1 blood group conflict a0 probability of occurrence. Hemolytic disease of newborns - physiological jaundice

Having registered at the antenatal clinic, every pregnant woman receives a lot of referrals for tests, among which there is a mandatory test to determine the blood group and Rh of both spouses. In most cases, everyone is concerned about the presence or absence of this very Rh factor, since everyone knows about the likelihood of the development of Rh conflict in mother and child. At the same time, few people are aware of the existing possibility of an immunological conflict between blood groups.

Why does an immunological conflict occur?

The first blood group does not contain antigens A and B in erythrocytes, but there are α and β antibodies. All other groups have such antigens, and therefore the first blood group, having encountered antigens A or B that are foreign to it, begins to “enmity” with them, destroying red blood cells containing these antigens. It is this process that is the immunological conflict in the AB0 system.

Who should be afraid of a blood type conflict?

Theoretically, this problem can arise if the mother and the unborn baby have different blood types:

• a woman with blood group I or III - a fetus with type II;
• a woman with blood group I or II - a fetus with III;
• a woman with group I, II or III - a fetus with IV.

The most dangerous combination is considered to be if a woman with blood group I carries a child with blood group II or III. It is this situation that most often leads to the development of all signs of conflict between mother and fetus and the occurrence of hemolytic disease in the newborn. Women at risk also include:

• have received blood transfusions in the past;
• survivors of several miscarriages or abortions;
• who previously gave birth to a child who developed hemolytic disease or mental retardation.

The possibility of developing a group immunological conflict according to the AB0 system exists in married couples with the following combinations of blood groups:

• woman with group I + man with group II, III or IV;
• woman with group II + man with group III or IV;
• woman with III + man with II or IV.

What contributes to the development of conflict?

A properly functioning and healthy placenta protects against the development of blood group conflict. Its special structure does not allow the blood of the mother and fetus to mix, in particular, due to the placental barrier. However, this can still happen if the integrity of the blood vessels of the placenta is violated, its detachment and other damage or, most often, during childbirth. Fetal cells that enter the maternal bloodstream, if they are foreign, cause the production of antibodies that have the ability to penetrate the fetal body and attack its blood cells, resulting in hemolytic disease. The toxic substance bilirubin, formed as a result of such exposure in large quantities, can damage the child’s organs, mainly the brain, liver and kidneys, which can have serious consequences for the baby’s physical and mental health.

Manifestations of group conflict, its treatment and prevention

A pregnant woman will not experience any signs of developing a blood group conflict. A blood test will help you find out about its occurrence, which will show a high titer of antibodies in the woman’s blood. With the development of hemolytic disease of the fetus and newborn, the following may be observed:

• swelling,
• jaundice,
• anemia,
• enlargement of the spleen and liver.

Prevention of serious complications is to regularly donate blood for analysis and identify specific antibodies in it - hemolysins. If they are found, the pregnant woman is placed under observation. If, as a result of repeated tests, the antibody titer continues to rise steadily and the fetal condition worsens, then premature delivery or intrauterine blood transfusion to the fetus may be required.

Some gynecologists regularly prescribe a test for group antibodies to pregnant women with the first blood group if there are prerequisites for this. In fact, this happens very rarely, due to the fact that a conflict in the AB0 system usually does not entail serious consequences and causes jaundice only in an already born child, with virtually no effect on the fetus in the womb. Therefore, there are no such mass studies as during the pregnancy of an Rh-negative woman.

Hemolytic disease a newborn requires mandatory treatment to avoid the development of severe complications. The more pronounced the symptoms, the more intense the conflict, which is confirmed by a blood test for elevated bilirubin levels. The point of treatment is to remove antibodies, damaged red blood cells and excess bilirubin from the child’s blood, for which phototherapy and other symptomatic treatment are carried out. If this does not help, or the level of bilirubin in the blood increases very quickly, then they resort to the procedure of blood transfusion to the newborn.

Future parents who are at risk of developing such a conflict need to know that, firstly, the likelihood of a real blood group conflict occurring in practice is very small, and secondly, it most often occurs much easier than Rh conflict, and cases of severe are relatively rare, therefore conflict according to the AB0 system is considered less dangerous for the baby’s health.

The article explains the risk of Rh conflict during pregnancy. Recommendations are given to future parents to prevent possible complications.

Having become pregnant, a woman registers with an antenatal clinic. She will have to undergo a lot of examinations and tests. An analysis will also be required that will help determine the blood groups of future parents and their Rh factors.

The Rh factor is a specific property of human red blood cells, which is determined by the presence of an antigen protein. Other group systems do not affect the presence of the Rh factor in the blood. Every person is born with a certain Rh factor. It remains unchanged until death and is inherited by children.

How is the Rh factor determined?

