turn can cause developmental delays or subsequent hearing loss.

How is Rh conflict diagnosed?

During pregnancy, a woman often donates blood and must undergo many tests and studies. If her Rh is negative, the first thing to do is determine the Rh of the child’s father, since with two negative Rhes, the child’s Rh will also be negative and a conflict will not arise.

If the father’s Rh is positive, the doctor conducts a thorough history taking, taking into account factors such as the woman’s history of miscarriages, abortions, childbirth, and the characteristics of the birth of her children. All these factors indicate the degree of risk of conflict and are important for subsequent examination.

Every two months (if there was no sensitization) an analysis is carried out to determine the titer of antibodies in the blood, in other words, their quantity, but even this does not give absolutely accurate information about damage to the fetus during conflict. In order to assess the child’s condition, do:

1. Ultrasound to assess the development of the fetus, the growth of the placenta, the size of the child’s internal organs, and to identify excessive swelling.
2. A cardiogram that allows you to assess the degree of oxygen deficiency in the child’s body.
3. Water research, which allows you to obtain the most accurate data about the Rh of the fetus, the development of its lungs, and the amount of bilirubin.

Treatment options

If, after testing, Rh antibodies are detected during pregnancy, especially in a significant titer, it means that Rh incompatibility occurs between mother and child. In this case, hospitalization is carried out and the health of the mother and child is subsequently monitored in a hospital setting.

Therapeutic measures aimed at reducing Rh conflict are:

• Taking vitamins and drugs that speed up metabolism;
• Preparations with high content iron to compensate for the lack of red blood cells in the fetus and speed up their production;
• Anti-allergy medications to “calm” the mother’s immune system, reduce antibody production and reduce conflict.

If the condition of the fetus is considered normal and does not cause concern, then independent childbirth is allowed at a period of more than thirty-six weeks.

If the child's condition is assessed as medium degree severity and higher - at a period of thirty-seven to thirty-eight weeks, a cesarean section is prescribed, but if the period is still insufficient, and the child’s condition is very serious, a specific operation for intrauterine blood transfusion can be performed. It is performed along the umbilical vein.

Mothers may undergo a series of blood collection procedures followed by purification and transfusion, which also help reduce antibodies and reduce Rh conflict.

After childbirth, if a child has signs of HDN (the concept, or rather the abbreviation that denotes hemolytic disease of the newborn) in severe form, a transfusion may be recommended; in case of a non-severe form of the disease, it is simply treated symptomatically.

If any symptoms of tension-type headache are detected, doctors prohibit breastfeeding for the first two weeks, otherwise the conflict can worsen.

If the baby has no signs of this disease, you can breastfeed immediately after the mother’s introduction special drug, which will accelerate the destruction of the baby’s red blood cells remaining in her body and thus reduce the production of antibodies.

Prevention

Considering that Rh conflict occurs when fetal red blood cells enter the body with positive Rh from a Rh-negative mother, the first step will be to determine the Rh factor of the parents. If the pregnant woman is Rh negative and the father is positive, then throughout the pregnancy, up to 1-2 times a month, blood is taken from the woman to identify antibodies in her (you should not be afraid of this procedure, it is painless, just a regular injection).

After birth, the baby’s Rh is determined; if it is positive, the mother is given a special serum to minimize the risk of Rh conflict during the next pregnancy.

The same procedure is performed on the fair sex with Rh negative, every time in the case:

1. abortion.
2. miscarriage or suspected miscarriage.
3. elimination of an ectopic or frozen pregnancy.
4. transfusions with positive or indeterminate Rh.
5. injuries and pathologies during pregnancy.

Modern medicine makes it possible to reduce the risk of fetal pathologies during conflict to a minimum, but for this it is necessary to carry out timely diagnostic studies and carefully follow all recommendations and instructions of doctors.

Future parents, even when planning the birth of a child, must take a blood test to detect the Rh factor. This is necessary in order to promptly determine possible incompatibility between a man and a woman. This study will help prevent adverse consequences– the likelihood of Rh conflict occurring between the child and mother.

Rh conflict during pregnancy

During conception, the embryo from one parent receives D-protein, located on top of red blood cells. If the Rh antigen D is present, the blood is considered positive, and if it is absent, the blood is considered negative.Rhesus conflict iswhen expectant mother negative Rh, and the partner’s is positive, because according to statistics, 50% of children receive the Rh factor from their father. In other cases there is no problem. Rhesus conflict during pregnancy threatens spontaneous miscarriage, premature detachment placenta, hemolytic disease of the infant.

