Since I’m reading a lot on this topic now, trying to understand what happened in my body and what’s happening now with my child, I’ll share it with you. Especially with mothers who have a different Rh factor with their child

Rh factor is a concept that was introduced into scientific use in 1940. It refers to the presence or absence of antigens (red blood cells) on the surface of red blood cells. It is the “plus” or “minus” sign that plays a decisive role in the manifestation of Rh conflict. Rh conflict occurs when antibodies from Rh positive blood enter “negative” blood. They are perceived by the body as foreign, so antibodies begin to be produced that perform a protective function. The onset of Rh conflict is possible in two cases. The first of these is blood transfusion. It is important to know that Rh-negative people can only be transfused with Rh-negative blood, and vice versa, Rh-positive people can only be transfused with Rh-positive blood. The second - the most common - . The danger of Rh conflict appears if the expectant mother is Rh negative and the father is Rh positive. All other combinations do not pose a threat. Often women and girls have a vague idea of ​​the Rh conflict and believe that the difference in the Rhesus of their partners puts an end to dreams of children. I hasten to reassure you: timely diagnosis and constant medical monitoring will help the birth of a healthy and strong baby. I propose to lift the veil over a “problematic” pregnancy. To begin with, a pregnant woman with a negative Rh factor must be examined for sensitization, that is, for the presence of antibodies in the blood that interfere with the positive blood antigen. The level of sensitization increases in a number of cases: with the transfusion of Rh-positive blood into Rh-negative, with an ectopic pregnancy of 7-8 weeks, abortion, miscarriage, trauma in a pregnant woman, chorionic villus biopsy (manipulation of the membranes). Also, sensitization can occur even before birth if red blood cells from a Rh-positive mother enter the blood of an Rh-negative girl who has not yet been born. The lowest level of sensitization occurs after an ectopic pregnancy, then after a miscarriage, abortion, and the highest after a normal birth (up to 10-15%). It all depends on how many red blood cells enter the mother’s bloodstream. The first pregnancy of an Rh-negative woman usually proceeds without complications, since antibodies have not yet been developed. But each of us needs to know the most important moments of a problematic pregnancy. The presence of antibodies to red blood cells in the blood of a Rh-negative mother will not affect her well-being in any way, but can harm the fetus. The breakdown of red blood cells leads to disruption of the liver, kidneys, and brain of the unborn baby, as well as to the development of hemolytic disease of the newborn child. The disease develops rapidly after birth, which is caused by the entry of a large number of antibodies into the child’s blood if the integrity of the placental vessels has been compromised. After birth, external signs of hemolytic disease are clearly expressed: jaundice, anemia. There is also a risk of disruption of brain activity, as well as the functioning of the nervous system, and developmental delays. Rhesus conflict is also dangerous due to the possibility of miscarriage or stillbirth.

Therefore, taking all precautions is the main task of the expectant mother. Fortunately, the modern level of development of medicine can significantly facilitate pregnancy and reduce the risk of complications. In a special perinatal center, the expectant mother and her child are under the constant supervision of doctors. If it is possible to bring the pregnancy to 38 weeks, a cesarean section is performed, but if not, an intrauterine blood transfusion is performed: 20-50 ml of red blood cells are transfused into the fetus, penetrating the umbilical cord vein through the anterior abdominal wall of the mother. This helps prolong pregnancy and improve the condition of the fetus. This procedure is carried out under ultrasound control. And so, the child was born. This is all? It turns out not. As soon as possible - within 72 hours - a woman should be given anti-Rhesus immunoglobulin into her blood, which will prevent the development of Rh conflict in a subsequent pregnancy

Rh conflict during pregnancy: what should a woman with a negative Rh factor do to avoid consequences

Rh conflict during pregnancy occurs as a result of blood incompatibility according to the Rh system (Rh). According to statistics, this type of incompatibility occurs in 13% of married couples, but immunization during pregnancy occurs in 1 out of 10-25 women.

Pregnancy of a woman with a negative Rh factor, in which the fetus has a positive Rh factor, leads to the production of antibodies by the mother's immune system to the child's red blood cells.

As a result, the fetal red blood cells “stick together” and are destroyed. This is a humoral immune response to the presence of the Rh factor protein, which is foreign to the mother’s body.