The Rh factor in medicine is designated by a combination of two Latin letters Rh. If the Rh antigen is detected in red blood cells, then the blood of such a person is considered Rh positive (Rh+). There are about 85% of such people in the world. The remaining 15% are carriers of Rh negative blood

Those with negative Rh do not experience any particular inconvenience and are not considered sick. But if a woman is going to become a mother, then she needs special attention.

If the same antigen and antibody are present in the blood, then their combination leads to the reaction of red blood cell adhesion

Sticky red blood cells are unable to carry oxygen. Antigens and antibodies of the same name are not found in the bloodstream of healthy people.

Rh conflict occurs when Rh-positive blood is mixed with Rh-negative blood. The fetal blood becomes incompatible with the mother's blood. All systems of the mother’s body will fight against the foreign protein that appears in it.

This happens when the father inherits Rhesus, due to immunological incompatibility of the blood groups: maternal and child. In case of blood group incompatibility, the danger is less than in case of Rh factor incompatibility.

Rhesus status is determined in several ways. This depends on whether special laboratory equipment is available. In its absence, express methods for determining the Rh factor are carried out:

• using a universal reagent; the test tube does not heat up
• on a white flat plate without heating the test tube

Rhesus status is determined by fresh, unclotted blood. It is taken from a finger or from a vein

For the express method, a universal serum is used, which is suitable for all blood groups. The whey is prepared using a special method. It is used during iso-immunization procedures for pregnant women. The sticking of red blood cells in a test tube indicates that there is Rh antigen in the blood.

The mother's body with negative Rhesus perceives the fetus, which has inherited the positive Rhesus of the father, as foreign. As a result, antibodies are produced that attack and destroy the fetus.

Sometimes it affects development, normal height baby. But serious consequences are also possible: antigens present in the blood can cause intrauterine death of the embryo, miscarriage

Symptoms of Rh conflict

A woman cannot independently determine by her well-being that she is at risk of developing an Rh conflict. The main sign is the presence of antibodies in her blood

• the fetus develops a hemolytic disease, which is manifested by anemia and disruption of the internal organs
• the baby has jaundice
• there is a risk of hypoxic damage to the brain and heart that is fatal to the fetus

Cause of Rhesus conflict:

• C-section
• various complications, bleeding before or during childbirth caused by placental disorders or abruption
• performing various procedures such as chorionic villus sampling, cordocentesis or amniocentesis
• with gestosis, diabetes, after suffering from influenza or acute respiratory infections
• after intrauterine sensitization of the expectant mother

A woman is at risk for developing Rh conflict due to complications during pregnancy (toxicosis, blood pressure surges, infectious diseases). They will learn about possible sensitization after the woman has passed all the tests and the Rh affiliation of the future parents and their blood groups has been determined.

Blood test for Rh factor

It is impossible to find out on your own that a couple does not match each other by blood. But if a woman does not become pregnant from her partner for a long time, or if the pregnancy ends in miscarriages, then she should seek help from doctors. An “infertile” couple, having passed all the necessary tests and following the recommendations, will be able to conceive a baby, and the woman will be able to successfully carry it to term

The first stage of examining a pregnant woman for the presence of antigens is to determine the Rh affiliation of the future parents. It is recommended to carry out such diagnostics before conception, or at the beginning of pregnancy. If both partners are negative, no further research is carried out, since a conflict is excluded.

Important: if the patient’s pregnancy ended in a miscarriage or there were abortions, the fetus died in the womb or the child born had a hemolytic disease, then there is a high risk of Rh conflict.

To find out whether the fetus suffers from a lack of oxygen due to Rhesus conflict, it is necessary to regularly undergo ultrasound diagnostics. Ultrasound is prescribed from the 20th week of pregnancy to the 36th week. The last time an ultrasound is prescribed is before childbirth. This allows you to monitor the baby's growth and development.

The development of the fetus is also judged by conducting research amniotic fluid(amniocentesis) and examining cord blood (cordocentesis). Diagnosis of this type is carried out in the last trimester of pregnancy. Analysis of cord blood to determine how much anemia develops based on the level of hemoglobin, bilirubin and other indicators.

What do antibodies mean?

In the body of a pregnant woman, only by the 7-8th week, compounds of the protein structure - Rh antibodies - begin to be produced. Before this, there are no Rh antibodies in the mother’s bloodstream that could harm the fetus.

The first pregnancy is characterized by the production of large antibodies. It is not easy for them to penetrate the placenta to the embryo. But in subsequent pregnancies, other antibodies against the Rh factor are produced.

There are fewer antibodies, but their presence is more harmful for the child, since they are easier to pass through the placenta and are more aggressive. Therefore, the female immune system reacts to the Rh antigen faster and stronger during subsequent gestation.

