Planning and management of pregnancy in women with negative Rh factor. IVF in patients with negative Rh factor Consequences for the expectant mother

For children
04.05.2020

Rh conflict is a dangerous condition that often ends in the death of the fetus or newborn. It occurs as a result of immunological incompatibility between a woman and her child. Occurs most often during the re-pregnancy of an Rh-negative patient with a Rh-positive fetus.

Prevalence

Studies from Western countries show that Rh conflict is the second most common cause of stillbirth. Hemolytic disease of the fetus (HDF) caused by this condition is diagnosed in 1 in 200 infants.

Russian studies demonstrate:

  • 63% risk of HDP in Rh-sensitized mothers;
  • 18% risk of stillbirth due to Rh conflict.

Different countries have different rates of HDP. It is primarily due to the prevalence of carriage of the Rh antigen. Rhesus conflicts are least common in Japan and China. On average, people of the European race are Rh-positive in 85% of cases, and Rh-negative in 15% of cases.

Causes

An Rh conflict occurs if the child is a carrier of the Rh antigen. There are already 55 known such antigens that can be determined in the laboratory. The most common of them are: D, C, E. Antigen D is the most immunogenic. When it is carried, the highest frequency of HDP is observed. It causes the formation of many antibodies in maternal blood, even at minimal concentrations. Rh antigens are inherited.

Rh conflict occurs when Rh antigens are introduced into the blood of an Rh negative person. This leads to the production of antibodies. The immune system begins to defend against antigens. It produces antibodies that destroy red blood cells. These are red blood cells that carry oxygen. It is on their surface that Rh antigens are located.

If the mother is Rh negative, her immune system is not familiar with these antigens. He perceives them as alien. Therefore, if the child is Rh positive (and the probability of this is 85%), the production of antibodies begins, aimed at destroying the fetal red blood cells.

There are immunoglobulins of different classes. The concentration of immunoglobulins G is of greatest clinical importance. They practically do not pass through the placenta until 24 weeks. Therefore, before this period, a Rhesus conflict almost never develops in a pregnant woman (except in cases where damage to the placental barrier occurs).

What is sensitization?

Sensitization is the process of “acquaintance” of the mother’s immunity with the antigens contained on the fetal red blood cells. After this, the production of specific antibodies begins that can attach to antigens and provoke hemolysis of red blood cells. However, this does not happen instantly. The body needs time for immunoglobulins to form in large quantities.

In the vast majority of clinical situations, sensitization does not occur during the first pregnancy. Rh antigens are contained in fetal red blood cells. Although she and her mother share a common bloodstream, red blood cells usually do not pass through the blood-placental barrier. That is, they do not enter the mother’s bloodstream from the fetal vessels. And this is a necessary condition for maternal immunity to “get acquainted” with antigens and produce immunoglobulins.

In no more than 5% of women, fetal red blood cells enter the bloodstream in the first trimester, in 15% in the 2nd trimester, in 30% in the third trimester. In most cases, contact with red blood cells occurs only during labor. It is this moment that triggers sensitization.

For this reason, in the vast majority of cases, during the first pregnancy there is no Rh conflict, even if the mother is negative for the Rh antigen and the fetus is positive. In more than 99% of cases, HDP manifests itself only in the 2nd or more pregnancies. Even during childbirth, immunization does not always occur. The risk increases with manual separation of the placenta and cesarean section.

Sometimes sensitization occurs even if the pregnancy did not result in childbirth. This is possible if:

  • an abortion was performed;
  • a miscarriage occurred;
  • amniocentesis was performed in the 2nd or 3rd trimester;
  • fetoplacental bleeding occurred.

Although during gestation a few fetal blood cells enter the mother's blood, this is not enough for immunization. It is believed that 50-75 ml of red blood cells are required for the primary immune response. But for secondary, only 0.1 ml of red blood cells is enough.

Diagnostics

Diagnostics is based on confirmation of the formation and titer of erythrocyte antibodies in the blood plasma of the expectant mother. Their formation in large numbers indicates that immunization has taken place.

Titer is a concept that determines the amount of immunoglobulins. When determining most laboratory parameters, the concentration is assessed - the mass or amount of a substance per unit volume of blood. But instead of concentration in immunology, the titer of immunoglobulins is determined - this is a dilution of blood serum while maintaining its immunogenicity.