• Rh factor - what is it?
• Probability of developing Rh conflict during pregnancy: table
• Causes
  • Feto-maternal transfusion
• Rh conflict during pregnancy: mechanism of occurrence
• Consequences for the child
• Risks
• Diagnosis, symptoms and signs of Rh conflict during pregnancy
• Treatment
  • Plasmapheresis for Rh-conflict pregnancy
  • Cordocentesis
• Immunoglobulin for negative Rhesus
• Can the Rh factor change during pregnancy?

What is Rh factor

To understand what Rh conflict is during pregnancy, you need to take a closer look at the concept of Rh factor.

Rh (+) is a special protein - an agglutinogen - a substance that can stick red blood cells together and damage them when they encounter an unfamiliar immune agent.

The Rh factor was first discovered in 1940. There are about 50 types of Rh antigens. The most mutagenic dominant antigen is D, which is found in the blood of 85% of people.

Antigen C is found in 70% of people, and antigen E is found in 30% of people on the planet. The presence of any of these proteins on the red blood cell membrane makes it Rh positive Rh (+), the absence makes it Rh negative Rh (-).

The presence of agglutinogen D has an ethnicity:

• among people of Slavic nationality, 13% are Rh-negative people;
• among Asians 8%;
• Among people of the Negroid race, there are practically no people with Rh-negative blood factor.

Recently, women with negative Rh factor blood have become increasingly common; according to the literature, this is associated with mixed marriages. Consequently, the frequency of Rh conflict during pregnancy in the population is increasing.

Inheritance of system D antigen

The types of inheritance of any traits are divided into homozygous and heterozygous. For example:

1. DD – homozygous;
2. Dd – heterozygous;
3. dd – homozygous.

Where D is a dominant gene, and d is a recessive gene.

Rh conflict during pregnancy - table

If the mother is Rh positive, the father is Rh negative, then one of their three children will be born Rh negative with a heterozygous type of inheritance.

If both parents are Rh negative, then their children will 100% have a negative Rh factor.

Table 1. Rh conflict during pregnancy

Causes

The cause of Rh conflict during pregnancy is:

• transfusion of incompatible blood using the AB0 system is extremely rare;
• feto-maternal transfusion.

What is feto-maternal transfusion?

Normally, during any pregnancy (physiological or pathological), a small number of fetal blood cells enter the mother’s bloodstream.

A negative Rh factor during pregnancy in a woman definitely poses a danger for a baby with a positive Rh factor. Rh conflict develops, just like any immunological reaction. At the same time, the first pregnancy can proceed without complications, but subsequent ones (second and third) lead to Rh conflict and severe symptoms of hemolytic disease of the fetus and newborn.

Mechanism of immunization (development of Rhesus conflict)

The Rh-negative mother and the Rh-positive fetus exchange blood cells, the mother’s immune system perceives the baby’s red blood cells as foreign proteins and begins to produce antibodies against it. For the development of a primary immune response, 35-50 ml of fetal red blood cells enter the mother’s bloodstream.

The volume of blood that flows from the baby's bloodstream to the mother increases during invasive obstetric procedures, cesarean section, childbirth, and other obstetric procedures.

The first immune response begins with the appearance of immunoglobulins M - these are large pentagram molecules (polymers) that hardly penetrate the placental barrier and do not destroy the red blood cells of the fetus, thus cannot cause harm to it. Therefore, the first pregnancy most often proceeds without consequences.

Secondary fetoplacental transfusion entails consequences for the child. It occurs during a repeat (second, third, fourth) pregnancy.

Cellular memory works in the body of a pregnant woman and, due to repeated contact with the Rh factor protein, protective antibodies are produced - immunoglobulins G - Rh conflict develops. Immunoglobulin G molecules are small monomers that can penetrate the placental barrier and cause hemolysis - the destruction of red blood cells of the fetus and newborn.

What contributes to the development of Rh sensitization?

The first pregnancy in an Rh-negative mother with an Rh-positive fetus in most cases ends successfully and ends with the birth of the fetus. Any subsequent pregnancy, regardless of the outcome (early miscarriage, abortion, spontaneous abortion) in an Rh-negative woman becomes an impulse for the development of a secondary immune response and the appearance of immunoglobulins that destroy the baby’s red blood cells in utero.

The cause of Rh conflict during pregnancy in an Rh negative mother can be:

• In the first trimester:
  • medical abortion (surgical or medical), provided that these complications arose at 7-8 weeks.