Rhesus conflict in second and subsequent pregnancies

If a woman is carrying a child for the first time, then the incompatibility of the blood groups of the future parents will not cause an Rh conflict, since the amount of antibodies produced is insignificant.

A second pregnancy increases the risk of conflict. This means that during childbirth, umbilical cord blood with protective antibodies - “memory cells” - enters the mother’s blood. Thus, the mother’s body becomes susceptible to the Rh antigen. Antibodies cross the placental barrier and destroy the fetal red blood cells.

Maximum risk for women

There is no threat to the mother's body from Rh sensitization. After a difficult pregnancy and childbirth, the mother’s problems with the presence of Rh conflict are exhausted. But the immunization that has occurred may affect the recurrence of the situation during a subsequent pregnancy.

Consequences of Rh conflict for the fetus

A child with Rh conflict develops hemolytic disease, swelling, jaundice, and an enlarged spleen and liver. The level of bilirubin in the blood increases, which poisons the small organism.

Favorable prognosis: the newborn child has a high probability of developing mild hemolytic anemia. In this case, jaundice and dropsy are absent.

In more severe forms, hemolytic anemia with jaundice occurs. But the most severe form of the disease is aggravated by both jaundice and dropsy. The child may die in the womb

Treatment of Rhesus conflict

Doctors may decide to give the baby an intrauterine blood transfusion up to 34 weeks of pregnancy, which improves the condition of the fetus. The transfusion is carried out through the umbilical cord. In this way, the development of anemia in the fetus can be avoided.

In particularly severe cases, a decision is made to induce premature birth. The newborn baby is treated for jaundice and given a course of phototherapy (placed under special blue lamps). Repeated blood transfusions may be needed. In some cases, no treatment is required at all.

Video: about the Rh factor and the threat to the child

Determining the blood type and Rh factor - this action is carried out first after confirmation that the woman is expecting a child. Experts in the field of immunology have long studied the factors that influence compatibility or, conversely, incompatibility on fetal development. What blood types and Rh conflicts negatively affect the baby?

What is it?

Since ancient times, women with negative Rh factor blood immediately lost their babies or were born too weak and sickly. Today, the conflict between the blood groups of mother and father can be prevented, since specialized drugs have been created for this. This may be an immunoglobulin that is created from human blood. This injection must be given to a pregnant woman at 28 weeks of pregnancy and must be repeated three days after birth if the baby’s Rh factor is positive.

There is an opinion among doctors that it is advisable for a woman with a negative Rh factor not to have an abortion at all, since this can significantly affect her condition and subsequent ability to bear and give birth to a child. In a situation where an abortion is not planned and childbirth will have to occur, it is necessary to take into account the fact that such women need to give birth at least once.

Then there is a high probability that the child will be healthy, and the mother’s health will not be in any danger either. Her blood composition during the first pregnancy will produce antibodies to the child’s Rhesus, but the second time it will not allow its intervention.

Mechanism of action

A stable placenta protects against the development of blood group conflict. Its special device prevents the blood of the mother and fetus from mixing, mainly through However, this can still happen due to the destruction of the blood vessels of the placenta, its detachment and other defects, or, more often, during delivery.

When incompatible, fetal cells that have entered the maternal blood provoke the production of antibodies that can penetrate the fetal body and attack its blood cells, resulting in hemolytic disease. The toxic element - bilirubin, which is formed during such an interaction in significant quantities, can cause damage to the child’s body, mainly to the brain and excretory system. This can be fraught with significant disruptions in the functioning of the body.

In case of compatibility, there is nothing to worry about, but if incompatibility between the blood groups of mother and child is revealed, then the expectant mother will need to be constantly monitored by a specialist in order to stop negative consequences for a child.

Incompatibility

It makes sense to study in detail what incompatibility of blood groups of mother and child is. People with blood type I do not have antibodies A and B, but have beta and alpha antibodies. Other blood groups have antibodies: second (A), third (B), fourth (AB).

As a result of this, the immunity of a woman with the first blood group begins to fight elements of other blood groups that are foreign to the body. The protective mechanisms of the expectant mother decompose the child’s red blood cells, killing unnecessary antigens contained in the child’s blood. This is what is called incompatibility of the blood groups of mother and baby.

When does it occur?

A conflict occurs when the mother’s blood is incompatible with the child’s blood type. A blood type conflict during pregnancy can contribute to hemolytic abnormalities in the baby.

Hemolytic disease of the newborn is fraught with the production of hemolysis of red blood cells. As a result, there is a great danger of the baby's death. One way or another, erythroblastosis disrupts the natural functioning of the child’s circulatory system. With this type of deviation, the unborn baby is not able to develop harmoniously.

Are there any symptoms?

