Conception (Rh blood factor). Spouses with different Rh factors: is it possible to have children?

When a couple decides to have a child, the man and woman often have questions about whether their Rh blood is compatible. For quite some time now, doctors and scientists have been studying these indicators. This article will tell you about the Rh factor compatibility. You will find out in what cases you should not worry about the formation of antibodies in blood cells. It is also worth saying what the Rh factor conflict is during pregnancy.

What is Rh in human blood?

Blood rhesus is the presence or absence of a certain protein on the membrane of red blood cells. In most cases it is present. This is why approximately 80 percent of the population has positive Rh values. About 15-20 percent of people become owners of negative blood. This is not some kind of pathology. In recent years, scientists have been talking about the fact that these people become special.

Rh factor: compatibility

Quite a long time ago, data became known that some blood goes well together, but other types do not. To calculate compatibility by Rh factor for conception or for other purposes, you need to refer to the tables. They are presented to your attention in this article. Depending on what you want to know, compatibility information may vary. Let's consider in what cases the compatibility of Rh factors is recognized and when it is not.

Donation

The Rh factor will be compatible in the case of blood donation in the following cases. A person with a positive value (when the so-called protein is present on the red blood cells) can pass the material for negative people. This blood is transfused to all recipients, regardless of whether they have Rh.

The Rh factor does not provide compatibility when a negative donor donates material for a positive person. In this case, serious cell conflict may occur. It is worth recalling that during transfusion of material it is necessary to take into account the compatibility of the Rh factor. This is exactly what experienced specialists do within the walls of medical institutions.

Planning a pregnancy

The compatibility of the Rh factors of the parents of the unborn baby is of great importance. Many couples mistakenly believe that the likelihood of conception depends on these values. Thus, with long-term infertility of unknown origin, a man and a woman blame their blood type and Rh affiliation. This is completely false.

It does not matter at all whether there is protein on the red blood cells of sexual partners. This fact does not in any way affect the likelihood of fertilization. However, during fertilization and establishing the fact of pregnancy, the Rh factor (compatibility of its indicators between the father and mother) plays a big role. How do these values ​​affect the unborn child?

Compatible Rh factors

• If a man does not have protein on his red blood cells, then most often there is no danger. In this case, a woman can be positive or negative. This fact is absolutely not important.
• When a woman's Rh factor is positive, the man's blood data is not particularly important. The father of the future baby can have any analysis indicators.

Possibility of conflict

The compatibility of the Rh factors of the parents may be impaired when the woman is negative and the man is positive. In this case, whose indicators the future baby acquired plays a big role. Currently, there are certain tests of the mother's blood. Their result can determine the identity of the child’s blood with up to 90 percent accuracy. Also, during pregnancy, women are recommended to take a blood test to determine the presence of antibodies. This helps prevent conflict and prevent it in time.

during pregnancy

While carrying a child, many women face various problems. One of them is incompatibility in blood group and Rh factor. In fact, it doesn’t matter at all what blood (type) the expectant mother has. The presence or absence of protein on the red blood cells of a pregnant woman is much more important.

If the woman’s Rh factor is negative, and the man (the father of the unborn baby) is positive, then a conflict may develop. But this will only happen if the fetus has acquired the properties of its father’s blood.

How does the complication develop?

The blood of the baby is determined even at about 12 weeks, the fetus develops independently due to the action of progesterone. In the second half of pregnancy, a continuous connection and mutual exchange of substances occurs between the mother and the unborn baby. The blood of a woman and the fetus are in no way connected with each other. However, the baby receives all its nutrients and oxygen through the umbilical cord. It gives away components it does not need, with which red blood cells can be released. Thus, the protein found on the blood cells enters the body of the expectant mother. Her circulatory system does not know this element and perceives it as a foreign body.

As a result of this entire process, the pregnant woman’s body produces antibodies. They are aimed at destroying the unknown protein and neutralizing its effect. Since most substances from the mother pass to the fetus through the umbilical cord, antibodies enter the baby’s body using the same method.

What is the risk of Rh conflict?

If a woman has those same antibodies in her blood, they can soon reach the fetus. Next, the substances begin to destroy the unknown protein and destroy the baby’s normal red blood cells. The consequence of such exposure can be many congenital diseases or intrauterine complications.