For example, the doctor dilutes the serum by 2 times. It evaluates whether there is an immune reaction when an antigen is added to it. If there is one, it dilutes it 2 times more and so on. Let's say he reaches a dilution of 1:32, and there is no longer a reaction. This means that the antibody titer is 1:16 (since this is the last dilution at which the immune response was still detectable).

All patients with Rh-negative blood donate blood for antibodies. This is done in the first trimester of pregnancy. Then the analysis is repeated once a month. The very fact of detection of immunoglobulins indicates a high risk of HDP. In this case, the titer has a certain prognostic value, but is still not used as a criterion influencing the choice of patient management tactics.

Other tests used to diagnose HDP:

  • Ultrasound of the fetus and placenta;
  • Doppler cerebral blood flow;
  • If non-invasive data are obtained in favor of Rh conflict, amniocentesis or cordocentesis is performed.

Ultrasound to detect signs of HDP begins at 18 weeks. They are not determined until this date. If the results of ultrasound and Doppler are favorable, further studies are carried out at intervals of 2-3 weeks. If signs of incipient hemolytic disease are detected, the condition of the fetus is assessed every few days.

The most accurate method for diagnosing HDP is considered to be cordocentesis and assessment of various indicators in umbilical cord blood. But this is an invasive procedure. It increases the risk of sensitization. Therefore, cordocentesis is performed only if signs of fetal anemia are detected on ultrasound.

Basic indicators:

  • hematocrit - the ratio of formed elements to the liquid part of the blood;
  • the level of hemoglobin - a protein contained in red blood cells that carries oxygen;
  • bilirubin level is a substance formed during the breakdown of red blood cells.

The blood must be tested for Rh status.

The fetus always has anemia if Rh conflict develops during pregnancy. Table of ideal hemoglobin (grams per liter) and hematocrit (%) in umbilical cord blood, based on gestational age:

In recent years, the method of studying fetal red blood cells has been increasingly used to avoid invasive interventions. The material used is maternal blood. The Rhesus status of the fetus is determined by its DNA.

Treatment

To treat HDP, intravascular blood transfusion (blood transfusion) is used. It is indicated only for moderate or severe anemia. Washed red blood cells are transfused into the fetus. They reduce immunization, reduce the likelihood of an edematous form of hemolytic disease and allow you to prolong pregnancy until delivery becomes safe.

Only washed red blood cells from Rh-negative donor blood are injected into the fetus. They are administered at a rate of 1-2 ml per minute. To combat edema, a 20% albumin solution is administered. After the procedure, blood is taken from the umbilical cord for analysis. It re-determines the hematocrit and hemoglobin level.

If necessary, the procedure can be repeated. The decision about whether it is needed or not is made based on measuring the speed of blood flow in the middle cerebral artery (for this purpose, Doppler ultrasound is performed - one of the types of ultrasound). Intrauterine transfusions are carried out until 32-34 weeks. In the future, the issue of early delivery is resolved.

The following methods were previously used, but are now found to be ineffective:

  • desensitizing therapy;
  • extracorporeal blood purification (including plasmapheresis);
  • transplantation of a skin flap from a spouse.

Forecast

Rhesus conflict during pregnancy does not always have serious consequences. In a mild form, hemolytic disease occurs with a small titer of anti-Rhesus antibodies. If it is from 1:2 to 1:16, there is a high probability that the child will be born completely healthy or with slight jaundice that does not have significant clinical significance.

But if the titer is 1:32 and higher (titers up to 1:4096 are found), then the disease, as a rule, is more severe. It carries a threat of intrauterine fetal death. However, the antibody titer is only a prognostic factor, indicating the likelihood of a severe course of HDP. Sometimes there is a discrepancy between the level of antibodies and the severity of the Rh conflict. This is associated with a violation of the barrier function of the placenta.

Other poor prognostic factors:

  • a sharp increase in antibody levels before childbirth;
  • early appearance of antibodies during pregnancy;
  • alternating increases and decreases in titer.