A pregnant woman may not experience the symptoms associated with blood type conflict during pregnancy. Analysis can reveal its presence. Laboratory tests will determine the high level of antibodies in the blood of the expectant mother. This is the main diagnostic method. With the development of blood diseases in the fetus or infant, the following may occur:

• swelling;
• yellow tint of the skin;
• anemia;
• increased size of excretory organs.

Prevention of significant complications can be achieved by constant monitoring of the mother's blood and determination of certain elements in it - hemolysins. If they are present, the expectant mother is carefully observed by specialists.

If, in the course of further research, the number of antibodies continues to constantly increase, and the condition of the fetus gets worse and worse, then it may be necessary to organize a premature birth or a blood transfusion to the fetus. Some specialists regularly test pregnant women with the first blood group for group antibodies when there is reason for it.

What is more important - group or rhesus?

Experts are convinced that the blood type at conception is not as important as the Rh factor of the father and mother. It is preferable that the father and mother have an identical Rh factor, this will make it possible to avoid problems that may appear during any period of pregnancy, conception, or even after the baby is born.

When to undergo treatment?

If parents find out in advance that their Rh factors are incompatible, then before conception it is best, and in some cases simply mandatory, to take a specialized course in order to prevent the woman’s body from rejecting the fetus.

If, however, spouses with different Rh factors are already expecting a child, and no preventive steps were taken during pregnancy planning, then it is necessary to carefully monitor the condition of the fetus throughout pregnancy. Currently, if a Rh conflict is detected, it is possible to prevent unpleasant consequences by introducing antibodies - immunoglobulin - at 26-27 weeks.

AVO conflict

In most cases, the ABO conflict is expressed in hemolytic (or physiological) jaundice in the child. In addition, children become restless, often scream or, on the contrary, lose activity, become overwhelmed, and sleep longer than children of their age should. In advanced situations, a bilirubin attack affects the baby’s brain and other important organs. But in most cases, congenital jaundice disappears within a couple of weeks with the support and constant monitoring of doctors. The main treatment is to support the child's body.

As during the period of bearing a child, if a high degree of group antibodies is detected, the specialist may prescribe additional injection of glucose into the veins or adding it to the baby’s diet, taking vitamins designed to improve the process of blood purification by the excretory system. If a child has an increased amount of bilirubin, there is no need to resist the prescription of additional complementary foods or medical procedures. As a rule, this does not interfere with breastfeeding. This is a kind of " ambulance» for the baby to improve his health. Such activities contribute to the harmonious growth and formation of the body.

Is jaundice possible?

If there is a conflict in the blood type of a newborn, the doctor may prescribe other medications, including during inpatient treatment. If jaundice begins to affect the baby's brain cells, therapy is carried out under close supervision by doctors. Nowadays they often talk about the benefits of late cutting of the umbilical cord after the birth of a child. The tying of the umbilical cord is delayed until its movement stops, which allows the child to receive useful substances after birth. This is exactly the procedure that is prohibited if the parents have different blood types.

Even if it is assumed that the baby received the mother's blood type and there is a high risk of developing a blood type conflict, the umbilical cord should be removed immediately after birth. This will protect the baby from possible problems. However, the main thing with neonatal jaundice is prevention. During the process of bearing a child, a woman does not feel the negative effects of incompatibility with the child. In this regard, if a blood type conflict may arise, it is necessary to be examined in a timely manner, plan the birth with an experienced specialist and remember the need the right image life.

Hormone levels

It will help to prevent the formation of a blood group conflict during pregnancy by identifying and regulating hormones in a woman’s body that affect the proper formation of the placenta. Since the placental embryonic organ turns out to be a reliable barrier to prevent contact of the mother’s blood with the blood of the fetus. This barrier is located between the maternal and fetal layers of the placenta.

Most often, pregnancy and childbirth proceed well, and advanced forms of hemolytic disease occur once in 200 pregnancies. In addition, it is necessary to register with the antenatal clinic in a timely manner, take all the required tests, and monitor whether the number of antibodies increases. The child's father must also take a blood test to determine the group and Rh factor. After all, if he has blood of the first group, then there will be no blood group conflict. The effectiveness of controlling such a deviation during pregnancy will depend on how long it will be detected.

When does Rh conflict appear?

The baby develops a Rh factor and a Rh blood group conflict during pregnancy, starting from the 7-8th week of fetal development. It is during this period that the child develops his own Rh factor. At the same time, antibodies tend to accumulate, and the situation can change rapidly.

You can read a lot today sad stories mothers who have experienced the result of blood group conflict. As the brain is damaged, they note delays in the baby's development; at times, vision or hearing may be lost. Some mothers battle baby seizures or raise their children with severe stages of cerebral palsy. But it is no longer possible to restore complete health to such children.

