Determination of blood group in combination with the Rh factor - this study is one of the first to be carried out after confirmation of pregnancy. Scientists in the field of immunology have long studied the fact of the influence of compatibility or, conversely, conflict of blood groups and Rh factors of parents on intrauterine development fetus In case of compatibility, there is nothing to worry about, but if there is a conflict between the blood groups of the mother and child, then the pregnant woman will need constant medical supervision in order to prevent adverse effects on the newborn. Let's explore in detail what constitutes a blood group conflict during pregnancy.
Cause of blood category conflict
People with the first blood flow group do not have A and B antigens in their blood, but have beta and alpha antibodies. In other blood groups, antigens are present: II (A), III (B), IV (AB). In view of this, the immune system of a pregnant woman with the first group of blood fluid begins to fight agglutinogens of other blood categories that are foreign to her body.
The protective system of the expectant mother destroys the red blood cells of the unborn baby, destroying antigens “harmful” to her in his bloodstream, which leads to hemolytic disease of the newborn. This is an immunological conflict state according to the AB0 system.
What are the consequences of blood flow group mismatch?
An immunological conflict occurs when the mother’s blood does not match the child’s blood substance. A conflict in the blood substance group during pregnancy can lead to hemolytic pathology of the baby. Hemolytic disease newborns, abbreviated as (GBN), are at risk of developing hemolysis of red blood cells, resulting in a huge risk of fetal death. In any case, erythroblastosis disrupts the full functioning mechanism of the baby’s circulatory system. With such a pathology, there is no proper development an embryo is out of the question.
Forms of hemolytic pathology:
The state of red blood cell hemolysis is characterized by the destruction of the red blood cell membrane and the release of hemoglobin into the plasma fluid. Released hemoglobin in large quantities has a poisonous effect on the body.
Therefore, simultaneously with poisoning and overload of the fetus’s body with bilirubin and other substances, such a pathology also entails anemia.
The liver does not have time to neutralize free bilirubin on a large scale. And this substance in a neurotoxic form wanders throughout the body of the embryo, disrupting oxidative processes in organs and tissues. This leads to irreversible, destructive consequences, including the death of the child. For this reason, the danger of blood substance group conflict during pregnancy should not be underestimated.
Exposure to risk of AB0 incompatibility
Parents can reliably calculate the blood flow category of their child using an online calculator by maintaining the blood data of the future father and mother. You can also independently calculate the expected category of the child’s blood substance, using a table with blood group data according to the theory of inheritance proposed by the geneticist Mendel.
In situations where there is a high risk of developing a conflict in the AB0 system, the pregnant woman is asked to do a blood test to determine the level of antibodies. A high titer of immunoglobulins in the bloodstream is an alarming signal. It indicates a conflict between the mother’s blood and the baby’s bloodstream.
This means that the antigens present in the blood of the embryo, placental blood substance and in amniotic fluid ah, they cause a protective reaction of the immune system in a woman’s body. It should be noted that the danger of conflict between the blood of mother and fetus lies in the absence of pronounced symptoms. A woman may feel quite normal, but in the meantime her child in the womb will be attacked by the mother’s immune system.
The likelihood of blood type conflict exists among married couples who are carriers of the following categories:
- A man with blood group II, III, IV, and a woman with I.
- A man with III or IV, and a woman with II.
- A man with II or IV, and a woman with III.
The most dangerous combination of ABO incompatibility is when the expectant mother has I and the fetus has blood type II or III. It is precisely this conflict of blood flow groups that contributes to the development of HDN pathology (hemolytic disease of the newborn). With this pathology, the fetus or already born baby may experience symptoms such as enlarged liver and spleen, swelling, anemia, and icteric skin color.
- A pregnant woman with blood group I or II, and the embryo with III.
- Pregnant with I or III, and the embryo with II.
- Pregnant with I, II or III, and the embryo with IV.
Women also have an objective likelihood of blood group conflict:
- Those who have had an abortion or suffered a miscarriage.
- Subjected to blood transfusion.
- Those who gave birth to a child with hemolytic pathology.
