Waiting for the birth of the desired baby is an amazing time in the life of both parents, especially mothers. So far, she is not only the closest relative to her child, but the whole world and a cozy house. However, sometimes the maternal organism regards the person growing inside as an enemy and begins to behave accordingly. This situation is characteristic of the Rh conflict during pregnancy. It can happen only under certain conditions and is not a cause for panic, but knowledge of the issue and timely knowledge that you are at risk will help to avoid serious consequences.
What is the Rh factor of the blood, how can it be positive or negative?
Each person’s blood contains red blood cells - red cells that are not the same in all people. On the surface of red blood cells there is a complex of antigens - a specific set of marker proteins by which human blood is classified - belong to a particular group. The more similar the composition of these proteins is for people, the greater their blood compatibility (the blood of one fits the other when transfused, for example).
The Rhesus factor (aka Rh or just Rhesus) is one of the antigens that is found in the red blood cells of most people in the world. There are many antigens in total, but when determining the Rh factor, they speak of protein D. Europeans possess it in 85% of cases, Asians in almost 99% and Africans in 93-95%. These people are called Rh-positive or have a positive blood type. The rest, respectively, will be owners of negative blood.
This difference does not affect the functioning of the body and general human health. Information is important in case of a blood transfusion or when planning a pregnancy, if the expectant mother is Rh-negative.
How and when rhesus is determined, the likelihood of conflict
The Rh factor of a person is determined at the time of conception and, with the exception of rare cases, remains unchanged throughout life. The probability is determined genetically, depending on what Rhesus is in each of the future parents.
Sometimes a blood type conflict occurs during pregnancy, and Rh in this case has absolutely nothing to do with it. Violations are caused by incompatibility in the AB0 system (most likely, when a woman has the first group - 0, and a baby has any other group that contains enzymes in red blood cells that are absent in the mother). However, this cause of the pathology is more rare than the Rh conflict (approximately one case in two to three hundred of all pregnancies, accompanied by risks of blood incompatibility).
A mother with a positive Rh factor of blood has no reason to conflict with her unborn baby, even if his Rhesus factor does not coincide with her, because in this case there is a protein in female red blood cells that the baby does not possess. Therefore, for the maternal body, no component of the fetal blood will be foreign, there will be nothing to defend against.
If the mother and the child are both Rhesus negative, the immune system will not follow either, since protein D is absent in both.
Only couples in which the Rhesus mother is negative and the father is positive have a chance of a Rhesus conflict in the blood type during pregnancy. In this case, having inherited the blood rhesus from the father, the baby can become hostile to the mother’s body on this basis. However, such a reaction of the female body does not always occur and not immediately. On numerous forums, you can find a lot of reviews about Rh-conflict pregnancies at risk, but in the end they are not problematic. Often, Rh-negative mothers of two or more Rh-positive children did not encounter the problem of blood incompatibility.
Rhesus Conflict
In the process of bearing a child, his blood and mother's blood mix. This can occur during natural childbirth, during cesarean section, interruption of an ordinary or ectopic pregnancy, in cases of diagnostic procedures, when the study is carried out using samples taken from the body of an unborn baby.
If there is no protein D in the mother’s blood and he never got into it, then antibodies to a foreign antigen have not yet developed in her body. After such a case, the Rh-negative organism produces antibodies to get rid of the hostile element in the blood, but the first substances produced are not very strong and are not able to overcome the protective barrier of the placenta to harm the baby. Therefore, the Rhesus conflict during the first pregnancy is unlikely.
However, upon repeated contact of a Rhesus negative mother with a positive child, her body already has experience of protection and produces antibodies of a different class, stronger. They easily overcome the placental barrier and enter the blood of the fetus, which can harm and cause negative consequences for the child.
Rhesus conflict during pregnancy becomes more and more possible and strong with each subsequent contact of the Rh negative mother with positive blood, be it a pregnancy or an incorrect transfusion. Therefore, for women with Rh- it is vital to know about the features of their blood. It is important to avoid abortions and unsuccessful pregnancies.