When a woman is Rh negative, she is strongly recommended to take an antibody test during the 7th to 8th week of pregnancy. If there is a risk of developing abnormalities, a new analysis should be performed at 28-30 weeks. With increased values ​​of the number of antibodies in the first trimester, fluctuations in the growth of blood enzymes are monitored more often - once every 14 days. In this case, much will depend on the position of the fetus.

If a blood transfusion cannot be given, then a decision must be made about premature birth. It is absolutely impossible to take risks with such a deviation. If the baby’s pulmonary system has already formed (28th week of pregnancy), then labor must be induced, otherwise expectant mother a miscarriage may occur.

Prevention of antibodies

The most effective method To prevent the appearance of antibodies to the D protein, it is considered to be the introduction of anti-Rh(D) immunoglobulin to the expectant mother. The drug allows you to block the antigenic areas of Rh-positive red blood cells, preventing the appearance of new ones. When passive antibodies are introduced, their excess appears, which leads to the suppression of their occurrence in the body.

Family planning is of primary importance in preventing incompatibility. A negative Rh factor does not pose any threat to conceiving a child. When planning maternity, you need to determine the indicators of the woman and her spouse. Before conception, it is necessary to carry out a study for the presence of Rh antibodies in the woman’s blood. When pregnancy occurs, you must register as early as possible and strictly follow all doctor’s instructions.

Treatment procedures

Blood diseases in infants require comprehensive, thorough treatment to avoid unpleasant and untreatable complications. The more pronounced the signs, the more noticeable the conflict of blood groups, to establish which an analysis is carried out for an increased amount of bilirubin.

The essence of the treatment procedures is to eliminate antibodies, affected red blood cells and excess bilirubin in the child’s blood. For this purpose, phototherapy and other treatment methods are used that are aimed at eliminating symptoms. In situations where this does not bring results, or the amount of bilirubin in the blood increases too rapidly, a blood transfusion is performed.

Most pregnant women have heard about Rh conflict. But not everyone knows that the mother’s blood type may not match the child’s blood type. However, such situations occur no less often than Rhesus conflict. And you need to be prepared for them.

If the expectant mother has the first blood group, and the child’s father has the second, third or fourth, the antenatal clinic may prescribe a test for group antibodies (hemolysins). This is done to determine whether the mother and baby are likely to have a blood type conflict.

What is an immunological conflict based on blood group?

There are four blood types. The blood of all groups, except I, contains antigens A or B in its erythrocytes. The blood plasma (except group IV) contains α or β antibodies.

• I (0) – antibodies α, β, does not contain antigens
• II (A) – antigen A, antibodies β
• III (B) – antigen B, antibodies α
• IV (AB) – antigens A and B, does not contain antibodies

When A and α or B and β meet, antibodies destroy red blood cells containing the “enemy” antigen. This is how a blood group conflict (or AB0 conflict) develops.

During pregnancy, an AB0 conflict is most likely to occur if a woman has blood type I, and the baby inherits type II or III.

Conflict? Let's decide!

In this case, in response to antigens contained in the child’s blood, as well as in the placenta and amniotic fluid, the mother’s body begins to produce group antibodies that destroy foreign red blood cells and release hemoglobin (this process is called hemolysis). Such an “attack” can occur during pregnancy and childbirth.

As with the Rh factor conflict, AB0 conflict sometimes develops hemolytic jaundice when the newborn’s liver cannot cope with a large amount of bilirubin (hemoglobin is excreted from the body in the form of this substance). To be prepared for such a development of events, after the 30th week of pregnancy, the expectant mother may be prescribed a blood test for group antibodies, which will need to be repeated regularly at intervals of 1 month. Immediately after birth, a cord blood test is taken. It shows what blood type the child inherited and the level of bilirubin in the baby’s blood (if there is still a conflict). Next steps doctors depend on the degree of hemolytic disease.

Unlike Rhesus conflict, blood group conflict can develop in the first pregnancy, but in subsequent ones it happens less often.

If you and your husband have prerequisites for an ABO conflict, there is no need to panic: it is usually much easier than an Rh conflict, and, as a rule, does not pose a danger to the baby’s health.

Some expectant mothers need to have their blood tested more often than others during pregnancy. Why? Are you one of them? Let's figure it out

There are many unsolved mysteries in modern science. One of them concerns hematology - the science of blood. Why do people with different blood groups live on Earth? Why is the Rh factor needed?.. There are still no answers to these questions. But we are on the way to a solution. If previously a blood conflict between a woman and the fetus she was carrying posed a huge threat to the child, now medicine has learned to solve this problem. The main thing is timely diagnosis!

