The time of bearing a child is one of the most wonderful times in a woman's life. Every expectant mother wants to be calm about the baby's health, enjoy the period of waiting for the addition. But every tenth lady, according to statistics, has Rh-negative blood, and this fact worries both the pregnant woman herself and the doctors who observe her.
What is the possibility of a Rh conflict between mother and baby, and what is the danger, we will tell in this article.
What it is?
When a woman and her future toddler have different blood counts, immunological incompatibility may begin, it is she who is called Rh-conflict. Representatives of humanity who have a Rh factor with a + sign have a specific protein D, which erythrocytes contain. A person with rhesus does not have a negative value for this protein.
Scientists still do not know for sure why some people have a specific protein of the rhesus macaque, while others do not. But the fact remains - about 15% of the world's population have nothing in common with macaques, their Rh factor is negative.
Between the pregnant woman and the child, there is a constant exchange through the uteroplacental blood flow. If the mother has a negative Rh factor, and the baby has a positive one, then the D protein entering her body is nothing more than a foreign protein for a woman.
The mother's immunity very quickly begins to react to the intruder, and when the protein concentration reaches high values, the rhesus conflict begins... This is a merciless war, which the immune defense of a pregnant woman declares to a child as a source of a foreign antigen protein.
The immune cells begin to destroy the baby's red blood cells with the help of special antibodies that it produces.
The fetus suffers, the woman experiences sensitization, the consequences can be quite sad, up to the death of the baby in the womb, the death of the baby after the birth or birth of a disabled child.
Rh-conflict can happen in a pregnant woman with Rh (-), if the baby has inherited the father's blood characteristics, that is, Rh (+).
Much less often, incompatibility is formed by such an indicator as a blood group, if a man and a woman have different groups. That is, a pregnant woman whose own Rh factor has positive values has nothing to worry about.
There is no reason to worry and families with the same negative rhesus, but this coincidence does not happen often, because among 15% of people with "negative" blood - the overwhelming majority of the fair sex, men with such blood characteristics are only 3%.
The toddler's own hematopoiesis in the womb begins at about 8 weeks gestation... And from that moment, a small number of fetal erythrocytes is determined in the laboratory in maternal blood tests. It is from this period that the possibility of a Rh-conflict arises.
Probability tables
From the point of view of genetics, the probability of inheriting the main characteristics of the blood - the group and the Rh factor from the father or mother - is estimated equally at 50%.
There are tables that allow you to assess the risks of Rh-conflict during pregnancy. Timely balanced risks give doctors time to try to minimize the consequences. Unfortunately, medicine cannot completely eliminate the conflict.
Rh factor
By blood type
Causes of the conflict
The likelihood of developing Rh-conflict strongly depends on how and how the woman's first pregnancy ended.
Even a "negative" mother can safely give birth to a positive baby, because during the first pregnancy, a woman's immunity does not yet have time to develop a lethal amount of antibodies to protein D. life-saving situations.
If the first pregnancy ended in miscarriage or abortion, then the likelihood of Rh-conflict in the second pregnancy increases significantly, since the woman's blood already has antibodies ready for an attack at an early stage.
In women who had a cesarean section during the first birth, the likelihood of conflict during the second pregnancy is 50% higher compared to women who gave birth to their first child naturally.
If the first birth was problematic, the placenta had to be manually separated, there was bleeding, then the likelihood of sensitization and conflict in subsequent pregnancy also increases.
Diseases during the period of gestation are also dangerous for the expectant mother with a negative Rh factor. Influenza, acute respiratory viral infections, gestosis, diabetes in history can provoke structural disruption chorionic villi, and mother's immunity will begin to produce antibodies destructive for the baby.
After giving birth, the antibodies that were developed during the gestation of the crumbs do not disappear anywhere. They represent the long-term memory of the immune system. After the second pregnancy and childbirth, the amount of antibodies becomes even higher, as well as after the third, and subsequent.
The danger
The antibodies that maternal immunity produces are very small in size, they can easily penetrate the placenta into the bloodstream of the baby. Getting into the child's blood, the mother's protective cells begin to inhibit the function of the fetal hematopoiesis.
