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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 Rhesus conflict during pregnancy.

Coincidence

All expectant mothers need to know that only an Rh-negative woman can face an Rh conflict. In addition, there are a few other things that must match:

The husband must be Rh-positive;

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

Pregnancy in most cases should not be the first.

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

Rhesus conflict during pregnancy: table by blood types

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

Rhesus conflict during pregnancy: consequences for the child

Rh-conflict of mother and fetus for a woman's body is not negative consequences does not have. It 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 an unborn child. A small amount of hemoglobin, that is, red blood cells, is fraught with hypoxia and anemia, because red blood cells supply oxygen to the blood.

Rhesus conflict during pregnancy: symptoms

Before the 20th week of pregnancy, the Rh conflict is very rare. As a rule, Rh-conflict during pregnancy, symptoms appear closer to the 28th week of gestation. On ultrasound, the so-called ultrasound markers are determined - polyhydramnios and thickness of the placenta. If the placenta is thicker than expected by the gestational age, this may be a sign of an incipient hemolytic disease, that is, a 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, then these organs may begin to produce young red blood cells instead of destroyed ones. Another symptom is a decrease in blood flow velocity in cerebral artery baby. This indicator is measured with dopplerometry.

To prevent such serious complications, at the first visit of a woman to 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 pass an analysis to determine the Rh factor and blood type. If the Rh is positive, the woman will be taken under special control.

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

If an antibody titer is detected, until the 20th week of pregnancy, the analysis is repeated once a month, with its rapid increase - once every 2 weeks. Ultrasound from the 20th week in this case is 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 future baby, the woman is hospitalized in a specialized hospital. If the antibody titer rises rapidly, the woman will have a puncture of the amniotic fluid to determine the severity of the hemolytic disease in the baby. At the same time, it is decided whether a cordocentesis is needed - a fence cord blood to determine the level of hemoglobin in the child's blood. With small indicators, intrauterine blood transfusion is done. Then once a week will determine the titer of antibodies. Such measures alleviate the condition of the baby, but do not relieve the disease. You can get rid of it only after birth.

Rhesus 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 moment of the birth of the child closer. It is believed that C-section in such cases best way the birth of a baby, but it all depends on the condition of the child. By itself, Rhesus conflict is not absolute reading to the operation.

After birth, the child is treated for anemia and other manifestations of hemolytic disease. The level of bilirubin is also monitored daily.

Prevention of Rh conflict during pregnancy

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

blood type conflict

Rhesus conflict during pregnancy should not be confused with a blood type conflict. In this case serious problems for the health of the baby usually does not occur. The table below shows the likelihood of such a conflict occurring. Group conflict manifests itself only after childbirth in the form of 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 happens much less frequently.

Mother	Father	The child will inherit	Risk of group incompatibility
0 (I)	0 (I)	0 (I) 100% chance	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) 50/50 chance	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) 50/50 chance	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 Rhesus 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 is the conflict of Rh factors during pregnancy, and what is the Rh factor in general.

What is the Rh factor?

Of course, it is worth starting with the very concept of the 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, only 15% are absent. Accordingly, the first are considered Rh-positive, and the second - 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 when studying rhesus monkeys, which gave the name to this phenomenon. The Rh factor is indicated by two Latin letters: Rp and plus and minus signs.

What is Rh-conflict of 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 an intervention. Therefore, in women with a positive Rh factor, no conflict on this basis can arise.

However, Rh-negative women are more likely to have normal pregnancies. If the father of the child is also Rh negative, then there is no ground for conflict. When does Rhesus conflict occur? When positive rh factor detected in the husband, the child's blood will also have Rp + with some degree of probability. In this case, an Rhesus conflict may arise.

It is possible to determine the Rp of a child without an intervention dangerous to his health only approximately based on the indicators of the parents. This is clearly shown in the table. Rhesus conflict during pregnancy occurs extremely rarely, 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 Rhesus 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, respectively, they react with the fetal red blood cells and destroy them. This process is called hemolysis.

Maternal and fetal blood occurs between the uterus and the 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. So the positive cells of the fetus are in the blood of the mother, and her red blood cells in the blood of the fetus.