Four options

When registering at the antenatal clinic, the doctor will send you for a number of tests, including determining your blood type and Rh factor.
Having received the results, the doctor will ask you to name the group and Rh factor of the father of the unborn child. Having brought the data together, he will tell you about the likelihood of a conflict between you and the fetus.
Could the blood of two close people, like you and your baby, “quarrel”? Unfortunately, yes. After all, she has her own tasks - to maintain the vital functions of the body and not to allow strangers into the “house”, which are components of blood that differ in blood group and rhesus.
There are four blood groups with the following designations: I = 0 (zero), II = A,
III = B, IV = AB.
So, you have the results of the analysis in your hands. Now you can calculate which group the baby may be born with. It's easy to do. Suppose you have IV (AB) group, and your husband has I (00). Let's solve a simple problem:
AB + 00 = A0 (II), A0 (II), B0 (III), B0 (III).
Now it becomes clear that the baby will be born with a second or third blood group.
All possible options inheritance is as follows:
I+I = I
I+II = I, II
I+III = I, III
I+IV = II, III
II+II = I, II
II+III = I, II, III, IV
II+IV = II, III, IV
III+III = I, III
III+IV = II, III, IV
IV+IV = II, III, IV
But is it only for this purpose that the blood type of the expectant mother is determined? Of course not. The main reason is to find out what kind of blood can be transfused to her in an emergency. In addition, based on the analyses, the possibility of conflict between mother and fetus is assumed.
Most often, blood type incompatibility occurs when the mother has group I and the baby has group II or III (accordingly, the child’s father must have group II, III or IV).
But such conflict is rare. More often than not, it is not possible to “make friends” with Rhesus dogs.

Simple equation

Rh factor is another blood indicator. If present, it is said to be positive (Rh+). Was it not found in the blood? Then it is called negative (Rh–).
In principle, it does not affect the life and health of an adult in any way. But they begin to pay special attention to it if the pregnant woman has Rh– blood, and the baby’s father has Rh+ blood. In this case, the baby may inherit the positive Rh of the father, which means there may be a Rh conflict with the mother. How does it manifest itself?
Just as with blood group incompatibility, the mother’s body begins to produce antibodies that can destroy the fetus’s red blood cells.
We hasten to calm you down! During the first pregnancy, conflict due to incompatibility between mother and fetus in terms of blood type and Rh factor rarely develops (if there have been no previous abortions or miscarriages). But with each subsequent pregnancy, the likelihood of conflict increases.
Knowing this, doctors have learned to prevent the formation of antibodies. Thus, all Rh-negative women who do not have the Rh factor at 28 weeks are advised to administer anti-Rhesus immunoglobulin in the interval between the 28th and 34th weeks. In Ukraine, it can be purchased at blood transfusion stations (domestic) or at a pharmacy (imported, higher quality).

Is there a conflict?

Let's assume that there is a possibility of a conflict between your blood group and your Rhesus (and perhaps both indicators at once!).
Typically, a progressive conflict does not affect a woman’s well-being. How can we determine that a negative process has started? Regularly donate blood to determine the amount (titer) of antibodies in the blood, namely:
until the 32nd week - once a month;
from 32 to 35 – twice a month;
after the 35th - every week.
If antibodies in the blood are detected in small quantities, you will have to visit the laboratory more often (tracking dynamics).
Is the titer high? Most likely, the woman will be admitted to a hospital, where she will first undergo a detailed ultrasound. Thickening of the placenta, polyhydramnios, as well as an increase in the size of the spleen and liver of the fetus, accumulation of fluid in its tummy can be manifestations of the conflict. In exceptional cases, doctors can perform amniocentesis (sampling of amniotic fluid from the amniotic sac under ultrasound guidance). Yes, the procedure is unpleasant and unsafe, but sometimes this is the only way to reliably determine the density of the water, the titer of antibodies to Rhesus, as well as the baby’s blood type. If the density of amniotic fluid is high, which indicates the breakdown of fetal red blood cells, they decide how to manage the pregnancy.
It is possible to perform cordocentesis (taking blood from the umbilical vein under ultrasound control).

Action plan

This is not your first pregnancy and a high titer of antibodies is detected in your blood? Have other studies confirmed the conflict? We need to start treatment! It usually consists of an intravenous infusion of vitamins and glucose solution. To reduce the amount of antibodies in the mother’s blood, the doctor will prescribe immunoglobulin injections.
The gestation period is short, but the titer is constantly growing? Such a mother will be offered plasmapheresis. The essence of the method is to take the mother’s blood in a volume of 250-300 ml, then the formed elements (red and white blood cells) are returned back, and the withdrawn liquid part (plasma) of the blood is replaced with medicinal solutions - albumin, rheopolyglucin. A mechanical cleansing of the mother's blood from antibodies contained in the plasma is carried out. This treatment method is used from the second half of pregnancy.
It is extremely rare to prescribe hemosorption (removal of toxic substances from the blood using a special device) and intrauterine transfusion of Rh-negative single-group blood to the fetus from 18 weeks.

How do we give birth?