Modern therapeutic methods make it possible to successfully carry a pregnancy to term. However, they try to carry out delivery as early as possible to avoid complications. Pregnancy is extended to 36 weeks. If the cervix is ​​ripe and the condition of the fetus is compensated, childbirth is carried out through the natural birth canal. In severe cases of HDP, a caesarean section is indicated.

Prevention

Primary prevention is to reduce the likelihood of sensitization in an Rh-negative woman. The secondary one is aimed at preventing Rh conflict if sensitization has already occurred.

Basic preventive measures:

  • blood transfusions are carried out only taking into account the Rh affiliation of the blood of the donor and recipient;
  • if possible - refusal of invasive procedures during the first pregnancy, physiological childbirth;
  • preservation of the first pregnancy (abortion increases the risk of sensitization).

To prevent Rh conflict in pregnant women without symptoms of sensitization, but with a high risk of sensitization, administration of human anti-Rhesus immunoglobulin is indicated. The risk is considered high if there is a history of pregnancy, no matter how it ends (abortion or childbirth), including ectopic.

Specific antibodies are administered intramuscularly at a dose of 300 mcg for 3 days after childbirth, abortion, surgery to remove the fertilized egg during an ectopic pregnancy, or other event that carries a risk of sensitization. If there was a cesarean section or manual placental abruption, the dose of the drug is increased to 600 mcg. The drug used inhibits the immune response.

All women with Rh-negative blood, when the father is Rh-positive, undergo antenatal sensitization prophylaxis during gestation if there are no anti-Rhesus antibodies in the blood. As a rule, red blood cells begin to enter the maternal bloodstream no earlier than 28 weeks. Therefore, it is from this period that prevention is carried out. Patients receive 0.3 mg of immunoglobulin per day. Special antibodies are introduced that are not able to penetrate the placenta.

Occasionally, prophylaxis begins earlier. Up to 28 weeks, it can be performed in case of pathology of the placenta, if the hematoplacental barrier may be broken, as well as after performing any invasive procedures that carry an increased risk of sensitization (amniocentesis, cordocentesis, chorionic villus biopsy). A newborn baby's blood is tested for Rh antigens. If the test is positive, a repeat injection of immunoglobulin is indicated within the first 3 days after birth.

Rhesus conflict is a life-threatening condition for the fetus that can be avoided if you undergo timely diagnosis and receive drug prophylaxis. To detect it, a blood test for antibodies to Rh antigens is used. In 99% of cases, the conflict develops only with a second pregnancy. If it occurs, it is indicated to administer washed red blood cells to the fetus and prolong the pregnancy until a safe delivery for the child or surgical delivery becomes possible.