Often babies who have undergone a Rh conflict with their mother suffer from jaundice. It is worth saying that such a complication becomes one of the most harmless. When red blood cells break down, bilirubin is formed in the baby's blood. It is this that causes the yellowness of the skin and mucous membranes.

After the birth of a child with Rh conflict, diseases of the liver, heart and spleen are often detected. The pathology can be easily corrected or quite serious. It all depends on the duration of the destructive effect of antibodies on the child’s body.

In rare cases, Rh conflict during pregnancy can lead to stillbirths or

What are the signs of complications?

Is it possible to somehow find out about the developing Rh conflict during pregnancy? In most cases, pathology is detected by a blood test. Every expectant mother who has negative Rh values ​​should regularly donate material from a vein for diagnosis. If the result shows the presence of antibodies in the body, then doctors take measures aimed at improving the baby’s condition.

Also, a routine ultrasound examination allows you to suspect Rh conflict during pregnancy. If, during diagnosis, a specialist discovers increased sizes of organs such as the liver and spleen, then perhaps the complication is already developing in full force. Diagnostics may also show swelling of the child’s entire body. This outcome occurs in more severe cases.

Correction of Rh conflict during pregnancy

After detecting a pathology, you need to sensibly assess the condition of the unborn child. In many ways, the treatment regimen depends on the stage of pregnancy.

So, in the early stages (up to 32-34 weeks) it is used in women. A new material is introduced into her body that does not have formed antibodies. Her blood, which is destructive for the child, is simply removed from the body. This regimen is usually carried out once a week until possible delivery.

In late pregnancy, a decision may be made to have an emergency caesarean section. After birth, the child’s condition is corrected. Most often, the treatment regimen includes the use of medications, physiotherapy, exposure to blue lamps, and so on. In more severe cases, a blood transfusion to the newborn is used.

Prevention of Rh conflict during pregnancy

Is it possible to somehow prevent the development of pathology? Absolutely yes. Currently, there is a medicine that fights the formed antibodies.

If this is your first pregnancy, then the likelihood of developing a Rh conflict is minimal. Most often, red blood cells do not mix. However, during childbirth, the inevitable formation of antibodies occurs. That is why it is necessary to administer the antidote within three days after the birth of a child with positive Rh in a negative mother. This effect will avoid complications in subsequent pregnancies.

What to do if time is lost and another conception occurs? Is there any way to protect your child from conflict? In this case, the expectant mother is recommended to regularly monitor her blood condition through routine tests. The above substance is introduced into the body of a pregnant woman at approximately 28 weeks. This allows you to carry your baby to term without complications.

Summarizing

You now know what the compatibility table for blood groups and Rh factor looks like. If you do not have the same protein on your red blood cells, then you should definitely tell your doctor about it. During pregnancy, special monitoring will be carried out over your well-being and the behavior of the fetus. This will allow you to avoid the occurrence of Rh conflict or prevent it in a timely manner. Good health to you!

Rh factor is a protein that is found on the surface of red blood cells. Such indicators as positive and negative Rh factor depend on its presence. It cannot change or affect a person's metabolism, immune system or health status.

The Rh factor is a genetic feature of a person.

Rh factor is an antigen that is found on the surface of red blood cells. 85% of people have a positive Rh factor. In the rest of the group of people it is negative. The Rh factor has absolutely no effect on a person's life.

The exception is pregnant women who have a negative Rh factor. If the test is positive, the father of the child may have a conflict antigen.

During pregnancy, the Rh factor of the fetus overcomes the mother's placental barrier. In turn, the mother’s body begins to recognize the child as foreign. This leads to the production of protective antibodies. When protecting a woman, she is observed for her child. If the conflict antigen is severe, it can lead to the death of the baby. A miscarriage in a representative of the fairer sex can occur at different stages of pregnancy.

Antibodies from the mother penetrate the placenta and destroy the red blood cells of the fetus. As a result, large quantities of bilirubin appear in the blood. It turns the baby's skin yellow. As a result of the conflicting antigen, rapid destruction of red blood cells is observed. The liver and spleen produce them intensively, which leads to the appearance of a conflict antigen.

The Rh factor is a fairly important aspect in bearing a child, which must be taken into account when.