The child suffers, suffers from oxygen deficiency, since decaying red blood cells are the carriers of this vital gas.
In addition to hypoxia, fetal hemolytic disease may develop., and subsequently a newborn. It is accompanied by severe anemia. The internal organs of the fetus enlarge - the liver, spleen, brain, heart and kidneys. The central nervous system is affected by bilirubin, which is formed during the breakdown of red blood cells and is toxic.
If doctors do not start to take action in time, then the baby may die in utero, be born dead, be born with severe damage to the liver, central nervous system, kidneys. Sometimes these lesions turn out to be incompatible with life, sometimes they lead to deep lifelong disability.
Diagnosis and symptoms
The woman herself cannot feel the symptoms of the developing conflict of her immunity with the blood of the fetus. There are no symptoms by which the expectant mother could guess about the destructive process that is taking place inside her. However, laboratory diagnostics can detect and track the dynamics of the conflict at any time.
To do this, a pregnant woman with Rh negative blood, regardless of which group and Rh factor of the father's blood, take a blood test from a vein for the content of antibodies in it. The analysis is done several times during pregnancy, the period from 20 to 31 weeks of pregnancy is considered especially dangerous.
The antibody titer obtained as a result of laboratory research indicates how severe the conflict is. The doctor also takes into account the degree of maturity of the fetus, because the older the baby is in the womb, the easier it is for him to resist an immune attack.
In this way, titer 1: 4 or 1: 8 at 12 weeks gestation is a very alarming indicator, and a similar titer of antibodies for a period of 32 weeks will not cause panic in the doctor.
When a titer is detected, the analysis is done more often in order to observe its dynamics. In a severe conflict, the titer rises rapidly - 1: 8 can turn into 1: 16 or 1: 32 in a week or two.
A woman with antibody titers in the blood will have to visit the ultrasound office more often. By ultrasound, it will be possible to monitor the development of the child, this research method provides sufficiently detailed information about whether the child has hemolytic disease, and even about what form it has.
With the edematous form of hemolytic disease of the fetus, the ultrasound will reveal an increase in the size of the internal organs and the brain, the placenta thickens, the amount of amniotic fluid also increases and exceeds normal values.
If the estimated weight of the fetus is 2 times higher than the norm, this is an alarming sign. - dropsy of the fetus is not excluded, which can lead to death even in the mother's womb.
Hemolytic disease of the fetus associated with anemia cannot be seen on ultrasound, but it can be diagnosed indirectly on CTG, since the number of fetal movements and their nature will indicate the presence of hypoxia.
About lesions of the central nervous system will become known only after the birth of the child, this form of hemolytic disease of the fetus can lead to a delay in the baby's development, to hearing loss.
Doctors in the antenatal clinic will deal with diagnostics from the very first day of registering a woman with a negative Rh factor. They will take into account how many pregnancies were, how they ended, whether children with hemolytic disease have already been born. All this will enable the doctor to assume the possible likelihood of a conflict and predict its severity.
During the first pregnancy, a woman will have to donate blood once every 2 months, with the second and subsequent - once a month. After 32 weeks of pregnancy, the analysis will be done once every 2 weeks, and from 35 weeks - every week.
If an antibody titer appears, which can occur at any time after 8 weeks, additional research methods may be prescribed.
With a high titer that threatens the child's life, a cordocentesis or amniocentesis procedure may be prescribed. The procedures are carried out under ultrasound control.
During amniocentesis, an injection is made with a special needle and a certain amount of amniotic fluid is taken for analysis.
With cordocentesis, blood is taken from the umbilical cord.
These analyzes make it possible to judge which blood group and Rh factor are inherited by the baby, how severely his red blood cells are affected, what is the level of bilirubin in the blood, hemoglobin, and with 100% probability determine the sex of the child.
These invasive procedures are voluntary, the woman is not forced to do them. Despite the current level of development of medical technologies, such interventions as cordocentesis and amniocentesis can still cause miscarriage or premature birth, as well as death or infection of the child.