Dear Maxim Stanislavovich! I want to contact you with my problem. Now I am 30 years old, I have one 3-year-old child. For 10 years I have been seeing a gynecologist due to the presence of multiple fibroids in combination with adenomyosis. The nodes do not stand still; there is growth dynamics. I have been seeing one gynecologist for a long time, but I also go to others for additional consultations. All the doctors, while doing ultrasounds, ooh and ahh about what’s wrong with my uterus at such a fairly young age. No one prescribed any treatment. We couldn’t get pregnant for a little over a year; we wanted to stimulate the ovaries and send her for IVF, but we managed to get pregnant on our own and carry her to term without any problems. After going to the doctor, who has been observing me and my organ for a long time, she said that everything is bad, everything is growing, she is afraid of degeneration into sarcoma and said that the uterus must be removed, the ovaries remain, everything is fine with them. But she sent me for a definitive consultation with a doctor who does surgeries, she looked at the last ultrasound, looked at it on the chair, and said, everything is huge, it needs to be removed, but since I am quite young, and removal is always possible, and this is the last thing that can be done, She said, let’s try 3 injections of Luprid Depot, there are cases where everything decreases significantly and you can postpone the operation for some period. Now there are no plans for a second child with her husband, if only later, but she said there are no deadlines, either now after the injections, or never. In general, I was offered 2 options - inject myself and see what happens next, or lie down and remove the uterus and cervix. The last ultrasound was on August 22, 2019, on the 7th day of menstruation, uterine dimensions: length 120 mm, anterior-posterior. 119, width 120, uneven contours, non-uniform structure, inter.subser along the front wall. m/u 36×30, in the day 52×30mm, this is what can be measured with a device, so the entire uterus is dotted with small nodes, like grape bunches, endometrium 7 mm-1 phase, left ovary 34×15, unchanged, right 35 ×18, no changes. Conclusion: multiple uterine fibroids in combination with adenomyosis. Before that, the previous ultrasound was done on April 6, 2019, uterine dimensions: length 98, anterior-posterior. 110, width 115, uneven contours, heterogeneous structure, differential, along the front wall inter. subser. m/y 38×32, nearby 35×31mm, endometrium 12 mm, ovaries without changes. So from April to August the uterus has enlarged and now corresponds to 14 weeks of pregnancy, my doctor considers the only solution to be removal. She also considers the only way out to be injections, but then to cancel it, put on the Mirena spiral for 5 years and not touch the uterus. Other nynecologists don’t even know what to do with me and say directly, we can’t help, you need specialists of a completely different level, I’m unlikely to find them in Gomel. An aspirate was taken from the uterine cavity on June 6, 2019, according to the results everything was normal, the diagnosis was fibroids combined with adenomyosis, endometrial pathology. Termination: endometrium in the secretion phase, middle stage. I donated blood for tumor markers CA 125 -33, 11, HE 4 -81.53, ROMA premenopausal -21.31, ROMA postmenopausal - 27.87, PEA/CEA - 0.919. Hemoglobin 147, serum iron 21.7, ferritin 38.2. In addition to this, my gynecologist sent me to treat a cyst on the cervix, there was always an inflammatory type of smear, the cytology was normal, she said go treat it, suppositories won’t help, nothing will help, go treat it, you’ll come back like a new penny with a good cervix. I went for an additional paid colposcopy, the doctor said it was a purulent cyst, it needed to be treated, it was like a pimple on the face with contents and it would not disappear anywhere. On April 8, for a fee, a professor performed radio wave ablation of my cervix, two months later I came to see this professor, did a colposcopy, said everything has healed, live as you lived before and sent me home. I went again to another specialist for a colposcopy, she looked and said the wound had not yet healed at all, let it heal for another 2 months and not go in there. And the last doctor I saw, who was operating and said to try injections for now, when examined on the chair, she said that the cervix was in poor condition, that there were foci of endometriosis on it and this was most likely after ablation. She even took a photo and showed how inflamed it was, red-burgundy in color, that’s why she said that if the uterus is removed, I won’t leave you with such a cervix, it’s in bad condition. And if you give injections, then within 3 months, while I’m getting the injections, I’ll have my neck treated again, but not by the professor who did the ablation. They took an aspirate because after this ablation I bleed on the 16th day of my period and before the start of the next one, and so on from month to month, although this had never happened before with all my problems. My gynecologist said that this is not related to the ablation, it just coincided, your endometriosis is making itself felt, so to rule out the worst, they took an aspirate for me. And this doctor who performed the operation said that it was the cervix with endometriotic lesions that was bleeding. They say about EMA that I can’t do it, since my whole uterus is covered with bunches of grapes, this is not my option. This is the situation. Sorry for such a long text. What is possible in my situation, please tell me. Or there are no options, only removal of the uterus and cervix. But 30 years, somehow completely cruel... Our doctors have this opinion: it’s bleeding, the cervix is ​​bad, the uterus is all covered with nodes, everything is growing, endometriosis can only be removed using abdominal surgery. To be honest, I don’t see the point in taking Luprid depot injections. What will happen to me after they are canceled... I think about it. And is there a need to remove the uterus and cervix in my situation? Thank you in advance!

Rh - conflict during pregnancy can develop with a negative Rh factor in a woman and a positive Rh factor in a man. If both are negative, there will be no conflict.

Rh antigens are a group of polypeptides closely located on the cell membrane of red blood cells: D, C, E, c, e. The most immunogenic is the D antigen; it is the main one in Rh immunization.

55% of Rh-positive people of the white race are heterozygous for the D gene. This means that if the mother is Rh negative and the father is Rh positive heterozygous, the fetus can be 50% heterozygous Rh positive like the father and 50% Rh negative.

If the father is homozygous for the D gene, all children will be Rh positive. This is important when planning IVF with the transfer of a Rh-negative embryo.