When it is determined that the blood of the pregnant woman and the fetus are incompatible according to the AB0 system, the woman is placed under regular monitoring by a gynecologist. In such circumstances, a planned analysis of the blood flow of the expectant mother for group indicators of immunoglobulins will be recommended. Constantly monitoring the amount of antibodies will allow you to take timely necessary measures to normalize the state of red blood cells in the fetus.
Prevention and treatment of AB0 incompatibility
Naturally, it is unrealistic to plan family life and conceive children, relying only on your partner’s blood type. Few people attach importance to AB0 compatibility; they usually choose a pair based on other characteristics. There are a great many people on the planet and they all have different blood types.
- As you know, the overwhelming majority is the first category of blood flow, more than 50%.
- It is followed by the no less common second group of blood substance, about 40%.
- The third category occupies no more than 30% of all inhabitants of the planet.
- And the fourth blood flow group is the rarest, accounting for less than 15% of people on earth.
In the meantime, the issue of procreation is one of the main components family life. Therefore, many couples are interested in how to get married, without thinking about the partner’s blood type, and what is called love. And prevent undesirable consequences of blood conflict during pregnancy. It is quite feasible if you know about the risk of discrepancy according to the AB0 system and register in time for continuous monitoring at the antenatal clinic.
Determining and regulating the level of hormones in a woman’s body that influence the proper formation of the placenta, such as human chorionic gonadotropin, placental lactogen and other biologically active substances, will help prevent the risk of developing a blood group conflict. Because the placental embryonic organ serves as a reliable barrier to prevent the mother’s bloodstream from contacting the fetal bloodstream. This barrier is located between the maternal and fetal layers of the placenta.
Problems can arise due to improper development of the placenta, its detachment and other pathologies.
In a situation where a conflict between the blood flow groups of the mother and the fetus is nevertheless diagnosed based on the results of tests with an excess of hemolysin antibodies, the following measures can be taken:
- Phototherapy using fluorescent lamps, which helps remove toxic substances from the fetus’s body, primarily released bilirubin.
- Normalization of liver activity through intrauterine administration of vitamins B, C, E, as well as cocarboxylase. In combination with a pregnant woman taking choleretic drugs, activated carbon to slow down the absorption of bilirubin in the intestines and conduct cleansing enemas.
- General detoxification therapy.
- Intrauterine blood transfusion into the embryo, mainly red blood cells.
- Premature birth, if timing allows.
It is necessary to remember, in order to ensure the health of your children, you need to start monitoring their well-being from the moment they are in the womb. Women should be even more aware of this and promptly come under the supervision of a gynecologist. The danger to the developing fetus lies not only in the development of hemolytic disease of the newborn. Severe cases of blood group conflict, fortunately, are rarely detected. More often, a discrepancy in the AB0 system occurs much simpler than a conflict in Rh factors and is expressed in jaundice in children in the first days of life.
A conflict between the blood groups of mother and child leads to hemolytic disease.
Why does immunological conflict occur?
There are four blood groups: first (0), second (A), third (B), fourth (AB). Blood also has a Rh factor: it can be positive or negative.So, if a pregnant woman and her baby have different blood types or Rh factors, it turns out that the child’s blood contains an antigen that is not in the mother’s blood. This antigen could have been inherited by the baby from the father, whose blood type or Rh is different from the mother’s.
Thus, the mother’s body perceives the fetal blood cells as a foreign formation and begins to produce antibodies aimed at destroying “foreign” cells.
Normally, the placental barrier prevents the mixing of maternal blood with the baby’s blood, but in some pathological conditions (placental abruption, etc.), the functions of the barrier may be impaired.
What is the danger of blood type conflict during pregnancy?
If the expectant mother’s blood begins to produce antibodies to the baby’s blood, then when these antibodies enter the baby’s circulatory system, they begin to destroy red blood cells in the baby’s blood.Blood group conflicts can lead to kidney and liver problems and brain damage.
A so-called hemolytic disease develops, the symptoms of which are anemia and jaundice.
But such serious consequences as disruptions in work nervous system, which lead to a child’s developmental delay in the future, are unlikely and rare.