The obstetrician-gynecologist who is leading her pregnancy will tell the woman about all the risks of carrying out procedures or refusing them.
Possible consequences and forms
Rhesus conflict is dangerous both during the period of bearing a baby, and after his birth. The disease with which such children are born is called hemolytic disease of the newborn (HDN). Moreover, its severity will depend on the amount of antibodies attacked the blood cells of the crumbs during pregnancy.
This ailment is considered severe, it is always accompanied by the breakdown of blood cells, which continues after birth, edema, jaundice of the skin, severe bilirubin intoxication.
Edematous
The most severe is the edematous form of HDN. With her, the little one is born very pale, as if "bloated", edematous, with multiple internal edema. Such crumbs, unfortunately, in most cases are born already dead or die, despite all the efforts of resuscitators and neonatologists, die in the shortest possible time from several hours to several days.
Jaundice
The icteric form of the disease is considered more favorable. Such babies, a couple of days after their birth, "acquire" a rich yellowish skin color, and such jaundice has nothing to do with the common physiological jaundice of newborns.
The baby has a slightly enlarged liver and spleen, blood tests show anemia. The level of bilirubin in the blood rises rapidly. If doctors fail to stop this process, then the disease can turn into nuclear jaundice.
Nuclear
The nuclear type of HDN is characterized by lesions of the central nervous system. A newborn may have seizures and may involuntarily move his eyes. The tone of all muscles is reduced, the child is very weak.
When bilirubin is deposited in the kidneys, the so-called bilirubin infarction occurs. A heavily enlarged liver cannot normally perform the functions assigned to it by nature.
Forecast
Doctors are always very careful in predicting HDN, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the baby in the future.
Children are given detoxification infusions in resuscitation, very often there is a need for replacement blood or donor plasma transfusions. If on the 5-7th day the child does not die from paralysis of the respiratory center, then the forecasts change to more positive ones, however, and they are rather arbitrary.
After suffering from hemolytic disease of newborns, children suck poorly and sluggishly, their appetite is reduced, sleep is disturbed, and there are neurological abnormalities.
Quite often (but not always), such children have a significant lag in mental and intellectual development, they get sick more often, hearing and vision impairments may be observed. Cases of anemic hemolytic disease end most safely, after the level of hemoglobin in the blood of the crumbs can be raised, it develops quite normally.
A conflict that has developed not because of the difference in Rh factors, but because of the difference in blood groups, proceeds more easily and does not usually have such destructive consequences. However, even with such an incompatibility, there is a 2% probability that the baby will develop quite serious central nervous system disorders after birth.
The consequences of the conflict for the mother are minimal. She cannot feel the presence of antibodies in any way, difficulties can arise only during the next pregnancy.
Treatment
If a pregnant woman has a positive antibody titer in the blood, this is not a reason for panic, but a reason for starting therapy and taking it seriously on the part of the pregnant woman.
It is impossible to save a woman and her baby from such a phenomenon as incompatibility. But medicine can minimize the risks and consequences of the influence of maternal antibodies on the baby.
Three times during pregnancy, even if antibodies do not appear during gestation, the woman is prescribed treatment. At 10-12 weeks, at 22-23 weeks and at 32 weeks, the expectant mother is recommended to take vitamins, iron preparations, calcium preparations, drugs that improve metabolism, oxygen therapy.
If up to 36 weeks of gestational age the titers were not found, or they are low, and the development of the child does not cause concern for the doctor, then the woman is allowed to give birth naturally on her own.
If the titers are high, the child's condition is serious, then the delivery can be carried out ahead of time by cesarean section. Doctors try to support the pregnant woman with medications until the 37th week of pregnancy, so that the child has the opportunity to "mature".
Unfortunately, such a possibility is not always available. Sometimes you have to make a decision about an earlier cesarean section in order to save the baby's life.
In some cases, when the baby is clearly not yet ready to appear in this world, but it is very dangerous for him to remain in the womb of his mother, intrauterine blood transfusion is carried out to the fetus.All these actions are performed under the control of an ultrasound scanner, every movement of the hematologist is verified so as not to harm the baby.