Rh conflict during the first pregnancy

In women with Rh (-), only 10% of cases develop a blood conflict if they become pregnant for the first time. This is due to the production of type 1 immunoglobulins, which cannot pass through the placenta and enter the fetal bloodstream due to their large size. In order for the erythrocytes of the child and the mother's antibodies to meet, and their agglutination (sticking together), they need to connect between the placenta and the uterine wall. If formerly a woman did not have abortions, and also did not receive blood transfusions, thenRhesus conflict during first pregnancyis almost completely eliminated.

Rh sensitization occurs more often during repeated pregnancy. In this case, the infant's erythrocytes penetrate the mother's vessels and trigger a humoral immune response, after which IgG antibodies are produced. Their size is small, so the placental barrier is easily overcome. The antibodies enter the infant's bloodstream and destroy red blood cells, causing hemolysis.Rh conflict during second pregnancyand all subsequent ones, especially with a short time interval, negatively affects the health of the fetus.

Rh conflict during pregnancy - consequences for the child

For an unborn baby, an Rh conflict is dangerous due to the occurrence of hemolytic disease. This is a very risky condition when an edematous form of the disease, ascites, occurs in an infant while still in the womb. If there is immunological incompatibility, the child may be born in a particularly serious condition or dead. At less severe complications basicconsequences of Rh conflict for a child– enlargement of the liver after birth, spleen and other internal organs, pale skin, anemia.

Already on the first day after birth, jaundice appears (with an icteric form), there may be a lack of blood circulation, cardiomegaly (an increase in the mass and size of the heart). Other consequences of Rh conflict:

• fast contractions eyeballs;
• generalized seizures;
• high-pitched screams;
• asymmetric spasticity;
• deafness.

Rhesus conflict - reasons

As it has already been found out, an Rh-conflict pregnancy occurs if the mother has an Rh negative factor, and the Rh factor is positive in the fetus. However, the destructive action after the "acquaintance" of the two organisms does not occur immediately. Only at 8-9 weeks, and in some women even after six months, do immunoglobulins appear that can penetrate the placenta.

When the blood flow between a woman and the fetus increases, the amount of anti-Rhesus antibodies in the baby’s body increases, which increases the risk of pathologies. An immunological conflict sometimes arises when a woman is sensitized to Rh(-) during her birth from an Rh(+) mother. There are otherscauses of rhesus conflict, if a woman with Rh (-) had the following pathologies:

• diabetes;
• Caesarean section in previous births;
• gestosis;
• artificial termination of pregnancy;
• flu;
• ORZ;
• genetic inheritance;
• ectopic pregnancy;
• donor blood transfusion.

Rh conflict during pregnancy - symptoms

A pregnant woman does not exhibit any specific clinical manifestations. Blood conflict during pregnancy is manifested only by fetal pathologies. Sometimes the development of incompatibility even leads to intrauterine death or miscarriage. The baby may be born still, premature, with edematous, anemic or icteric form hemolytic disease. Mainsymptoms of Rh conflictduring gestation and after the birth of the baby:

• the appearance of immature red blood cells;
• hypoxic damage to internal organs;
• anemia;
• thickening of the placenta;
• increase in the size of the fetal abdomen;
• swelling of the scalp tissue;
• bilirubin intoxication of the central nervous system;
• increase in amniotic fluid.

Analysis for Rh conflict during pregnancy

To prevent the likelihood of Rh conflict during pregnancy, mothers with Rh (-) are prescribedanalysis for Rh conflict(for antibodies), which she must undergo monthly. If antibodies are present (any titer), the pregnant woman is observed at a local consultation until the 20th week, after which she is sent to specialized clinics to determine treatment tactics and delivery dates. Starting from the 18th week, the condition of the fetus and other signs of Rh conflict are assessed using ultrasound (ultrasound).

Prevention of Rhesus conflict

Antenatal prophylaxis is important, that is, prenatal, starting with an analysis for Rh conflict, which should be carried out from the first days of pregnancy. In the absence of antibodies, a woman is given intramuscular injection(injection) of anti-Rhesus immunoglobulin, preventing their further production. If after the birth of the baby the Rh is negative, then there is no need to fear the occurrence of hemolytic pathology. Mom is injected with another dose of immunoglobulin to prevent the risks of immunological incompatibility during the next pregnancies.