Symptoms of the Rh conflict during pregnancy
There are no special manifestations of the Rhesus conflict noticeable to the expectant mother. This fact does not affect the woman’s feelings. To determine pathological disorders, a laboratory test and an ultrasound examination will be required.
Some experts note a general deterioration in the condition of the mother in the event of a Rh conflict in the blood group during pregnancy, the appearance of edema, and an increase in blood pressure. This phenomenon is called the “mirror syndrome” - the more antibodies the baby produces, the worse she feels. However, the results of such studies have not been scientifically confirmed; officially, doctors do not link these two facts.
The manifestations and consequences of the Rh conflict during pregnancy directly concern the baby.
What threatens the Rhesus conflict?
The occurrence of a Rhesus conflict during pregnancy threatens the health, and sometimes the life of a little man. Exposure to the antibodies of the mother’s body can lead to complications such as:
- miscarriage;
- the birth of a premature baby;
- hemolytic disease of the fetus and newborn.
All the complications arising as a consequence of the Rh conflict can be attributed to the problems associated with hemolytic disease, but not in all cases, doctors can reliably establish the cause of premature arbitrary termination of pregnancy.
How is hemolytic disease manifested?
Otherwise, this dangerous pathology is called fetal erythroblastosis. The main violation in the body is the breakdown of red blood cells (hemolysis). Hemolysis products are toxic and cause swelling, hemolytic jaundice (an increase in the amount of bilirubin pigment in the blood, one of the main components of bile resulting from the breakdown of red blood cells), hemolytic anemia (a decrease in the amount of red blood cells and hemoglobin, the blood pigment responsible for oxygen transfer).
The consequences of hemolytic disease
Intrauterine symptoms of hemolytic disease are recorded in the second half of pregnancy. Possible complications are different depending on the form of its manifestation.
Anemia provokes a lack of oxygen and can lead to pathological changes in the central nervous system, including the brain, slowed fetal growth, and impaired functioning of the intestines, heart, and kidneys. With a severe manifestation of the disease, a newborn can manifest many problems, both in the work of various body systems and in mental development. Usually this form of the disease is easier and the prognosis for the development of the child is often favorable.
Jaundice during pregnancy is almost not manifested, complications mainly relate to already born children. In the first few days of life, intoxication of the body, a significant increase in the volume of the liver and spleen, manifestations characteristic of a severe course of the anemic variant of the disease are detected. Convulsions, heart attack, disturbances in the respiratory system can occur, leading to the death of the baby. Forecasts are determined by the degree of damage to the nervous system - from the normal development of the child to mental retardation or death.
Edematous manifestation of hemolytic disease is the most dangerous and severe. It is expressed in a strong general edema, the presence of fluid in the cavities of the child's body. The liver, heart, spleen are greatly enlarged. Often leads to the death of the fetus or newborn.
Measures to eliminate hemolytic disease
It is not always possible to get rid of the consequences of the disease, but in cases where there is a chance to defeat the disease, the faster the treatment process begins, the higher the chances of saving the baby and its further normal development.
A newborn receives several blood transfusions - first, a general replacement, and then an infusion aimed at regulating some of its necessary components. In severe prenatal manifestations of the disease, blood transfusion is performed in utero.
Intravenous administration of special nutritional strengthening solutions or heavy drinking is prescribed.
About three weeks later, maternal breastfeeding is canceled - it is during this time that antibodies to the components of the baby’s blood are removed from the female body. During this period, it is possible to use mother's milk, but only after boiling.
The consequences of the disease, manifested later - with the further development of the child - are adjusted in accordance with their type and severity.