In the early stages, other methods of preventing complications can be used. So, there is a technique for stitching a pregnant woman with a piece of her husband's skin. A skin flap is usually implanted on the lateral surface of the chest.
While a woman's immunity is throwing all its strength into rejection of a skin fragment foreign to itself (and this is several weeks), the immunological load on the child is somewhat reduced. Scientific disputes about the effectiveness of this method do not subside, but the reviews of women who have gone through such procedures are quite positive.
In the second half of pregnancy, with an established conflict, plasmapheresis sessions can be assigned to the expectant mother, this will slightly reduce the amount and concentration of antibodies in the maternal body, respectively, the negative load on the baby will also temporarily decrease.
Plasmapheresis should not scare a pregnant woman, there are not so many contraindications to it. Firstly, this is an acute respiratory viral infection or another infection in the acute stage, and, secondly, the threat of miscarriage or premature birth.
There will be about 20 sessions. In one procedure, about 4 liters of plasma are cleared. Along with the infusion of donor plasma, protein preparations are injected, which are necessary for both mother and baby.
Babies who have suffered from hemolytic disease are shown regular examinations by a neurologist, massage courses in the first months after birth to improve muscle tone, as well as vitamin therapy courses.
Prevention
A pregnant woman at 28 and 32 weeks is given a kind of vaccination - an anti-rhesus immunoglobulin is injected. The same drug must be administered without fail to a woman in labor after childbirth no later than 48-72 hours after the birth of the baby. This reduces the likelihood of conflict development in subsequent pregnancies to 10-20%.
If a girl has a negative Rh factor, she should know about the consequences of abortion during the first pregnancy. It is desirable for such representatives of the fair sex keep the first pregnancy at any cost.
Blood transfusion without taking into account the Rh-affiliation of the donor and recipient is not acceptable, especially if the recipient has his own Rh with a "-" sign. If such a transfusion takes place, an anti-rhesus immunoglobulin should be administered to the woman as soon as possible.
A full guarantee that there will be no conflict can only be given by a Rh-negative man, moreover, preferably with the same blood group as his chosen one. But if this is not possible, you should not postpone pregnancy or abandon it just because a man and a woman have different bloods. In such families, planning for a future pregnancy plays an important role.
A woman who wants to become a mother needs to undergo blood tests to detect antibodies to protein D even before the “interesting situation” occurs. If antibodies are found, this does not mean that the pregnancy will have to be terminated or that it is impossible to become pregnant. Modern medicine does not know how to eliminate the conflict, but it knows perfectly well how to minimize its consequences for the child.
The introduction of anti-rhesus immunoglobulin is important for women whose blood does not yet contain antibodies that are not sensitized. They need to do such an injection after an abortion, after even a slight bleeding during pregnancy, for example, with a slight placental abruption, after surgery for an ectopic pregnancy. If antibodies are already there, then you should not expect a special effect from vaccination.
Common questions
Can I breastfeed my baby?
If a woman with a negative Rh factor has a child with a positive Rh factor, and there is no hemolytic disease, then breastfeeding is not contraindicated.
Babies who have experienced an immune attack and were born with hemolytic disease of newborns are not recommended to eat breast milk for 2 weeks after the administration of immunoglobulin to their mother. In the future, neonatologists make the decision about breastfeeding.
In severe hemotic disease, breastfeeding is not recommended. To suppress lactation, a woman after childbirth is prescribed hormonal drugs that suppress milk production in order to prevent mastopathy.
Is it possible to carry a second child without conflict if there was a conflict during the first pregnancy?
Can. Provided that the child inherits a negative Rh factor. In this case, there will be no conflict, but antibodies in the mother's blood can be detected during the entire gestation period, and in a sufficiently high concentration. They will not affect the baby with Rh (-) in any way, and you should not worry about their presence.
Before getting pregnant again, mom and dad should visit a geneticist who will give them comprehensive answers about the likelihood of their future children inheriting one or another blood characteristic.