In case of development of Rh sensitization at any timeprevention of Rh conflict during pregnancyrequires special attention: after 32 weeks, blood tests are carried out 2 times a month, and before childbirth - weekly. Even in the early stages, the woman is admitted to a special clinic, where from 22 to 32 weeks an intrauterine transfusion is given, when the fetus is infused the right group blood. This gives a high possibility of full pregnancy and eliminates future ectopic pregnancy.

Find out about normal indicators during pregnancy and its planning.

As a rule, for most people, the first “meeting” with the Rh factor occurs during the determination of their blood group. Then the doctor tells you that you have a positive or negative Rh factor (Rh+ or Rh–). What does it mean? It's simple. This is a special protein that is found on the surface of red blood cells. 85% of people who are called Rh positive have it. Those 15% who do not have this specific protein are Rh negative. The factor is named after the rhesus monkeys on which research was conducted when this protein was discovered.

Why does Rh conflict occur during pregnancy?

How does the presence or absence of a protein affect pregnancy? Problems may arise if the expectant mother is Rh negative, and the future father is Rh positive. Moreover, the danger arises only if the child’s blood contains a protein inherited from the father. Then there is a chance that it will overcome the placental barrier and enter the Rh negative blood mothers. Her body will receive a signal about the presence of a foreign agent and immediately declare “mobilization” - it will begin to produce protective antibodies designed to destroy “ uninvited guests". At the same time, it does not take into account the fact that the unborn child acts as the source of “strangers”.

If incompatibility occurs, a special test is sometimes performed to determine the number of damaged red blood cells in the embryo. This way you can understand how dangerous the situation is. While protecting the mother’s body, antibodies can cause serious damage to the fetus, including intrauterine death and miscarriage, and this can happen at any stage of pregnancy. The “attack” happens like this: the mother’s antibodies penetrate the placenta and destroy the “hostile” red blood cells of the child. Appears in his blood a large number of bilirubin (a yellow-green pigment that is formed as a result of the breakdown of hemoglobin), it colors the baby’s skin in yellow. Hemolytic disease of the fetus develops; it can manifest itself in three forms: anemic, icteric and edematous. Each of them can lead to serious malformations of the fetus, since the cells will lack oxygen.

Since during the Rhesus conflict the fetal red blood cells are continuously destroyed, its liver and spleen begin to work in emergency mode, trying to speed up the production of new red blood cells and compensate for losses. But the mother’s body is naturally stronger, so most often this “ unequal battle" ends with the development of anemia in the fetus ( low content in the blood of erythrocytes and hemoglobin). In severe cases, the newborn can only benefit from a replacement blood transfusion (he is given Rh-negative blood that matches his group). Unfortunately, this condition can cause brain damage and impaired hearing and speech functions in a child.

Is Rh conflict inevitable? Does Rh conflict between mother and fetus necessarily occur if the parents have different Rh factors?

Not at all necessary. If the expectant mother is Rh-positive and the father is Rh-negative, then there is no danger. The child still has an equal chance of inheriting the protein or not, but it won't affect anything. Let's say protein appears in the fetal blood. But exactly the same will be present in the mother’s blood. That's why protective system her body will accept the baby as “its own” and will not take any action. If the child has not inherited the protein, then problems will not arise either - after all, there will simply be nothing to react to. Therefore, as mentioned above, danger can only arise if the mother’s blood is Rh-negative and the father’s is Rh-positive, and the child has inherited the protein from the father. Whether this happened becomes clear at 8–10 weeks prenatal development. However, even with Rh-incompatible pregnancy, Rh conflict between mother and fetus does not always occur. It often happens that the amount of antibodies in a child’s blood is so small that it does not pose a serious danger. So it's actually not that scary.

Under constant surveillance

However, it is necessary to keep the process under control. In the first pregnancy, the study is carried out already at 18–20 weeks. Using ultrasound at this time, you can determine signs of hemolytic disease of the fetus (thickening of the placenta, enlargement of the liver and spleen). Also, the expectant mother should regularly donate blood for the presence of antibodies throughout the entire period of pregnancy. Until the 32nd week - once a month, from the 32nd to the 35th week - 2 times a month, and then weekly.

In the absence of antibodies at 28 weeks, immunization with anti-Rhesus gammaglobulin is carried out to prevent their formation. This preventative measure, a kind of “Rh vaccination” that helps prevent the appearance of antibodies in the mother’s blood that can begin to destroy the fetus’s red blood cells.