The Rh factor appears in the fetus at 7-8 weeks of pregnancy. Antigens of other erythrocyte systems appear from 5 to 6 weeks of pregnancy.

Rh incompatibility can lead to hemolytic disease of the fetus, in which the Rh-negative mother develops antibodies to the Rh-positive red blood cells of the fetus. The mother's Rh antibodies penetrate through the placenta into the bloodstream of the fetus and lead to the destruction of its red blood cells. The fetus develops anemia and hypoxia (oxygen starvation).

How to prepare for conception in an Rh-negative woman.

If first pregnancy, there has been no blood transfusion in the past, it is necessary to take an antibody titer test to rule out Rh sensitization. According to literature data, about 5% of newborn girls are sensitized during childbirth due to the combination of an Rh-negative child and an Rh-positive mother.

It is believed that after the first pregnancy with an Rh-positive fetus, 10% of Rh-negative women are sensitized. If this does not happen, then during the next pregnancy she can again become immunized in 10% of cases.

If not my first pregnancy and after a previous pregnancy the woman was administered gammaglobulin, antibodies to the Rh factor should not be detected. The exception is an inadequate dose of immunoglobulin, which did not prevent the development of Rh sensitization. During surgical delivery and bleeding, as well as during manual separation of the placenta and placenta, when a massive release of fetal red blood cells into the mother’s blood is expected, it is necessary to increase the dose of immunoglobulin. In this regard, before conception, it is also necessary to determine the presence of antibodies. In 5% of women, antibodies to the Rh factor in a low titer - no more than 1:2 - 1:4 are determined during the first 12 weeks after immunoprophylaxis, occasionally up to 6 months.

If a woman has antibodies to the Rh factor after a previous pregnancy, no preparatory invasive procedures (plasmopheresis, transplantation of a skin flap from her husband), or nonspecific desensitizing therapy are necessary. These methods are currently recognized as ineffective. It is only necessary to determine the initial antibody titer before conception for subsequent monitoring of the dynamics of its growth.

If the husband is heterozygous for the Rh factor, IVF with the transfer of a Rh negative embryo is possible.

Observation during pregnancy.

From 8 weeks of pregnancy it is possible to determine the Rh factor of the fetus from the mother's blood taken from a vein. Information content 95 - 98%.

1. The titer of Rh antibodies should be monitored once a month, preferably in one laboratory where testing with gel cards is carried out. If the antibody titer does not increase, this is a good prognostic sign.

2. From 20 weeks of pregnancy, ultrasound determination of signs of hemolytic disease of the fetus: thickening of the placenta, polyhydramnios, increase in abdominal circumference, vertical size of the liver.

3. Doppler study of the fetal middle cerebral artery - blood flow speed increases with HDP.

If antibodies to the Rh factor are present, ultrasound is performed every 2 weeks, in some cases more often.

The main thing in monitoring women with the presence of antibody titers to the Rh factor:

Timely diagnosis of hemolytic disease of the fetus,

Resolving the issue of the need for intrauterine blood transfusion,

Determining the timing of delivery.

If the patient has an antibody titer of 1:16 or higher and has a history of Rhesus - a conflict with hemolytic disease of the fetus and newborn, observation is necessary in a specialized medical center where it is possible to conduct intrauterine blood transfusions. There are such centers in Moscow (Family Planning and Reproduction Center, Perinatal Medical Center) and in St. Petersburg (D. O. Ott Research Institute of Obstetrics and Gynecology of the Russian Academy of Medical Sciences).

The presence of antibodies only indicates the possibility of developing hemolytic disease of the fetus, so in no case no need to terminate pregnancy! The next pregnancy may be accompanied by an even higher titer of antibodies.

During pregnancy no need conduct plasmapheresis! With this method, some antibodies are removed from the bloodstream, but in response, even more antibodies are produced!

During pregnancy no need conduct nonspecific desensitizing therapy! When carrying out such therapy, uterine-placental blood flow improves and the delivery of antibodies to the fetus increases.

Hello again, dear readers! Those who, for one reason or another, have encountered in vitro fertilization in their lives are concerned with the question: is the IVF procedure possible with a negative Rh factor? Why is he dangerous? What are the risks?