Who is at risk based on blood type?
It is believed that women with blood type O are most at risk of blood group conflict.In addition, those expectant mothers who are pregnant more than once from the same man are at risk of having a blood type conflict.
Rh factor: 
Blood types: 
First pregnancy with blood type incompatibility
The first pregnancy, which is accompanied by a blood group conflict, is the safest.After childbirth, antibodies produced to the baby’s blood remain in the mother’s body. Thus, during subsequent pregnancies from the same man, these antibodies will continue to be produced, their quantity will be significantly higher than during the first pregnancy.
Even if the first pregnancy was terminated by abortion or premature birth or miscarriage occurred, the female body has already managed to produce antibodies.
Manifestations of group conflict, its treatment and prevention
While pregnant, there may be no signs of blood group conflict. The baby can be absolutely healthy until the moment of birth, when the placental barrier disappears and the mother’s blood enters the baby’s circulatory system.A blood test is taken from the newborn to see if there is any group conflict. If it is present, the child will have severe anemia - a low level of hemoglobin in the blood.
The baby may also experience hemolytic jaundice. Unlike physiological jaundice, which appears a few days after birth, is safe and goes away on its own, hemolytic jaundice is a pathological condition. The baby may be born immediately with yellow skin, or may turn yellow a little later. Even the whites of a baby's eyes can turn yellow. This is caused by a huge excess of bilirubin in the blood, which puts a tremendous burden on the baby's liver.
To treat a child, he may be placed under a special lamp, which will use radiation to reduce the level of bilirubin. There are also various medications for this purpose.
In extreme cases, the child may need a blood transfusion.
There is no special prevention against blood group conflict. But to establish the likelihood of developing such a process, both parents take a blood test to determine the group and Rh factor.
Special IV blood group
The fourth blood group in combination with a negative Rh factor is considered very rare. If the wife has this particular blood type, then the likelihood of a conflict with the baby’s blood is very high, so the expectant mother will be under close supervision and undergo regular examinations throughout the pregnancy.All expectant mothers are well aware that there is a contradiction between the Rh factors of the father and mother, which can negatively affect the fetus and the course of pregnancy itself. But for many, it is a shock to learn that there is a risk of a blood group conflict during pregnancy. This occurs in cases where the unborn child inherits blood from his father that does not fit well with the mother’s blood type.
The immunological contradiction between the blood of the mother and the fetus is called a conflict according toblood group This phenomenon is noted if the fetus receives the paternal blood type, which does not coincide with the maternal one and conflicts with it. Most often this happens if the mother has blood group I, and the fetus has blood group II or III, but there may be other combinations.
The severity of incompatibility is not as great and dangerous for the fetus and mother as in case of disorders of the Rh factor combination, however, in some cases it can harm the health of both.
Despite the fact that direct mixing of the blood of the fetus and mother does not occur, a small amount of it still enters the mother’s circulatory system. Her immune system perceives the ingress of blood from a fetus with a different group as a foreign protein and attacks it.
The mother's body begins to produce blood from the fetus, that is, there is a threat that the mother's body may reject the pregnancy, and the fetus risks suffering from hemolytic disease of the newborn.
In contrast to the conflict of Rh factors in case of incompatibility of blood groups, the first pregnancy is the least risky, since in its process the body only adapts to “foreign” blood, its sensitization occurs. Therefore, the first child from one husband is at the least danger, but with subsequent pregnancies from the same man, the risk level constantly increases. Such pregnant women need constant monitoring.
Causes of the problem
A blood group conflict occurs when conflicting antibodies O± and OI and antigens A and B are found in the blood of the mother and fetus.
During a healthy pregnancy, the blood of mother and child does not connect due to the flawless functioning of the placental barrier. It is located between two layers of the placenta - fetal and maternal. In its normal state, the placental barrier serves as a faithful guardian of the health and safety of the fetus. But with various pathologies, for example, with, the blood of the mother and fetus mixes.
In the mother's body, the formation of fetal blood cells occurs, they enter the fetal bloodstream and cause the destruction of its blood cells. When they decay, toxins are formed that affect vital organs - the brain, etc.