If no antibodies are found during pregnancy or they are found in small quantities, then childbirth is carried out in the usual way. The only caveat: it is recommended to cut the umbilical cord immediately, without waiting for the pulsation to stop.
Did the conflict appear shortly before giving birth? Mom is hospitalized to constantly monitor the amount of antibodies. If the increase is significant, and the baby’s condition worsens, then induction of labor or a cesarean section are indicated.
After the baby is born, a neonatologist will immediately take care of it. Will be held necessary research and treatment was prescribed aimed at eliminating his anemia, jaundice, and edema.
Did you have the possibility of a conflict, but no antibodies were detected during pregnancy? After giving birth, you should be given an immunoglobulin injection within 48 hours to prevent conflict in subsequent pregnancies!

Human blood has two important characteristics– blood group (AB0 system) and Rh factor (Rh system). Most often, during pregnancy, problems arise with pregnancy due to incompatibility according to the Rh system, so we will analyze it first.

What is the Rh factor?

Rh factor (Rh) is an erythrocyte antigen of the Rh system. Simply put, it is a protein located on the surface of red blood cells (erythrocytes).

People who have this protein are Rh+ (or Rh positive). Accordingly, negative Rh Rh- (or negative Rh) indicates the absence of this protein in human blood.

What is Rh conflict and how is it dangerous for the fetus?

Rhesus conflict– the immune response of the mother’s body to the appearance of a “foreign” agent within itself. This is the so-called struggle of the mother’s Rh-negative blood bodies with the child’s Rh-positive blood bodies, which is fraught with the appearance of hemolytic anemia or jaundice, hypoxia and even fetal hydrops.

During the first pregnancy, the bloodstream of the mother and child functions separately from each other and their blood does not mix, but during previous births (possibly also during abortions and miscarriages), the child’s blood may enter the mother’s blood, and as a result, the woman’s body becomes Rh negative -factor will produce antibodies to the antigen even before the next pregnancy occurs. Therefore, a repeat pregnancy may take another early end intrauterine death embryo, and as a result, miscarriage.

The first pregnancy usually proceeds without complications, since the mother’s blood does not yet have antibodies to the “foreign” blood of the child.

Simply put, fetal blood cells penetrate through the placenta into the pregnant woman’s blood and if the blood is incompatible, the expectant mother’s body perceives the baby as a “stranger,” after which the protective reaction of the woman’s body produces special antibodies that destroy the baby’s blood cells.

The destruction of fetal red blood cells by antibodies is called hemolysis, which leads to anemia in the baby. The pregnant woman’s condition does not worsen, and the woman is not even aware of the previous threat to the baby’s health.

When does Rh conflict occur during pregnancy?

If the mother's Rh is positive, Rh conflict will never arise, no matter what the blood of the child's father is.

If both future parents have a negative Rh factor, there is also no reason to worry, the child will also have a negative Rh factor, it cannot be any other way.

If the blood Rh factor is negative in the pregnant woman and the father of the child is positive, the baby can inherit both the Rh factor of the mother and the Rh factor of the father.

If the father of the child is Rh-positive, homozygous, and has the DD genotype, and the pregnant woman is Rh-negative, then in this case all children will be Rh-positive.

If the father is Rh-positive, heterozygous, and has the Dd genotype, and the pregnant woman is Rh-negative, then in this case a child can be born with both Rh-positive and Rh-negative factors (the probability in this case is 50 to 50).

Therefore, it is also important for a man to donate blood for the Rh factor to determine the genotype in case of a negative blood group in a woman planning a pregnancy or carrying a fetus.

If there is a risk of developing an Rh conflict, a pregnant woman is prescribed a blood test to check for the presence of Rh antibodies.

Table 1 - Probability of developing Rh conflict during pregnancy

Judging by the table above, we can say that Rh conflict occurs only when the pregnant woman has a negative Rh and the child’s father has a positive Rh, and only in 50 cases out of a hundred possible.

That is, it is not necessary to experience a Rh conflict during pregnancy. The fetus can also inherit negative Rh from the mother, then there will be no conflict.

It should also be noted that during the first pregnancy, antibodies are produced for the first time, and therefore they are larger in size than during repeat pregnancy. It is more difficult for large antibodies of the IgM type to penetrate the placental barrier into the child’s blood; they seem to be unable to “get through” the walls of the placenta, and during the next pregnancy, other, more “modified” antibodies of the IgG type are produced. They are smaller, and their ability to penetrate the walls of the placenta is much higher, which is more dangerous for the fetus. Then the antibody titer increases.

Therefore, first-time mothers should not worry about Rh conflict, just be vigilant (it is enough to determine the antibody titer once a month), and enjoy the pregnancy period, because there are worries ahead about caring for the baby and raising it.