Today, I want to help you find answers to these and many other related questions that you will probably have (or have already had).

How to prevent danger?

Planning an IVF program involves undergoing a huge number of tests for both parents. All this is done in order to identify any deviations from the norm and prevent possible risks. One of these tests is to determine the blood group and Rh factor. Why are these procedures needed?

“In nature” is only “positive” or “negative” (the first case is more common). In the second case, this is a fundamental factor for the possible emergence of certain difficulties.

If the expectant mother and father are negative, then their future baby is 100% likely to be born negative. If, on the contrary, both are Rhesus positive, then this probability is reduced to 25%. A baby born in a family where one of the parents is “plus” and the other is “minus” has equal chances.

However, there is one important detail. If the mother is Rh-negative and the father is Rh-positive, there is a possibility of occurrence. What is it and what consequences does it carry?

In the worst cases, the mother’s body may reject the fetus, and even the threat of pregnancy failure; however, thanks to timely diagnosis and adequate treatment, any, even the most minor, problems can be completely avoided.

But do not forget about one nuance: the so-called immunization process. Such a problem can arise only after the first (!) birth of a negative mother, provided that her fetus will have the opposite. What's the catch?

During the first pregnancy, antibodies to another Rhesus can form in the mother only during the birth process itself (that is, when there is a possibility of blood mixing). Until then, pregnancy may well proceed without complications.

What can immunization do? Difficulties in planning subsequent children. Of course, thanks to drug treatment and prevention, you will be able to conceive and give birth without much difficulty. However, the risk, although not great, still remains.

Necessary tests for IVF

What we haven’t figured out yet are blood groups—there are only four of them. Depending on the rhesus and group number, it can be either rare or more common.

Why do you need to know your group exactly? Why are such analyzes carried out during planning?

It is necessary to take into account that the first negative one is quite suitable for any person, since it is “universal”. Any type of blood interacts well with the fourth positive, but it itself is not suitable for everyone. The first, second and fourth negative groups, as well as the fourth positive, are quite rare by their nature and do not occur often.

As you may have guessed, depending on the type of group, there are certain restrictions in case of need for blood transfusion.

This is interesting: for those who are concerned about its negative Rh factor, I want to tell you about one of its advantages. It has been scientifically proven that such people are taller, have a fast metabolism, are stress-resistant and have an unusual eye or hair color (for example, bright red hair or blue eyes).

An example from personal experience

What does planning look like in practice in such a situation? If you scour the Internet, you will find many reviews on this matter and almost all of them will be positive.

I won’t go far, I’ll give an example from life. My friend, after many years of unsuccessful attempts, decided on IVF. During the examination, it turned out that she has a high probability of developing a Rhesus conflict. However, the doctor assured that this was absolutely no problem and there was no danger here. (By the way, she has already given birth, pregnancy and childbirth went wonderfully; mother and daughter are alive, healthy and happy).

By the way, there are no changes in the IVF procedure itself in such cases either! That is, it remains the same, standard.

Now let's draw the line:

  • under any conditions, the in vitro fertilization procedure is unchanged;
  • the likelihood of a Rhesus conflict occurring is not at all scary, and any possible complications can be easily eliminated thanks to medications;
  • Blood type and Rh factor will in no case become an obstacle on the path to happy motherhood.

OK it's all over Now. I hope all your fears and doubts have disappeared. I wish you all good health and successful conception. Until new articles.

Always yours, Anna Tikhomirova

Sunday, September 7, 2014

Everyone knows that Rh conflict is bad, but few people know how it manifests itself and what it threatens. Unfortunately, ideas about this problem appear only when we are faced with its negative consequences, although they could have been avoided. That is why it is necessary to understand this issue.

What is the Rh factor?

The Rh factor is a system of human antigens that is located on the surface of the red blood cell. If the Rh factor is present in the blood, then “Rh positive” is determined, if it is not, then “Rh negative”.

Many women learn about their blood type and Rh factor already when they are pregnant, when registering at the antenatal clinic. Remember that blood type and Rh factor do not change throughout life, and you need to find out as early as possible; to do this, donating blood from a vein once is enough.