Conception and Rh factor

When conceiving a child, it is imperative to take into account the Rh factor of the father and mother. If the father is Rh positive, it is often passed on to the child. When the mother's Rh factor is negative, a conflict antigen often arises between her and the child. Since antigen transmission is carried out only by hereditary means, the threat of Rh conflict can only appear in the case described above.

Many couples are very worried about this when planning pregnancy. Some do not even start a family when they arise similar situation. But you shouldn't do this. In most cases, among representatives of the fairer sex, the first course proceeds normally. If a woman has not previously had experience with a positive factor, then her body is characterized by the absence of antibodies. That is why a conflict antigen cannot arise. Also, during the first pregnancy, antibodies are produced in small quantities, which significantly reduces the risk of conflict.

After a representative of the fairer sex bears her first child, the memory of a positive Rh factor will remain in her body. During subsequent pregnancies, the woman will intensively produce antibodies, which will lead to the death of the fetus. The result of Rh-incompatible pregnancy plays a fairly important role.

The appearance of a conflict antigen is directly affected by the number of red blood cells that enter a woman’s bloodstream during pregnancy.

If antibodies are detected in a pregnant woman, which rapidly increase in quantitative ratio, one can judge that a conflict antigen has begun. In this case, the fairer sex is sent to a specialized perinatal center to undergo a course of treatment. In this case, constant monitoring of the condition of the woman and fetus is recommended.

After the baby is born, its antigen is immediately determined. If positive results are obtained within 72 hours, the woman is given anti-Rhesus serum. Its action is aimed at eliminating possible conflicting antigens in subsequent pregnancies.

To avoid the appearance of a conflict antigen, it is imperative to take certain preventive measures:

• A pregnant woman needs to undergo antigen tests. If she was determined to be Rh negative, then they test for the father's Rh factor.
• If there is a risk of a conflicting antigen, repeated blood tests are performed on a representative of the fairer sex. With its help, a woman’s antibodies to fetal red blood cells are determined in quantitative terms.
• Tests are carried out every four weeks during the eight months of pregnancy. After this, tests are carried out once every two weeks or every week.
• The level of antibodies in the blood of a representative of the fairer sex makes it possible to determine the onset of the appearance of a conflict antigen. The test can also determine the Rh factor in a child.
• If a female representative has an ectopic pregnancy, then she also needs serum administration within 72 hours. This procedure is also carried out during artificial termination of pregnancy or.
• When transfusion of Rh-positive blood or platelet masses, serum administration is also necessary.
• The procedure for administering the serum is also carried out if a woman’s placenta separates.

The Rh factor does not affect human life. If a pregnant representative of the fairer sex has a negative Rh factor, a conflict antigen may arise. If both parents have the Rh factor, the expectant mother should be under strict medical supervision.

In a responsible and balanced approach to planning pregnancy and childbirth, future parents need to take into account not only the health of their bodies, but also many factors that can affect the health of the unborn baby. One of these factors is incompatible blood groups of future parents.

In medicine, the following are distinguished:

• 1 blood group – 0 (I).
• – A (II).
• – B (III).
• – AB (IV).

Depending on whether the antigen, best known as , is present or absent on the surface of red blood cells, the blood can be either Rh positive (Rh+) or Rh negative (Rh-).

A person's blood type is a constant characteristic. It is determined by genetic laws and does not change under the influence of external factors. perhaps as early as the third month of intrauterine development.

As a rule, most doctors deny the fact that future parents have incompatible blood groups for conceiving a child. A woman’s inability to fertilize, carry a pregnancy and give birth to a healthy baby is more due to the immunological and genetic incompatibility of a man and a woman, as well as the production of sperm by the female body against the partner’s sperm.

Parents' blood groups for pregnancy may be incompatible due to the Rh factor. This factor should never be neglected in matters of pregnancy planning.

For conception, the Rhesus antigen has no significance. It also does not affect the development and bearing of the baby if a woman is pregnant for the first time or if she and her husband have Rhesus - positive blood type.

Only in the case when the father of the unborn child is Rh positive, this can lead to incompatibility of the blood groups of the mother and the pregnant child, and, as a result, to the development of such a life-threatening condition for the baby as an isoimmune conflict for the Rh factor , better known as during pregnancy.

Conflict during pregnancy arises because the mother’s Rh-negative blood reacts to the red blood cells of the developing baby, on the membranes of which specific proteins are present, as if they were a foreign organism. As a result, the female body begins to actively produce antibodies directed against the fetus.