Update: October 2018

Most women who are preparing to become mothers have heard about the “terrible and terrible” Rh conflict during pregnancy. But this problem concerns only those representatives of the fairer sex whose blood is Rh negative.

Rh conflict during pregnancy threatens only those pregnant women and those planning a pregnancy who have negative Rh blood, and even then, not in 100% of cases.

Let's understand the Rh factor

It is known that human blood consists of red blood cells or erythrocytes, which are responsible for the transport of oxygen, white blood cells - leukocytes, which guard the health of the body, platelets, which are responsible for blood clotting and many other cells and systems.

The Rh factor is a D protein, which is an antigen and is localized on the surface of red blood cells. A significant proportion of people have the Rh factor, then their blood is called Rh positive. For example:

• Among Europeans, there are 85% of Rh-positive people
• while for Africans this figure rises to 93%
• among Asians up to 99%

If D protein is not detected, then such people are called Rh negative. The Rh factor is determined genetically, just like hair or eye color, it remains for life and does not change. The presence or absence of the Rh factor does not bring any benefit or harm; it is simply a characteristic feature of each person.

What is this – Rhesus conflict?

Click to enlarge

It becomes clear that pregnancy with Rh conflict occurs in situations where the mother’s blood is Rh negative, and the father’s, on the contrary, is Rh positive, and the unborn child inherits the Rh factor from him.

However, this situation occurs in no more than 60% of cases, and the occurrence of Rh conflict accounts for only 1.5%. The mechanism of Rh conflict while waiting for the birth of a baby is that the red blood cells of the fetus, which carry the D-antigen, meet the red blood cells of a Rh-negative pregnant woman and stick together, that is, agglutination occurs.

To prevent clumping, the mother’s immunity is activated, the immune system begins to intensively synthesize antibodies that bind to the antigen - the Rh factor and prevent clumping. These antibodies or immunoglobulins can be of two types, both IgM and IgG.

• Rh conflict during the first pregnancy

It almost never occurs, which is due to the production of type 1 immunoglobulins. IgM is very large and cannot cross the placenta to enter the fetal bloodstream. And in order for the red blood cells of the unborn child and antibodies to meet, they need to “collide” in the gap between the uterine wall and the placenta. The first pregnancy almost completely eliminates this situation, which prevents the development of a Rh conflict situation.

• If a woman becomes pregnant again with an Rh-positive fetus

In this case, his red blood cells, penetrating the mother’s vascular system, “trigger” an immune response, during which IgG begins to be produced. These antibodies are small in size, they easily cross the placental barrier, penetrate the baby’s bloodstream, where they begin to destroy his red blood cells, that is, cause hemolysis.

In the process of destruction of the red blood cells of the fetus, bilirubin is formed from them, which in significant quantities is a toxic substance for the child. Excessive formation of bilirubin and its action contributes to the development of such a formidable pathology as hemolytic disease of the fetus and newborn.

What leads to Rh conflict?

For the development of Rh conflict, two conditions are needed:

• Firstly, the fetus must have Rh-positive blood, which means it will inherit its Rh-positive father
• Secondly, the mother’s blood must be sensitized, that is, have antibodies to the D-protein.

The production of antibodies is mainly due to previous pregnancies, no matter how they ended. The main thing is that there was a meeting between maternal blood and fetal blood, after which IgM antibodies were developed. It could be:

• previous births (during the process of expulsion of the fetus, contact with its blood cannot be avoided by a woman)
• C-section
• ectopic pregnancy
• artificial termination of pregnancy (regardless of the method, both surgical and)
• spontaneous miscarriage
• separation of the placenta by hand.

It is also possible to develop antibodies after performing invasive procedures during gestation, for example, after cordocentesis or amniocentesis. And such a reason cannot be ruled out, although this is rather nonsense, like transfusion of Rh-positive blood to a woman in the past who has an Rh-negative factor.

Diseases of the woman who is carrying the baby are also important. , diabetes mellitus, ARVI and influenza damage the villi, and, consequently, the chorionic vessels and the blood of the mother and the unborn baby mix.

But you should know that hematopoiesis in the fetus begins to form from the 8th week of embryogenesis, which means that abortions performed before 7 weeks are safe in terms of the development of an Rh conflict situation in the future.