What is Rh conflict?

If during pregnancy a woman with Rh-negative blood receives Rh-positive red blood cells from the fetus (we’ll talk about the reasons later), then her body begins to produce antibodies in response to the foreign antigen.

Repeated entry of Rh-positive erythrocytes causes massive formation of Rh antibodies, which easily overcome the barrier of the placenta and enter the bloodstream of the fetus, causing the development of hemolytic disease of the fetus and newborn. Antibodies are directed against the Rh factor on the surface of the red blood cell and lead to the destruction of fetal red blood cells.

Severe anemia develops in utero, which leads to tissue hypoxia, enlargement of the spleen and liver, and dysfunction of the internal organs of the fetus. When a red blood cell is destroyed, a large amount of bilirubin enters the blood, which, deposited in the brain, leads to encephalopathy and kernicterus. Without treatment, anemia and dysfunction of internal organs steadily progress, and the terminal stage of hemolytic disease of the fetus develops - edematous, in which fluid accumulates in the chest and abdominal cavity. As a rule, at this stage the fetus dies in utero.

It is worth noting that Rh conflict is one of the causes of late pregnancy losses, but never affects conception and miscarriage in the early stages.

When should you be concerned?

Mom is Rh-positive - dad is Rh-negative: there is no reason to worry, this situation does not affect conception, pregnancy, or childbirth.

Mom is Rh-negative - dad is Rh-negative: there will be no problems either, the child will be born with Rh-negative blood.

Mom is Rh negative - dad is Rh positive: this situation requires special attention not only from doctors, but also from the woman herself, since your health is in your hands, and all subsequent information is extremely important to you.

Women with Rh-negative blood must take a very responsible approach to planning. Remember that every unwanted pregnancy increases the risk of not having a child in the future.

Situations leading to the development of Rh conflict

As mentioned above, the triggering point for the development of Rh conflict is the entry of Rh-positive red blood cells of the fetus into the bloodstream of the Rh-negative mother.

When it's possible:
artificial termination of pregnancy (abortion) at any time;
spontaneous miscarriage at any time;
ectopic pregnancy;
after childbirth, including after caesarean section;
nephropathy (preeclampsia);
bleeding during pregnancy;
invasive procedures during pregnancy: cordocentesis, amniocentesis, chorionic villus biopsy;
abdominal injuries during pregnancy;
history of blood transfusion without taking into account the Rh factor (currently this is extremely rare).

All described situations require specific prophylaxis, the administration of anti-Rhesus gammaglobulin.

Prevention of Rhesus conflict

The only proven method of preventing Rh conflict at present is the administration of anti-Rh gammaglobulin - and patients should remember this first of all! All situations described above require the administration of anti-Rh gammaglobulin in the first 72 hours, but the sooner the better. For high effectiveness of the preventive action, it is necessary to strictly adhere to the timing of drug administration.

Pregnancy in a woman with Rh negative blood

After registering a patient with Rh-negative blood, it is recommended to draw blood to determine the titer of anti-Rh antibodies in the blood monthly, starting in early pregnancy.

The first signs of possible hemolytic disease of the fetus are determined by ultrasound results at 18-20 weeks of pregnancy.

The following dates for the study are further recommended: 24-26 weeks, 30-32 weeks, 34-36 weeks and immediately before birth. However, it is worth noting that the break between studies is determined by the doctor individually.

For the purpose of specific prevention of Rh conflict, at the 28th week of pregnancy, in the absence of antibodies in the blood, it is necessary to administer anti-Rh gammaglobulin. After the administration of anti-Rhesus gammaglobulin, blood is no longer tested for the titer of anti-Rhesus antibodies.

After birth, a neonatologist (pediatrician) determines the Rh status of the newborn baby; in the case of Rh-positive blood, a dose of anti-Rh gammaglobulin is re-administered.

Thus, during a normal pregnancy, anti-Rh gammaglobulin is administered twice: at 28 weeks and after birth.

We did not touch upon methods of treating hemolytic disease of the newborn in the article, since this is the task of other doctors. It is only worth noting that modern technologies, in most cases, help save children with such a diagnosis. But you need to remember that preventing a problem is much easier than solving it, so every pregnancy you have should be desired!