Prevention of hemolytic disease
Methods for preventing hemolytic disease are:
- prevention of potential Rh antibodies from the potential mother: avoidance of incorrect blood transfusions, exclusion of abortions;
- elimination of the consequences of the primary manifestation of blood incompatibility after childbirth, ectopic or incomplete pregnancy. In these cases, a woman is injected with an anti-Rhesus immunoglobulin - this is a kind of vaccine against the occurrence of a Rhesus conflict during pregnancy. The injection is done once intramuscularly in the event that antibodies have not yet formed in the mother's body. This procedure is carried out at the 28th week of pregnancy and repeatedly within 3 days after the birth of a child with Rh-positive blood, or once after childbirth (many questions are asked on the rationality of such a vaccination in the forums, most experienced mothers advise to resort to this procedure only with the second Rhesus-conflict pregnancy); with a high probability of a miscarriage or miscarriage that occurred at any gestation period; after abortion; if possible damage to the tissues of the abdominal cavity is detected - after some types of intrauterine diagnosis or trauma.
Precautions can reduce the likelihood of developing a Rhesus conflict to a minimum. In some countries, this duty is entirely assigned to the attending physician and in the event of a Rhesus conflict, the specialist loses his diploma.
Diagnosis of Rh factor conflict during pregnancy
Expectant mothers who register for pregnancy donate blood three times - at the first visit to the doctor, at the 30-week gestation period and immediately before delivery. This schedule is standard and can be changed if more careful monitoring of the condition of mother and baby is necessary.
In the case of a woman with negative blood, the analysis for Rh conflict during pregnancy is carried out at least once a month. Early diagnosis of rhesus blood of the fetus allows you to take timely measures and avoid more traumatic and dangerous procedures.
A standard secondary ultrasound examination for any pregnancy for a period of 18 to 24 weeks allows you to identify the primary signs of hemolytic disease of the fetus. Depending on the presence and course of the disease, further examinations are prescribed:
- If a blood test and an ultrasound scan do not show the presence of abnormalities, then the third screening is carried out at standard times (at 32-34 weeks of gestation).
- When antibodies to Rh-positive blood are detected in the mother’s blood, but there are no fetal development disorders determined by the second ultrasound, the study is repeated every two weeks.
- If signs of hemolytic disease are detected by ultrasound, the fetus is monitored much more often - from daily to weekly. The frequency is determined by the current diagnostic readings.
Signs of the manifestation of the Rhesus conflict during pregnancy, determined by ultrasound, are: an increase in the spleen and liver of the fetus, a thickening of the placenta by more than 5 millimeters, an excessive amount of amniotic fluid, an expansion of the umbilical cord vein to a diameter of more than one centimeter. Additionally, fetal blood flow velocity can be measured. If the blood in the middle artery of the brain moves too fast, invasive diagnostic procedures are prescribed - analysis of biological material taken directly from the fetus or of fruit origin (amniotic fluid, placenta, umbilical cord blood).
Invasive procedures are carried out only in case of emergency and only with the consent of the mother, as they carry a certain risk for the unborn baby.
Childbirth in Rh conflict
Natural births are considered more preferable during pregnancy with a blood rhesus conflict, since surgical operations increase the risk of plentiful ingestion of Rh-positive blood of the baby into the mother's body, and also increase the sensitivity of her immune system to D. antigens.
Nevertheless, in some cases, preference is given to cesarean section:
- a severe form of hemolytic disease of the fetus;
- underdevelopment of the cervix or its immaturity before childbirth (physiological unpreparedness, softness, which normally should occur 2-4 days before childbirth);
- extragenital pathology - any of many different diseases of the body, disorders and syndromes of varying severity and significance, manifested in a pregnant woman and not associated with gynecological diseases or directly complications of the process of bearing a child.
Is a successful pregnancy possible after being weighed?
With all the possibilities of modern medicine, cases of unsuccessful completion of a Rh-conflict pregnancy are recorded - fetal death, increased production of antibodies to positive RH in the mother.
Even with such pathologies, one should not despair and abandon the hope of giving birth to a healthy baby, since artificial, in vitro fertilization of a Rh-negative mother by an embryo compatible with her is possible.