Manifestations of Rh conflict

There are no external, that is, visible manifestations of Rh conflict. Incompatibility of maternal and fetal blood does not in any way affect the condition of the pregnant woman. As described above, the Rh conflict “ripens” during the second pregnancy, and with each subsequent pregnancy the risk of this condition increases.

Incompatibility of the blood of the child and the expectant mother according to the Rh factor has a very adverse effect on his condition and health in the future. To find out what devastating damage the Rhesus conflict has caused to the baby, an ultrasound scan of the fetus is performed. During an ultrasound examination, the following signs are clearly visualized:

• the contour of the head becomes double, which indicates edema
• the placenta and umbilical vein swell and increase in diameter
• Fluid accumulates in the abdominal cavity, heart sac, and chest
• the size of the fetal abdomen exceeds the norm
• splenohepatomegaly develops (increase in the size of the liver and spleen), the fetal heart is larger than normal
• the baby in the uterus takes a certain position in which the legs are spread apart due to the large belly - this is called the “Buddha pose”

All of these ultrasound signs indicate the development of hemolytic disease of the fetus, and after birth it will be called hemolytic disease of the newborn. This pathology has three forms:

• icteric
• edematous
• and anemic

The most unfavorable and severe is the edematous form. The icteric form ranks second in severity. A child who has high levels of bilirubin in the bloodstream after birth is very lethargic, apathetic, has poor appetite, constantly regurgitates (see), has reduced reflexes, and often has convulsions and vomiting.

Bilirubin intoxication negatively affects the child in utero, and is fraught with the development of mental and mental disability. In the anemic form, the fetus has a lack of red blood cells, which causes oxygen starvation (hypoxia) and immature red blood cells (erythroblasts, reticulocytes) are present in large quantities in the blood.

Diagnostics and dynamic control

In the diagnosis of the described pathology, the woman’s early attendance at the antenatal clinic is of great importance, especially if this is the second, third, etc. pregnancy and the pregnant woman has been diagnosed with either antibody sensitization in the past, or, which is much more unfavorable, a history of hemolytic disease of the fetus/newborn.

• When registering at a dispensary, all pregnant women, without exception, are determined to have their blood type and Rh status.
• If the mother is diagnosed with Rh-negative blood, in this case, determination of the group and Rh factor in the father is indicated.
• If he has a positive Rh factor, a woman up to 20 weeks of pregnancy is prescribed tests for antibody titer every 28 days.
• It is important to determine the type of immunoglobulins (IgM or IgG).
• After the pregnancy has reached the second half (after 20 weeks), the woman is sent for observation to a specialized center.
• After 32 weeks, a blood test for antibody titer is carried out every 14 days, and after 35 every 7 days.
• The prognosis depends on the gestational age (see) in which the antibodies were detected. The earlier the Rh factor immunoglobulins were diagnosed, the more unfavorable it is.

If antibodies are detected, especially if there is a second pregnancy and the chances of an Rh conflict increase, the condition of the fetus is assessed, which is carried out using both non-invasive and invasive methods.

Non-invasive ways to determine the condition of the unborn baby:

Ultrasound should be performed at 18, 24–26, 30–32, 34–36 weeks of gestation and on the eve of birth. The position of the child, swelling of the tissues, dilated umbilical veins, and how the baby grows and develops are determined.

• Doppler

The speed of blood flow in the placental vessels and in the unborn child is assessed.

• Cardiotocography (CTG)

Allows you to determine the state of the heart and vascular system in the fetus and diagnose the presence of a lack of oxygen (hypoxia).

Invasive methods:

• Amniocentesis

During amniocentesis, amniotic fluid is collected by puncturing the amniotic fluid and the bilirubin content in it is determined. Amniocentesis is prescribed when the antibody titer is 1:16 or higher and is performed at 34–36 weeks. The negative aspects of this procedure should also be taken into account. Amniocentesis is fraught with infection, leakage of amniotic fluid, premature rupture of water, bleeding and placental abruption.

• Cordocentesis

The essence of the procedure is to puncture the umbilical vein and take blood from it. A highly informative method for diagnosing hemolytic disease, in addition, it allows intrauterine blood transfusion to the fetus. Cordocentesis has the same negative aspects as amniocentesis, and the formation of a hematoma at the puncture site or bleeding from it is also possible. This manipulation is carried out when the antibody titer is 1: 32 and in the case of hemolytic disease of the fetus/newborn in the previous child or his death.