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

What is it 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 blood of the child, 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. The size allows them to freely enter the baby through the placenta. As a result, the process of hemolysis continues in his body, the toxin bilirubin, a product of the breakdown of hemoglobin, accumulates in the body.

What is dangerous Rhesus conflict? Liquid accumulates in the organs and cavities of the baby. 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, the condition worsens. It is called hemolytic disease of the newborn, abbreviated as HDN.

In acute cases, a miscarriage is possible due to an Rhesus conflict. In a number of cases this phenomenon causes 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 Rhesus 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 that take place in her body and are associated with the Rhesus conflict are not dangerous at all, and do not have any 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 increases, and the baby is forced to spread the legs to the sides. In addition, there is a double contour of the head, this is also due to the development of edema. The size of the placenta and the diameter of the vein in the umbilical cord also change.

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

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

Antibody test during pregnancy

One of the ways to determine the very presence of a Rh conflict is an antibody test. This analysis is carried out for all women with suspected Rhesus 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, a woman will be tested once a month for a Rh conflict, that is, for the amount of antibodies.

Starting from the 20th week, if the situation is threatening, a woman from the antenatal clinic will be transferred for observation to a specialized center. Starting from week 32, 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 is detected. The earlier this happened, the more problems portends such a pregnancy, since the effect of the Rhesus conflict has the ability to accumulate. After 28 weeks, the blood exchange between mother and child increases, and, consequently, the amount of antibodies in the baby's body increases. Starting from this period, the woman is given special attention.

Studies to determine the degree of damage to the fetus

It is possible to determine the condition of the fetus 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 child with the help of ultrasound. The 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 in the region of 18-20 weeks, the next - at 24-26, then at 30-32, one more at 34-36 weeks and the last one immediately before childbirth. However, if the condition of the fetus is assessed as severe, mothers may prescribe additional ultrasound examinations.

Another method of research that allows you to assess the condition of the baby is dopplerometry. 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 condition of the child. It allows you to determine the reactivity of cardio-vascular system and suggest the presence of hypoxia.

Worth mentioning separately invasive evaluation methods fetal condition. There are only 2 of them. The first - amniocentesis- puncture amniotic sac and sampling 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 condition of the child.

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

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

The second research method is cordocentosis. In this study, the umbilical cord is pierced and a blood sample is taken. This method even more accurately determines the content of bilirubin, in addition, it is with these methods that a blood transfusion is performed for 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 antibody titer 1:32, the presence of previously born children with severe HDN or children who died due to Rh conflict.

Treatment of Rh conflict during pregnancy

Unfortunately, the only one really in an efficient way treatment of Rh-conflict during pregnancy remains a blood transfusion to the fetus. This is a very risky operation, but it provides significant improvement fetal condition. Accordingly, this prevents premature birth.

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

Delivery in Rh conflict

In most cases, a pregnancy that occurs with the development of an Rhesus conflict ends up being planned. Doctors by all accessible ways monitor the condition of the baby and decide whether it makes sense to continue the pregnancy or whether it would be safer for the baby to be born prematurely.

Natural childbirth with Rhesus conflict rarely occurs, only with a satisfactory condition of the fetus and the absence of other contraindications.

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

However, most often childbirth with a Rh conflict takes place 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, a woman is injected with a special substance - immunoglobulin. Immunoglobulin is usually given within 72 hours of delivery, abortion, miscarriage, bleeding, or blood transfusion to the baby.

Immunoglobulin will help not only when planning a pregnancy after an 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 Rh conflict

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

According to other sources, there is no need to restrict breastfeeding. 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. In the end, only 0.8% of pregnant women with Rp- face 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 the formation of the fetus and even his death.

The conflict of the Rh factor during pregnancy may not appear immediately. First, Rh can be inherited from both father and mother, so there is some chance that the child will also be Rh-negative (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. When carrying without complications, the blood of the fetus does not mix with the blood of a woman, and even when mixed, certain immune processes are needed to produce antibodies, which takes a long time, or may not happen at all.