The consequences of Rh conflict for a pregnant woman can be irreversible and include:

• in the threat of miscarriage in early pregnancy or premature birth;
• in the formation of intraorgan edema in the fetus, which can lead to intrauterine growth retardation;
• in the development of a hemolytic disease in a newborn, characterized by the destruction () of its red blood cells by maternal blood cells, which continues to circulate in the child’s body for some time after birth.

For the woman herself, the development of an autoimmune conflict does not pose any danger. She will feel well even if the developing fetus begins to suffer in utero.

Therefore, it is extremely important for pregnant women who have had antibodies detected in their blood using the Coombs test to strictly follow all the recommendations of the doctor monitoring the development of pregnancy, promptly donate blood for examination and not neglect an ultrasound examination, since this will help identify the appearance of edema in the baby and the onset of development. hemolytic disease.

Are there always complications?

If a woman with Rh negative factor becomes pregnant for the first time in her life, there are still no specific antibodies in her blood. Therefore, the pregnancy will proceed completely normally, and there will be no threat to the health and life of the unborn baby. Immediately after giving birth, she will be given anti-Rhesus D serum, which will help stop the formation of these antibodies.

In addition, since antibodies in the blood of a Rh-negative woman do not disappear over time, but on the contrary, their number only increases with each subsequent pregnancy, the administration of this serum is indicated after each pregnancy, regardless of how it ends (childbirth, spontaneous or drug-induced abortion).

If a woman with a negative Rh factor already has antibodies in her blood, the administration of serum is strictly contraindicated.

Types of conflicts

There is also the concept of incompatible blood groups during pregnancy in mother and child, which can also lead to the development of conflict, but according to the ABO system.

This type of complication is as common as Rhesus incompatibility, but its consequences are less catastrophic. It can develop if the mother, that is, does not contain agglutinogens, and the child inherits any other group from the father, and accordingly his blood contains antigens A and B, both individually and together.

A conflict in the ABO system can develop even during the first pregnancy, but the fetus will not develop pathological conditions, and there will be no signs of anemia. But just as in the case of Rh-conflict, in the first days after birth the level of bilirubin in the child’s blood will be significantly increased and in order to eliminate the manifestations of pathological jaundice in him it will be necessary to carry out the same therapeutic measures as in the case of an isoimmune conflict for Rh- factor.

The blood groups of the child and the mother may also be incompatible for the birth of a child if the expectant mother has a history of a disease such as thrombocytopenia, that is, a decrease in the number of platelets in her blood. In this case, the woman experiences the formation of antibodies directed against the platelets of the fetus.

Conclusion

When making an initial visit to the antenatal clinic, the expectant mother will initially receive a referral to donate blood to determine her blood type and Rhesus affiliation. In the case of Rh(-) factor, her husband will receive the same direction. If the Rh factors of the future parents coincide, there will be no development of an autoimmune conflict.

In the case of different Rh factors of the spouses, the pregnancy will proceed under close supervision by a gynecologist, in order to early determine signs of the development of Rh conflict during pregnancy between mother and fetus, as well as the increase in signs of hemolytic disease in the baby. If they are detected, the woman will need urgent hospitalization and specific treatment.

Under no circumstances should you be upset and refuse to become pregnant and give birth to a baby if, for one reason or another, the blood groups of the future parents are incompatible.

Subject to careful medical supervision of the development of pregnancy, compliance with all recommendations and prescriptions of the gynecologist, it is possible, if not avoided, then to minimize all the negative consequences caused by different blood types of future parents. We hope you learned what incompatible blood groups are for pregnancy.

All cells of the human body have antigens, or “tags” in other words. Tags are special proteins on the surface of cells. There are usually not one or two such antigens, but many, up to 50. The Rh factor is the presence of these proteins on the outer membrane of red blood cells. If these proteins are present, then the person is Rh positive; if they are not there, Rh is negative. The ratio of Rhesus in the world is approximately as follows: 1-2 people out of ten are owners of Rh-negative blood.