Methods for countering Rhesus conflict

Today, there is only one way to alleviate the condition of the fetus and improve its situation - this is intrauterine blood transfusion through cordocentesis. This method reduces the likelihood of premature birth and the development of severe hemolytic disease after birth. All other methods do not have a significant effect or are completely useless (desensitizing treatment, transplantation of a skin flap from the mother’s husband, etc.).

A woman usually gives birth ahead of schedule. Preference is given to abdominal delivery, since in this case the risk of complications is reduced. But in some situations (absence of hypoxia, gestational age more than 36 weeks, not the first birth) independent childbirth is also possible.

To prevent Rh conflict during the next pregnancy, a first-time mother is given anti-Rhesus immunoglobulin within 72 hours after the birth of the child, which will destroy the baby's red blood cells that enter the mother's blood, which will prevent the formation of antibodies to them.

It is for the same purpose that specific immunoglobulin is administered after artificial and spontaneous termination of pregnancy. In addition, the administration of immunoglobulin after an ectopic pregnancy and for bleeding during the current period of gestation is indicated. For prevention purposes, administration of this immunoglobulin is indicated at 28 and 34 weeks.

Rhesus conflict and breastfeeding

There is no consensus on the issue of breastfeeding during Rh conflict. Doctors evaluate the baby’s condition and possible risks, and in some cases, immediately after birth, they do not recommend breastfeeding for several days, sufficient to remove antibodies from the mother’s body.

However, there is also the opposite opinion of doctors that such a restriction is not necessary. There are no proper studies in this area confirming this or that position yet.

What does rhesus conflict portend?

The consequences of pregnancy with Rh-conflict are very unfavorable. The presence of a huge amount of bilirubin in a child’s blood affects the condition of his internal organs and brain (the damaging effect of bilirubin).

Hemolytic disease of the newborn often develops, the baby has mental retardation, and his death is possible, both in the womb and after birth. In addition, Rh conflict is the cause of termination of pregnancy and recurrent miscarriage.

There are so many different factors that influence the course of pregnancy, and all of them simply need to be taken into account. Many women have heard something about such a sad phenomenon as Rh conflict during pregnancy. However, not all of them understand what it is and what this phenomenon is connected with. And misunderstanding quite naturally gives rise to fear, and even panic.

Therefore, it is very important to know what a conflict of Rh factors is during pregnancy, and what the Rh factor is in general.

What is the Rh factor?

Naturally, we should start with the concept of Rh factor itself. This word refers to a special protein that is located on the surface of red blood cells. This protein is present in almost all people, but is absent in only 15% of people. Accordingly, the former are considered Rh-positive, and the latter – Rh-negative.

In fact, the Rh factor is just one of the immunological properties of blood, and does not affect human health in any way. Blood with a positive Rh factor is considered stronger.

This property of blood was discovered by two scientists: Landsteiner and Wiener in 1940 while studying rhesus monkeys, who gave the name to this phenomenon. The Rh factor is denoted by two Latin letters: Rp and plus and minus signs.

What is Rh conflict between mother and child? When positive and negative red blood cells come into contact, they stick together, which does not lead to anything good. However, stronger Rh-positive blood easily tolerates such intervention. Consequently, in women with a positive Rh factor, no conflict can arise on this basis.

However, in women with a negative Rh factor, pregnancy will most likely proceed normally. If the father of the child is also Rh negative, then there is no basis for conflict. When does Rh conflict occur? When a positive Rh factor is detected in the husband, the child’s blood will also have Rp + with some degree of probability. This is where a Rhesus conflict may arise.

It is possible to determine a child’s Rp without an intervention dangerous to his health only approximately based on the parents’ indicators. This is clearly shown in the table. Rhesus conflict during pregnancy occurs extremely rarely, in only 0.8%. However, this phenomenon is fraught with very serious consequences, which is why so much attention is paid to it.

What are the causes of Rh conflict? Positive blood of a baby for a mother with negative Rp is a serious threat, and in order to cope with it, the woman’s body begins to produce antibodies, and accordingly, they react with the red blood cells of the fetus and destroy them. This process is called hemolysis.

Maternal and fetal blood occurs in the space between the uterus and placenta. It is in this place that exchange occurs: oxygen and nutrients enter the baby’s blood, and waste products of the fetus enter the mother’s blood. At the same time, some of the red blood cells seem to change places. This is how positive fetal cells end up in the mother’s blood, and her red blood cells end up in the fetal blood.