Thirdly, if the child's blood cells have penetrated into female body in a small amount, the formation of “memory cells”, which contribute to the accelerated production of antibodies, does not occur, and even with further gestation, sensitization may not occur.

Rh-conflict by blood groups is not divided in any way, since Rh is not associated with a blood group and does not depend on its type.

What are the symptoms of Rh conflict

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

• On early term can cause miscarriage or premature birth dead birth child;
• If the child is full-term, he may have all the signs of damage to the liver and spleen: edema, yellowish color skin, pathological changes organs, liver and spleen are significantly enlarged 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 it. internal organs;
• Detachment or a significant increase in the placenta and the amount of water may develop;
• In the body of a child, bilirubin is produced in large quantities as a result of the death and splitting 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, reflexes are reduced, which in turn can cause developmental delay or subsequent hearing loss.

How is Rh conflict diagnosed?

During gestation, a woman often donates blood and must undergo many tests and studies. If her Rh is negative, the first step is to determine the Rh of the father of the child, since with two negative Rh, the Rh of the child will also be negative and there will be no conflict.

If the father's Rh is positive, the doctor conducts a thorough history taking, taking into account such factors as the woman's past miscarriages, abortions, childbirth, and the birth of her children. All of these factors indicate the degree of risk of conflict and are relevant 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 number, but even this does not give absolutely accurate information about the defeat of the fetus during the conflict. In order to assess the condition of the child, do:

1. Ultrasound to assess the development of the fetus, the growth of the placenta, the size of the internal organs of the child, to identify excessive swelling.
2. A cardiogram that allows you to assess the degree of lack of oxygen in the child's body.
3. The study of waters, which allows you to obtain the most accurate data on the Rh of the fetus, the development of its lungs, the amount of bilirubin.

Methods of treatment

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

Therapeutic measures aimed at reducing the Rhesus conflict are:

• Taking vitamins, drugs that speed up metabolism;
• Preparations with high content iron to compensate for the lack of red blood cells in the fetus and accelerate their production;
• Antiallergics to "calm down" the mother's immune system, reduce antibody production and ease conflict.

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

If the child's condition is assessed as medium degree severity and above - for a period of thirty-seven to thirty-eight weeks, a caesarean is prescribed, but if the period is still insufficient, and the child's condition is very serious, they can perform a specific operation for intrauterine blood transfusion. It is performed through the umbilical vein.

Mothers can have a series of blood draws followed by cleanings and transfusions, which also help to reduce antibodies and reduce Rh conflict.

After childbirth, if the child has signs of HDN (the concept, or rather the abbreviation for hemolytic disease of the newborn) in a severe form, a transfusion may be recommended, with a mild form of the disease, it is simply treated symptomatically.

If any symptoms of HDN are detected, the doctors prohibit breastfeeding for the first two weeks, otherwise the conflict can be aggravated.

If the child does not have signs of this disease, you can breastfeed immediately after the introduction of the mother. a 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

Given that the Rh conflict occurs when the erythrocytes of the fetus enter the body with a positive Rh 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 during the entire pregnancy, blood is taken from the woman up to 1-2 times a month to detect antibodies in her (do not be afraid of this procedure, it is painless, a regular injection).

After childbirth, the Rh of the baby is determined, if it is positive, mothers are injected with a special serum to minimize the risk of an Rhesus conflict during the next gestation.

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

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

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

Future parents, even when planning the birth of a child, should be tested for the detection of the Rh factor in the blood. This is necessary in order to timely determine the possible incompatibility of a man and a woman. This research will help prevent adverse effects- the likelihood of a Rh-conflict between the child and the mother.

Rhesus conflict during pregnancy

During conception, an embryo from one parent receives a D-protein located on top of red blood cells. In the presence of Rh antigen D, the blood is considered positive, and in its absence - negative.Rhesus conflict iswhen future mother negative Rh, and the partner 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 with spontaneous miscarriage, premature detachment placenta, hemolytic disease of the infant.

Rhesus 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 used to be a woman did not have an abortion, and also did not transfuse blood products, thenRhesus conflict during first pregnancyalmost completely excluded.