Dropsy of the brain is also possible, since when blood cells are destroyed, a large amount of “excess” fluid appears. A characteristic manifestation of conflict is also. But such grave consequences are still more the exception than the rule.
The possibility of incompatibility is identified during pregnancy, especially if the woman has risk factors in the form of previous blood transfusions, miscarriages, or children born with hemolytic disease of the newborn, jaundice, or various pathologies.
A blood test reveals the presence of antibodies, the pregnant woman is closely monitored, and, if necessary, sent to a hospital for treatment.
If a woman falls into the high-risk category, she must be regularly tested for antibody titers. But the presence of a potential threat does not necessarily mean defeat. In most cases, with a successful pregnancy, the conflict never manifests itself or does not produce dangerous consequences.
Danger to the fetus
Blood group conflict poses the greatest danger to the fetus in the following cases:
- Mother with group I or II - fetus with group III.
- Mother with group I or III - fetus with group II.
- Mother with group I, II or III - fetus with group IV.
The most risky form is considered to be a combination of the first blood group in the mother and the second or third in the child. After the first pregnancy, the risk of hemolytic disease in subsequent children increases significantly.
We can say that women with blood type I are at greater risk than others of developing an immunological problem when conceiving a child from a man with any other blood group. In this case, the Rh factor does not play a decisive role. Women with other blood groups are well compatible with carriers of their own and group I.
Even if no signs of incompatibility were found during the entire pregnancy, this does not mean that the fetus is not at risk of developing neonatal hemolysis.
During childbirth, the placental barrier ceases to function and ceases its protective function. The placenta separates, and the mother's blood can easily mix with the fetus' blood, provoking a conflict. If childbirth proceeds quickly, the disease in the newborn may manifest itself in a mild form or may not affect his condition and health at all.
Long, protracted labor increases the risk of developing incompatibility, and the baby may become ill some time after birth, so a thorough examination and close monitoring of the condition of both mother and child are required. Immediately after birth, a blood sample is taken from the newborn. If a hemolytic problem is detected, action will be taken immediately.
More information about what Rhesus conflict is can be found in the video:
Severe manifestations of the disease are quite rare, occurring within one case in 200 - 250 births in high-risk pregnancies. In order to timely identify a potential risk, not only the expectant mother, but also the father donates blood for antibodies and blood type.
Throughout pregnancy, a woman needs to be wary of various interventions that can lead to the connection of the blood of the fetus and mother. Puncture of the amniotic sac for testing amniotic fluid or taking blood from an unborn baby can lead to a sharp increase in antibodies.
Treatment, possible consequences and prognosis
Modern medicine cannot yet completely cope with or prevent blood type conflict, but there are ways to reduce the dangerous manifestations of the disease in newborns. Timely determination of the presence allows you to quickly begin treatment and begin cleaning the mother’s blood. She is prescribed activated carbon and Enterosgel.
During childbirth, the child is carried out and, if antibodies are present, phototherapy is immediately carried out - they are placed under a special lamp, the radiation of which contributes to a rapid decrease in the level. If the antibody titer is very high and the bilirubin level rises rapidly, then even timely phototherapy may not help. In such a situation, it is necessary to resort to blood transfusion, hemosorption or plasmaphoresis in order to improve the condition of the newborn. A sharp increase in bilirubin levels leads to a negative effect on cells and the development of jaundice, enlarged spleen, etc. To avoid this, drugs are prescribed that can bind bilirubin and remove it from the body, enterosorbents and choleretic agents.
In the event of a potential blood conflict, breastfeeding is not recommended to avoid the transfer of antibodies from mother to child.
Previously, this was not known or practiced, but now in modern maternity hospitals they are not allowed to feed the newborn colostrum, since it also contains antibodies, and in sufficiently large quantities to intensify or provoke a conflict. In cases of severe damage, breastfeeding can be stopped altogether, immediately after birth the baby is selected with a special diet that provides him with nutrients without risk to health.