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

What is this connected with? Everything is quite simple: at the first “meeting” of the blood of the mother and fetus, IgM type antibodies. The size of these antibodies is quite large. Rarely and in very small quantities they enter the child’s blood, and therefore do not cause problems.

Rp inheritance table

Rh conflict during the second pregnancy is much more likely, since upon repeated contact with Rh-negative blood cells, the woman’s body produces antibodies of another type – IgG. Their size allows them to easily pass through the placenta into the baby’s body. As a result, the process of hemolysis continues in his body, and the toxin bilirubin, a product of the breakdown of hemoglobin, accumulates in the body.

Why is Rh conflict dangerous? Fluid accumulates in the baby's organs and cavities. This condition leads to disruption of the development of almost all body systems. And the saddest thing is that after the birth of a child, antibodies from the mother’s blood continue to function in his body for some time, therefore, hemolysis continues and the condition worsens. It is called hemolytic disease of newborns, abbreviated as GBN.

In acute cases, miscarriage is possible due to Rh conflict. In a number of cases, this phenomenon becomes the cause of miscarriage. That is why women with negative Rp need to be very careful about their condition and not miss scheduled visits to the gynecologist, tests and other studies.

Symptoms of Rh conflict

How does Rh conflict manifest itself? Unfortunately, there are no external manifestations visible to the naked eye. For the mother, all the processes occurring in her body and associated with Rh conflict are completely harmless and have no symptoms.

Symptoms of Rh conflict can be seen in the fetus during ultrasound examination. In this case, you can see the accumulation of fluid in the cavities of the fetus, swelling; the fetus, as a rule, is in an unnatural position: the so-called Buddha pose. Due to the accumulation of fluid, the abdomen enlarges, and the baby’s legs are forced to spread apart. In addition, a double contour of the head is observed, this also occurs due to the development of edema. The size of the placenta and the diameter of the vein in the umbilical cord also change.

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

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

Antibody test during pregnancy

One way to determine the very presence of Rh conflict is an antibody test. This analysis is performed on all women with suspected Rh conflict. To determine the risk group at the beginning of pregnancy, everyone is tested for the Rh factor, and the father of the child must also undergo the same procedure. If the combination of Rh factors in a particular case is dangerous, the woman will be tested once a month for Rh conflict, that is, for the number of antibodies.

Starting from week 20, if the situation is threatening, the woman from the antenatal clinic will be transferred for observation to a specialized center. Starting from 32 weeks, a woman will be tested for antibodies 2 times a month, and after 35 weeks - once a week until the onset of labor.

Much depends on how long the Rh conflict was detected. The sooner this happens, the more problems such a pregnancy portends, since the effect of Rh conflict has the ability to accumulate. After 28 weeks, blood exchange between mother and child increases, and, consequently, the number of antibodies in the baby’s body increases. Starting from this period, the woman is given special attention.

Studies to determine the extent of fetal damage

The condition of the fetus can be determined using a number of studies, including invasive ones, that is, associated with a certain risk to the health of the fetus. From the 18th week, they begin to regularly examine the baby using ultrasound. Factors that doctors pay attention to are the position in which the fetus is located, the condition of the tissues, placenta, veins, and so on.

The first study is scheduled around 18-20 weeks, the next at 24-26, then at 30-32, another at 34-36 weeks and the last one just before birth. However, if the condition of the fetus is assessed as serious, the mother may be prescribed additional ultrasound examinations.

Another research method that allows you to assess the baby’s condition is Doppler ultrasound. It allows you to evaluate the work of the heart and the speed of blood flow in the blood vessels of the fetus and placenta.

CTG is also invaluable in assessing the child's condition. It allows you to determine the reactivity of the cardiovascular system and suggest the presence of hypoxia.

Separately worth mentioning invasive assessment methods condition of the fetus. There are only 2 of them. The first one is amniocentesis– puncture of the amniotic sac and collection of amniotic fluid for analysis. This analysis allows you to determine the amount of bilirubin. In turn, this allows you to very accurately determine the child’s condition.

However, puncture of the amniotic sac is a truly dangerous procedure, and in some cases it entails infection in the amniotic fluid and can cause leakage of amniotic fluid, bleeding, premature placental abruption and several other serious pathologies.