Daddy's Rh factor unknown
When the expectant mother is registered with the antenatal clinic, immediately after she has a negative rhesus, the father of the future baby is also invited to the consultation for a blood test. Only in this way can the doctor be sure that he knows exactly the initial data of the mother and father.
If the dad's rhesus is unknown, and it is impossible to invite him to donate blood for some reason, if the pregnancy came from IVF with donor sperm, then a woman will have a blood test for antibodies a little more oftenthan other pregnant women with the same blood. This is done in order not to miss the moment of the beginning of the conflict, if any.
And the doctor's proposal to invite her husband to donate blood for antibodies is a reason to change the doctor to a more competent specialist. There are no antibodies in the blood of men, since they do not become pregnant and do not physically come into contact with the fetus during their wife's pregnancy.
Is there any fertility impact?
There is no such connection. The presence of a negative rhesus does not mean that it will be difficult for a woman to get pregnant.
Fertility is influenced by completely different factors - bad habits, caffeine abuse, excess weight and diseases of the genitourinary system, a burdened history, including a large number of abortions in the past.
Is a medical or vacuum abortion safe for terminating the first pregnancy in an Rh negative woman?
This is a common misconception. And, unfortunately, such a statement can often be heard even from medical workers. The abortion technique does not matter. Whatever it is, the baby's red blood cells still enter the mother's bloodstream and cause antibodies to form.
If the first pregnancy ended in abortion or miscarriage, how great are the risks of conflict in the second pregnancy?
In fact, the magnitude of such risks is a rather relative concept. No one can say with an accuracy of a percentage whether there will be a conflict or not. However, doctors have certain statistics that estimate (approximately) the likelihood of sensitization of the female body after an unsuccessful first pregnancy:
- short term miscarriage - + 3% to a possible future conflict;
- artificial termination of pregnancy (abortion) - + 7% to the likely future conflict;
- ectopic pregnancy and surgery to eliminate it - + 1%;
- delivery on time with a live fetus - + 15-20%;
- delivery by cesarean section - + 35-50% to a possible conflict during the next pregnancy.
Thus, if a woman's first pregnancy ended in abortion, the second in miscarriage, then during the gestation of the third, the risks are estimated at about 10-11%.
If the same woman decides to give birth to another baby, provided that the first birth went well naturally, then the probability of the problem will be more than 30%, and if the first birth ended with a cesarean section, then more than 60%.
Accordingly, any woman with a negative Rh factor who is planning to become a mother again can weigh the risks.
Does the presence of antibodies always indicate that the child will be born sick?
No, this is not always the case. The baby is protected by special filters in the placenta, which partially inhibit aggressive maternal antibodies.
A small amount of antibodies will not do much harm to a child. But if the placenta ages ahead of time, if the amount of water is small, if a woman is ill with an infectious disease (even a common ARVI), if she takes medications without supervision from the attending physician, then the likelihood of a decrease in the protective functions of placenta filters increases significantly, and the risk of giving birth to a sick baby will increase ...
It should be borne in mind that during the first pregnancy, antibodies, if they appear, have a sufficiently large molecular structure, it can be difficult for them to "break through" the protection, but with repeated pregnancy, the antibodies are smaller, mobile, fast and "evil", therefore the immunological attack becomes more probable.
Is there a conflict during pregnancy, contrary to all predictions and tables, between two negative parents?
This cannot be ruled out, despite the fact that all existing genetic tables and teachings indicate that the probability tends to zero.
Some of the three mom-dad-child may turn out to be a chimera. Chimerism in humans sometimes manifests itself in the fact that once transfused blood of a different group or rhesus "takes root", and a person is a carrier of genetic information about two types of blood at once. This is a very rare and little-studied phenomenon, although experienced doctors will never discount it.
Everything related to the issues of genetics is not well understood yet, and any "surprise" can be obtained from nature.
History knows several cases when a mother with Rh (-) and a father with a similar rhesus had a child with positive blood and hemolytic disease. The situation requires careful study.
For more information on the likelihood of Rh-conflict during pregnancy, see the next video.