Rhesus sensitization during re-carrying a child occurs more often. 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.Rhesus conflict during the second pregnancyand all subsequent ones, especially with a short time interval, negatively affects the health of the fetus.

Rhesus conflict during pregnancy - consequences for the child

For the future baby, the Rh-conflict is dangerous by 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. With immunological incompatibility, the child may be born in a particularly serious condition or dead. At less severe complications mainconsequences of Rhesus conflict for a child- this is an increase in the liver after birth, the 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 the Rhesus conflict:

• fast cuts eyeballs;
• generalized convulsions;
• high-pitched screams;
• asymmetric spasticity;
• deafness.

Rhesus conflict - causes

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 for a period of 8-9 weeks, and in some women even after six months, immunoglobulins appear that can cross the placenta.

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

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

Rhesus conflict during pregnancy - symptoms

The pregnant woman does not detect any specific clinical manifestations. The blood conflict during pregnancy is manifested only by pathologies of the fetus. Sometimes the development of incompatibility even leads to intrauterine death or miscarriage. The baby can be born dead, premature, with edematous, anemic or icteric form hemolytic disease. Mainsymptoms of rhesus conflictduring gestation and after the birth of the baby:

• the appearance of immature erythrocytes;
• hypoxic damage to internal organs;
• anemia;
• thickening of the placenta;
• growth in the size of the fetal abdomen;
• swelling of the tissues of the head;
• bilirubin intoxication of the central nervous system;
• increase in amniotic fluid.

Analysis for Rh conflict during pregnancy

To prevent the likelihood of a Rh conflict during gestation, mothers with Rh (-) are prescribedanalysis for rhesus conflict(for antibodies), which she must undergo monthly. In the presence of antibodies (any titer), a pregnant woman is observed at a local consultation until the 20th week, after which she is sent to specialized clinics to determine the tactics of treatment and the timing of childbirth. Starting from the 18th week, the condition of the fetus and other signs of the 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 at 28 weeks is intramuscular injection(shot) of anti-Rhesus immunoglobulin, preventing their further production. If after the birth of the baby's Rh is negative, then you can not be afraid of the future occurrence 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 initial stages, a woman is placed in a special clinic, where from 22 to 32 weeks they do an intrauterine transfusion, when the fetus is infused desired group blood. This gives a high possibility of full-fledged gestation and excludes further ectopic pregnancy.

Learn about, norm indicators during pregnancy and its planning.

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

Why does Rh conflict occur during pregnancy?

How does the presence or absence of a certain protein affect pregnancy? Problems can arise if the expectant mother is Rh negative, and the future father is Rh positive. Moreover, the danger arises only if there is a protein inherited from the father in the blood of the child. Then there is a chance that he will overcome the placental barrier and get into Rh negative blood mothers. Her body will receive a signal about the presence of a foreign agent and will immediately announce “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 a source of "strangers".

When incompatibility occurs, a special test is sometimes performed to determine the number of damaged erythrocytes of the embryo. This makes it possible to understand how dangerous the situation is. Protecting the mother's body, antibodies can cause serious damage to the fetus - up to its intrauterine death and miscarriage, and this can happen at any stage of pregnancy. The “attack” happens like this: the mother’s antibodies cross the placenta and destroy the baby’s “hostile” red blood cells. Appears in his blood a large number of bilirubin (this is 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, as the cells will lack oxygen.

Since the fetal erythrocytes are continuously destroyed during the Rhesus conflict, his liver and spleen begin to work in emergency mode, trying to speed up the production of new erythrocytes and compensate for the losses. But the mother's body is naturally stronger, so most often this " unequal fight» ends with the appearance of anemia in the fetus ( low content in the blood of erythrocytes and hemoglobin). In severe cases, only a replacement blood transfusion can help a newborn (he is injected with a suitable Rh-negative blood group). Unfortunately, this condition can cause brain damage, impaired hearing and speech in a child.

Rhesus conflict is inevitable? Is it necessary to have a Rh conflict between the mother and the fetus if the Rh factors of the parents are different?