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

The second research method is cordocentosis. During this test, the umbilical cord is pierced and a blood test is taken. This method even more accurately determines the bilirubin content; in addition, this is the method used to give a blood transfusion to a child.

Cordocentosis is also very dangerous and leads to the same complications as the previous research method, in addition there is a risk of developing a hematoma on the umbilical cord, which will interfere with the metabolism between mother and fetus. Indications for this procedure are an antibody titer of 1:32, the presence of previously born children with a severe form of HDN or deceased children due to Rh conflict.

Treatment of Rh conflict during pregnancy

Unfortunately, the only truly effective way to treat Rh conflict during pregnancy is blood transfusion to the fetus. This is a very risky operation, but it provides a significant improvement in the condition of the fetus. Accordingly, this helps prevent premature birth.

Previously, other treatment methods were widely used, such as plasmapherosis during pregnancy, skin transplantation of the husband to the woman, and some others are considered ineffective or not at all effective. Therefore, the only answer to the question of what to do in case of Rh conflict is constant observation by a doctor and following all his recommendations.

Delivery in case of Rhesus conflict

In most cases, pregnancy that occurs with the development of Rh conflict ends in planned pregnancy. Doctors monitor the child’s condition in every available way and decide whether it makes sense to continue the pregnancy or whether it would be safer for the child to be born prematurely.

Natural childbirth with Rhesus conflict occurs rarely, only if the condition of the fetus is satisfactory and there are no other contraindications.

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

However, most often birth in case of Rh-conflict occurs by caesarean section, since in this case it is considered more gentle.

For a happy, enjoyable pregnancy and, as a result, the birth of a healthy baby, a woman must arm herself with the necessary basic knowledge so that no myths or prejudices can throw her out of balance. Previously, pregnancy was considered incompatible and caused real fear among expectant mothers. To find out the truth, we must first understand what this Rh factor is?

The concept of the Rh factor arose only 35 years ago. This is a blood antigen (protein) that is located on the surface of blood cells and is determined through a blood test. People with negative Rhesus do not have this protein in their blood. According to statistics, approximately 20% of women in the world have this Rh factor, and many of them are happy mothers. Doctors say that Rh negative during pregnancy is not at all synonymous with infertility. What is dangerous is not the emerging Rh conflict, which happens only in isolated cases.

When is Rh negative during pregnancy dangerous?

Such cases include the moment when the Rh factor of the woman in labor does not coincide with the Rh factor of the child. What is the reason for the possible occurrence of Rh conflict? Our body has the ability to protect itself from foreign bodies. During infectious diseases, the body fights the virus, ensuring recovery. The same reaction of the body in Rhesus conflict. Aggressive antibodies, the purpose of which is to isolate foreigners (in this case, the child’s blood proteins), pose a threat to his full development. The penetration of antibodies through the placenta and their conflict with the red blood cells of the fetus can also lead to possible damage to the child’s brain and hearing. The worst consequences are congenital hydrops of the fetus and even its death.

Thanks to the achievements of modern medicine, Rh negative during pregnancy is no longer as threatening as it used to be. There are many ways to successfully cope with the problem of Rh conflict between the blood of mother and child. A woman with a negative Rh factor feels no worse than other mothers. The only condition for preventing the consequences of a possible conflict is regular visits to the doctor and blood tests. If a conflict does arise, doctors sometimes have to provoke early labor and transfuse blood to the newborn. These procedures are happening quite successfully today, so you shouldn’t worry too much in advance.

It should be noted that Rh negative during pregnancy with the first child very rarely provokes a conflict. A woman who has never come into contact with a positive Rh factor simply does not have antibodies that can harm the child. But during childbirth, the baby's protein may enter the mother's bloodstream. In this case, antibodies may appear. To prevent problems with subsequent pregnancy, the expectant mother is recommended to administer a drug called anti-Rh immunoglobulin. It binds aggressive antibodies and allows them to be removed from the body.

Therefore, if your first child had a positive Rh factor and you dream of having more children, so that if you have a negative Rh factor it will be successful, it would be advisable to introduce such a vaccine. It can be administered both during pregnancy itself and after childbirth.

Modern medicine deals with the treatment of Rh conflict quite successfully. Therefore, even when the result of your tests determines the Rh conflict, this is not yet a reason to panic. If you take a responsible and conscious approach to this problem and its solution, with the help of experienced doctors, you will soon find yourself in your arms with a healthy toddler, and you will become another happy mother.