Rhesus conflict as it is

If an Rh-negative mother carries an Rh-positive baby (and vice versa) from a correspondingly Rh-positive father, then she gradually develops a serious condition, which doctors call “Rh-conflict”. With it, the woman’s body begins to react to the embryo as a foreign body, hostile in nature. Antibodies to the baby's blood proteins begin to be produced in the mother's blood. The production of antibodies is essentially the destruction of a foreign body. In 99% of cases it leads to miscarriage or death of the fetus inside the mother's body, but this happens under certain circumstances.

Why is this happening

Rh conflict triggers a process in the mother’s body called agglutination. This word literally means blood clotting: red blood cells stick together due to the influence of foreign proteins on them, and the blood coagulates like sour milk, leading to the woman’s death. To prevent this from happening, the human body has developed a protective mechanism - the production of antibodies that destroy the red blood cells of a fetus with the opposite rhesus. This process of protection is called sensitization.

What does this mean for mother and child?

If this is your first pregnancy, there will be no Rh conflict - attention! - if even microscopic particles of the child’s blood do not enter the mother’s bloodstream. The placenta is a kind of barrier between the blood of the fetus and the pregnant woman. It protects the female body from the penetration of the child's red blood cells. But if children's red blood cells enter the mother's blood, the mechanism of sensitization, or antibody production, is immediately triggered.

When this might happen:

After a normal first birth;
after an abortion or miscarriage;
as a result of the first ectopic pregnancy;
due to uterine bleeding in a pregnant woman;
as a result of taking a sample of amniotic fluid, which is done during an analysis such as amniocentesis;
with a number of other examinations that are necessarily carried out in the first trimester to identify serious pathologies in the baby’s development.

Thus, any situation where the blood of the mother and fetus with different Rh factors are mixed triggers a Rh conflict. The result of such activity of the maternal body is miscarriage, miscarriage. Even if the first pregnancy went without problems, during the second there will definitely be a Rh conflict, which will lead to the death of the child. But there is no reason to despair. Modern medicine has developed a number of measures that prevent the loss of a baby and allow you to safely carry a second pregnancy to term.

What does this mean for a child?

Rhesus conflict is a very serious and dangerous condition, which is fraught not only with miscarriage. Even if the second pregnancy was carried to term without appropriate treatment, sensitization will lead to severe developmental defects of the child:

Hemolytic disease with the development of subsequent anemia;
damage to internal organs (liver, heart, etc.);
brain damage with subsequent development of dementia and other abnormalities.

If a woman was not properly observed by a doctor during her second pregnancy and has a healthy first child, there is almost a 100% guarantee that her second baby will be born seriously ill (if she is born at all). For this reason, all pregnant women and women planning to conceive must have a blood test and, if there is a threat, be especially carefully observed by a doctor throughout the entire period of gestation.

If characteristic signs of Rh conflict appear, the baby may require a blood transfusion while still in the womb. To prevent problems in the future, the mother is given Rh immunoglobulin serum after the first birth (or abortion). This procedure must be repeated for the second, third and all other pregnancies, because the immunoglobulin is only valid for 12 weeks. With all the problems and difficulties listed above, it is possible to give birth with a difference in the parents’ Rhesus, but you should treat this process with special care, keeping in mind the existing threats.

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Ignorance of the blood type and Rh factor of the mother and fetus can affect the intrauterine development of the child and even his life. Different Rh blood levels in the parents of the unborn baby can cause Rh conflict during pregnancy. It develops against the background of incompatibility between the blood of the pregnant woman and the fetus, if the mother has Rhesus and the child (+). If there is a positive Rh in the mother and a negative Rh in the child, there is no Rh conflict (Rh conflict).

The influence of Rh conflict on conception and pregnancy

The Rh factors of the husband and wife do not affect conception; successful fertilization is possible regardless of these indicators. It is also a mistake to believe that Rh conflict will necessarily lead to serious problems during pregnancy. With proper preparation for the birth of an heir, the consequences of the conflict can be avoided.

During the very first pregnancy, the Rh conflict will not be acute. But during the next attempts to carry and give birth to a healthy baby, the risk of the mother’s immune reaction will increase, since her body will produce more antibodies to the Rh factor of the embryo.

How does Rh conflict develop?

When erythrocytes of different polarities come into contact, they cause agglutination. In response to this reaction, the mother’s immune system produces proteins (antibodies) that do not allow red blood cells with Rhesus (-) to contact the woman’s own red blood cells.