If there is a tendency towards an increase in the level of antibodies, desensitizing therapy is prescribed (i.e. treatment aimed at reducing the body’s sensitivity to any antigens), which is carried out in outpatient setting. The expectant mother may be prescribed, for example, intravenous administration glucose solutions, ascorbic acid, ingestion vitamin preparations etc. All this is done so that the woman’s immune system reacts less to a foreign protein (in this case, a blood protein - the Rh factor).

If suddenly the analysis shows a critical increase in the number of antibodies, it is necessary urgent hospitalization the expectant mother will be taken to a specialized hospital, where her condition will be constantly monitored. In this situation, doctors should monitor the dynamics of the increase in the level of antibodies in the blood, as well as an increase in the size of the fetal liver, thickening of the placenta, the appearance of polyhydramnios and fluid in the pericardium (heart sac) and the abdominal cavity of the fetus. In addition, in some cases, amniocentesis is performed - a puncture of the fetal bladder to examine the amniotic fluid and determine the level of bilirubin in it. If it is quite high, the doctor may prescribe one of the following procedures:

• The most in a simple way will plasmapheresis– plasma is taken from the woman, purified of antibodies, and then transfused back.
• Also carry out hemosorption- deletion toxic substances using a special machine in which the blood is passed through filters and then reintroduced into the body.
• In particular difficult cases appoint fetal blood transfusion. It is considered the most effective way combating progressive Rh conflict. The principle is this: under ultrasound control in umbilical vein Substances that relax the fetal muscles are introduced, and then donor blood with an Rh-negative indicator is introduced, the red blood cells of which should not be destroyed by “fighting” maternal antibodies. After 2–3 weeks, the transfusion is repeated. In fact, donor blood temporarily replaces the fetus's own blood. If this procedure does not help, the question of early birth arises. Therefore, doctors are doing their best to bring an Rh-conflict pregnancy to at least 34 weeks, because by this time the baby’s lungs will already be sufficiently formed so that he can breathe on his own.

As you can see, the consequences of Rh conflict can be very serious. Therefore, if you know that you have a negative Rh factor, and your husband has a positive one, you need to carefully approach pregnancy planning. It is very important to avoid cases of “collision” with rhesus incompatible blood. This can happen, for example, during an abortion or miscarriage if the fetus was Rh-positive. Thus, any termination of pregnancy for you is associated with great risk. After all, if antibodies have already been developed once, they will be formed again and again with each Rh-incompatible pregnancy, creating serious threat child's health.

After pregnancy, it is necessary to register as soon as possible with the antenatal clinic and immediately inform the gynecologist about your Rh factor. In any case, it is important to remember: the likelihood of a Rh conflict in itself and even the presence of antibodies in the blood are not contraindications to pregnancy, and certainly not a reason to terminate it. It’s just that such a pregnancy requires a much more responsible and attentive attitude. Try to find a competent specialist whom you can completely trust, and strictly follow all his recommendations.

Second pregnancy – is there a greater risk of Rh conflict?

Many women are concerned about the question: does the risk of Rh conflict increase during a second pregnancy? Indeed, if a Rh-negative mother’s second child, like the first, has a positive Rh factor, the likelihood of an Rh conflict increases. The point is that after last pregnancy Special cells remain in a woman’s blood that “remember” the past struggle. Therefore, during subsequent encounters with the child’s “enemy” blood cells, they organize the rapid production of antibodies according to the already familiar pattern.

In addition, during the birth of the first Rh-positive child, contact with incompatible blood occurs. That is why, if you do not take certain preventive measures, then in subsequent pregnancies the likelihood of problems will increase significantly. To prevent this from happening, after the birth of the baby, the mother must be given an injection of anti-Rhesus immunoglobulin within 24–48 hours after birth. Its task is to prevent the production of antibodies and bind hostile Rh-positive red blood cells. This way, the mother’s immune system will not remember them and will not destroy them in the future. This significantly reduces the risk of complications during your next pregnancy. To ensure that the injection is done for sure, it makes sense to discuss this issue with your doctor in advance and, if possible, monitor the timely administration of the drug after childbirth. Some people prefer to purchase the vaccine themselves.

Thus, if during your first Rh-incompatible pregnancy you avoided problems with antibody production, and the immunoglobulin injection was carried out on time, next pregnancy will be no different from the previous one. That is, the likelihood of a Rh conflict occurring will still remain small.