Prevention and treatment of Rh conflict

During the first pregnancy (i.e. there have been no abortions or miscarriages in the past), the first test for antibodies is carried out from 18-20 weeks 1 time per month (until 30 weeks), then from 30 to 36 weeks - 2 times a month, and after 36 weeks of pregnancy - 1 time per week.

In case of repeated pregnancy, they begin to donate blood for antibodies from the 7-8th week of pregnancy. If the titer is no more than 1:4, then this test is performed once a month, and if the titer increases, more often, once every 1-2 weeks.

An antibody titer of up to 1:4 inclusive is considered acceptable (normal) during a “conflict” pregnancy.

Titles of 1:64, 1:128 and more are considered critical.

If there is a risk of developing a “conflict” pregnancy, but antibodies were never detected before week 28 (or were detected, but not more than 1:4), then later they may appear in significant quantities.

Therefore, for preventive purposes, pregnant women are given human anti-Rhesus immunoglobulin D at 28 weeks, which blocks the work of the woman’s immune system to destroy foreign bodies, i.e. after the injection, the woman’s body will not produce antibodies that destroy the blood cells of the embryo.

It is advisable to carry out an immunoglobulin injection in the absence of antibodies in the blood of a pregnant woman, since in other cases it is simply useless.

The vaccine does not have any effect negative influence on the health of the mother and fetus, it is completely safe.

After an injection (provided there are no antibodies in the blood shortly before the injection, or at least when their titer is no more than 1:4), it is not reasonable to donate blood for antibodies, since a false-positive result may be observed.

It is also advisable to monitor the baby’s cardiac activity by regularly conducting cardiotocography (CTG), starting from 26 weeks.

Doppler or Doppler is an ultrasound examination of blood flow in the fetal vessels, uterine arteries and umbilical cord.

When the fetus is suffering, the blood flow velocity (V max) in the middle cerebral artery will be higher than normal. When this indicator approaches the 80-100 mark, an emergency CS is performed to prevent the baby from dying.

If there is an increase in antibodies and the child’s health condition worsens, then this indicates the development of hemolytic disease of the fetus (abbreviated as HDF), then it is necessary to carry out treatment, which consists of: intrauterine transfusion fetal blood.

In case of a “conflict” course of pregnancy, the following signs of hemolytic disease of the fetus may be observed during an ultrasound examination:

• enlargement of the fetal abdomen due to accumulation in its abdominal cavity liquid, as a result of which the baby takes the “Buddha pose”, spreading his bent legs to the sides;
• swelling of the subcutaneous fatty tissue of the head (ultrasound shows a “double contour” of the fetal head);
• an increase in the size of the heart (cardiomegaly), liver and spleen;
• thickening of the placenta up to 5-8 cm (normal 3-4 cm) and expansion of the umbilical cord vein (more than 10 mm).

Due to increased swelling, the weight of the fetus will increase by 2 times compared to the norm.

If it is not possible to carry out a blood transfusion, then it is necessary to discuss the issue of early delivery. You cannot delay, and if the baby’s lungs have already formed (28th embryonic week or more), then it is necessary to perform labor stimulation, otherwise the pregnant woman risks losing the child.

If the baby has reached 24 weeks, a series of injections can be given to mature the fetal lungs so that he can breathe on his own after an emergency delivery.

After the baby is born, he is given a replacement blood transfusion, plasmapheresis (filtration of blood from dangerous cells) or phototherapy, otherwise the destruction of the baby’s red blood cells will continue to occur.

Modern labor intensive care services are capable of delivering a premature baby even when it is born at 22 weeks of pregnancy, so in a critical case, entrust saving the baby’s life to qualified doctors.

Group incompatibility of mother and fetus

Less commonly, but still, blood type incompatibility does occur.

Blood group is a combination of surface antigens (agglutinogens) of red blood cells of the AB0 system, genetically inherited from biological parents.

Each person belongs to a certain blood group according to the AB0 system: A (II), B (III), AB (IV) or 0 (I).

This system is based on a laboratory test to determine two agglutinogens (A and B) in human blood.

• Blood group I - otherwise it is group 0 (“zero”), when agglutinogens neither A nor B were found on red blood cells during a blood group test.
• Blood group II is group A, when the red blood cells contain only A agglutinogens.
• Blood group III is group B, that is, only B agglutinogens are found.
• Blood group IV is group AB; both A and B antigens are present on red blood cells.

Group incompatibility is often observed if the expectant mother has blood type I, and the future father of the child has IV, then the fetus will inherit blood group II or III. But there are other options for blood group incompatibility (see Table 2).

Table 2 - Probability of developing a blood group conflict during pregnancy

Typically, group incompatibility is much easier than Rhesus incompatibility, so blood type conflict is considered less dangerous, and babies who have suffered a blood type conflict are born with normal jaundice, which soon goes away.