When fetal red blood cells (+) first encounter maternal red blood cells, IgM immunoglobulin is produced, the size of which does not allow them to penetrate the placental protection. Therefore, during the first pregnancy, a conflict of Rh factors arises only occasionally. The risk increases with subsequent pregnancy, since further entry of fetal antigens into the maternal circulatory system provokes the production of IgG, which overcomes the placental protection and causes the destruction of its red blood cells.

Causes

• The launch of the production of antibodies and the reaction of the pregnant woman’s immune system due to the entry of blood (+) into her body during the birth process.
• Penetration of fetal blood (+) into the female circulatory system during an abortion, during an ectopic pregnancy or during a miscarriage, or in the case of a blood transfusion.
• There is a risk (albeit small) of a woman developing antibodies after certain tests are performed that require penetration into the mother's body.

What is the risk of Rh conflict?

In case of Rh conflict, during pregnancy, the child's red blood cells are destroyed, which causes toxic damage to the organs and systems of the embryo. The condition of the fetus worsens, its nervous system is affected, and the most important organs are destroyed. Sometimes the outcome is fatal intrauterine death. Therefore, women with (-) are often diagnosed with “threatened miscarriage.”

Factors that increase negative outcomes

The following factors increase the likelihood of an Rh conflict:

When carrying a baby:

• Pathologies of pregnancy;
• The birth process;
• Some complications during pregnancy and childbirth;
• Miscarriage, abortion;
• Amniocentesis, cordocentesis.

In other situations:

• Immunization during blood transfusion;
• Using a non-sterile needle.

Symptoms (signs) of Rh conflict

Rh incompatibility with fetal blood does not affect the health of the mother. Complications appear only in a newborn baby. Fetal pathology can be diagnosed using an ultrasound examination, during which the following signs are detected:

• Accumulated fluid inside the fetus
• Swelling and enlargement of the placenta
• Increased size of the baby's belly
• Swelling
• Bending the fetal legs in a characteristic position
• Inconsistency between the size of internal organs and the deadline
• Swelling of the head

Diagnosis and management of pregnancy

At the antenatal clinic, a pregnant woman who is registered will definitely be sent for a blood test to determine her group and Rh-conflict. The father of the child will have to undergo the same examination.

An Rh-negative mother will have to undergo appropriate tests every month until the 20th week in order to track the dynamics of antibody production during pregnancy. After the 20th week, the patient is sent to the hospital, where issues of further management of her pregnancy, prescription of treatment and establishment of the date and method of delivery will be decided.

From the 18th week, ultrasound is regularly performed to monitor the condition of the fetus. In some cases, the doctor prescribes additional procedures (Doppler ultrasound, cardiotocography, amniocentesis, cordocentesis). A number of these procedures are associated with great risk.

Treatment of Rhesus conflict

Prepare for conception in advance. Take a blood test to determine antibodies to determine whether the system has been immunized with Rh (+) blood. It is appropriate to do such an analysis before the 28th week of pregnancy.

If the baby's father has Rh (+), a pregnant woman who is Rh-negative is given an injection of anti-Rh immunoglobulin on the 28th. This injection will have to be repeated at 7 months if the pregnant woman experienced bleeding during pregnancy or amniocentesis was performed. Also, the drug is administered again after childbirth for 2-3 days. If the mother and father have (-) blood, these procedures will not be necessary.

The doctor is obliged to carefully monitor the course of pregnancy with complications. He decides whether the pregnant woman will be able to carry the child to term and give birth on time, or whether labor will have to be induced ahead of schedule.

The most effective treatment method is an intrauterine blood transfusion procedure performed in a hospital. This procedure significantly reduces the likelihood of pathologies and early birth.

Delivery and prognosis for Rhesus conflict

The prognosis depends on the time of diagnosis of immunization. The earlier the presence of antibodies was diagnosed, the worse the prognosis for pregnancy. If the antibody titer increases rapidly, the risk of developing a problem such as hemolytic disease of the fetus is predicted.

With Rh sensitization, premature birth is stimulated, since towards the end of pregnancy there is a rapid and significant increase in the number of antibodies reaching the embryo. As for the method of delivery, it is determined individually. The most gentle procedure for the fetus is a caesarean section. If the condition of the fetus is assessed as “satisfactory,” then with a pregnancy of more than 36 weeks, a multiparous woman can give birth naturally.

The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.