Not necessarily. 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 that won't make a difference. Suppose a protein appears in the blood of the fetus. But exactly the same will be present in the blood of the mother. That's why protective system her body will take the baby for “its own” and will not take any action. If the child has not inherited the protein, then there will be no problems either - after all, there will simply be nothing to react to. Therefore, as mentioned above, the danger can only arise if the mother's blood is Rh-negative, and the father's blood is Rh-positive, and the child has inherited the protein from the father. Whether this happened, it becomes clear at the 8-10th week prenatal development. However, even with an Rh-incompatible pregnancy, the Rh conflict between mother and fetus does not always occur. It often happens that the amount of antibodies in the child's blood is so small that it does not pose a serious danger. So it's really not all 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 the 18-20th week. With the help of ultrasound at this time, signs of hemolytic disease of the fetus (thickening of the placenta, enlargement of the liver and spleen) can be determined. Also, the expectant mother regularly, during the entire period of pregnancy, must donate blood for the presence of antibodies. 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 for a period of 28 weeks, immunization with anti-Rhesus gamma globulin is carried out to prevent their formation. This preventive measure, a kind of "Rh-vaccination", which allows you to prevent the appearance of antibodies in the mother's blood that can begin to destroy the erythrocytes of the fetus.

If there is a tendency to increase 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 settings. An expectant mother can be assigned, 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, the blood protein is the Rh factor).

If suddenly the analysis shows a critical increase in the number of antibodies, it is necessary urgent hospitalization future mother to a specialized hospital, where her condition will be constantly monitored. In this situation, doctors should monitor the dynamics of an 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 bag) 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 them. If it is quite high, the doctor may prescribe one of the following procedures:

• by the most in a simple way will plasmapheresis- plasma is taken from a woman, purified from antibodies, and then poured back.
• Also carry out hemosorption- removal toxic substances using a special apparatus in which blood is passed through filters and then injected back into the body.
• In particular difficult cases appoint fetal blood transfusion. It is considered the most effective way fight against the progressing Rhesus-conflict. The principle is as follows: under the control of ultrasound in umbilical vein substances are introduced that relax the muscles of the fetus, and then - donor blood with a Rh-negative indicator, the erythrocytes of which should not be destroyed by "combat" maternal antibodies. After 2-3 weeks, the transfusion is repeated. In fact, donated blood temporarily replaces the fetus's own blood. If such a procedure does not help, the question of early birth arises. Therefore, doctors are doing their best to bring the 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 an Rhesus conflict can be very serious. Therefore, if you know that you have a negative Rh factor, and your husband is positive, 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 big 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 the onset of pregnancy, it is necessary to register as soon as possible in women's consultation and immediately inform the gynecologist about your Rh factor. In any case, it is important to remember: in itself, the likelihood of a Rh conflict and even the presence of antibodies in the blood are not contraindications to pregnancy, and certainly not a reason for its termination. Just such a pregnancy requires a much more responsible and attentive attitude. Try to find a competent specialist whom you could completely trust, and clearly follow all his recommendations.

Second pregnancy - the risk of Rh-conflict more?

Many women are concerned about the question - does the risk of Rh conflict increase during the second pregnancy? Indeed, if a Rh-negative mother has a second child, just like the first, has a positive Rh factor, the likelihood of an Rh conflict increases. The point is that after past pregnancy in the blood of a woman there are special cells that "remember" the past struggle. Therefore, during subsequent collisions with the “enemy” blood cells of the child, 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 certain preventive measures are not taken, then in subsequent pregnancies the likelihood of problems will increase significantly. To prevent this from happening, after the birth of the baby, the mother should 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. So the maternal immune system will not remember them and will not destroy them in the future. This greatly reduces the risk of complications during the next pregnancy. In order for the injection to be done for sure, it makes sense to discuss this issue with the doctor in advance and, if possible, control the timely administration of the drug after childbirth. Some prefer to buy the vaccine themselves.

Thus, if in the first Rh-incompatible pregnancy the problems of antibody production passed you, and the injection of immunoglobulin was carried out on time, next pregnancy will be no different from the previous one. That is, the likelihood of an Rhesus conflict will still remain small.