Since severe manifestations of hemolytic disease with blood conflict are much less common than with incompatibility of Rh factors, the prognosis for normal, problem-free development of pregnancy is positive. The risk is minimal, and with proper control, dangerous consequences can be stopped at the earliest stages. This cannot harm the baby in any way. In the rarest cases, a newborn may develop jaundice or anemia, or some other diseases that, with timely treatment, will not adversely affect the child’s health.
If the initial stages of hemolysis are detected, the newborn is placed under a blue lamp and this simple action it is often enough to reduce bilirubin levels and avoid severe intoxication. Subsequently, the blood picture and the state of other systems and organs are balanced and the newborn develops in the same way as all other babies of his age. In a critical situation, the baby can be saved by blood transfusion or purification.
Why does mother-fetus conflict arise?
Conflict " mother-fetus“occurs when there is incompatibility between the blood of the mother and the fetus, when antibodies are formed in the mother’s blood that damage the red blood cells of the fetus, which leads to hemolytic disease of the newborn. This phenomenon is based on the difference in human blood into groups depending on the presence of different antigens in erythrocytes, and group-wide antibodies in plasma. The number of group antigens is large, and they determine the blood type. The child receives the blood group system from the father and mother, according to Mendel's law. In practice, identifying a group is not difficult. Not all antigens are equally common or equally potent, so not all cause serological conflict. Most often, incompatibility occurs in the Rh factor and the AB0 system.
Conflict according to the ABO system
Isoimmunization can develop as a result of incompatibility between the blood of mother and fetus according to the ABO system, when the mother has O(I) blood type, and the fetus has any other. Fetal antigens A and B can enter the mother's bloodstream during pregnancy, leading to the production of immune alpha and beta antibodies, respectively, and the development of a reaction in the fetus
antigen-antibody. Although group incompatibility of mother and fetus occurs more often than incompatibility due to the Rh factor, hemolytic disease of the fetus and newborn is milder and, as a rule, does not require intensive care.
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.
A little physiology.
Let's figure out what a blood type is and why such a conflict can arise during pregnancy. Let's remember school biology. Blood consists of blood cells (erythrocytes, leukocytes) and plasma (liquid part). Red blood cells appear as red biconcave discs. 
The red blood cell contains a huge amount of hemoglobin, a complex protein that can carry oxygen. It is estimated that each red blood cell contains more than 3 million hemoglobin molecules.
Also, special proteins, so-called agglutinogens, can be located on the surface of red blood cells. Their presence varies from person to person. If red blood cells that contain certain agglutinogens enter the body of a person who does not have such agglutinogens, he perceives them as foreign and produces special antibodies against them - agglutinins. The purpose of such antibodies is to destroy foreign red blood cells. Approximately this situation occurs when there is a conflict between the blood groups of mother and child during pregnancy. The same thing happens when incompatible blood is transfused.
There are actually a huge number of agglutinogens, but in practical medicine only a few are usually determined. These are agglutinogens A, B, and D. It is by the presence of these agglutinogens that a person’s blood type is judged:
Group I - there are no agglutinogens A and B on red blood cells.
Group II - red blood cells contain agglutinogen A.
Group III - there is agglutinogen B on erythrocytes.
Group IV - red blood cells contain agglutinogens A and B.
And agglutinogen D determines the Rh factor. If it is present on red blood cells, the blood is considered Rh-positive, and if not, it is Rh-negative.
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.
- 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.
- 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.
Sensitization according to the ABO system is not big problem. It is important to know about it, to check the antibody titer twice during pregnancy and not to carry the pregnancy to term, since it is late births that give rise to the most severe forms of HDN, requiring replacement blood transfusions.
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.
In a conflict according to the ABO system, the fetus does not get sick, and the newborn does not have anemia. However, the manifestations of jaundice in the first days of life are very severe and many children require treatment.
In most cases, hemolytic disease of the newborn about the ABO system does not recur in subsequent children (i.e. repeat pregnancies As a rule, they occur more easily, unlike Rh sensitization), but it cannot be ruled out (HDN). Since there is no threat to the life of the fetus, mass diagnosis of ABO conflict in pregnant women is not carried out.
A distinctive feature of immunoconflict according to the ABO system is the later appearance of signs of hemolytic disease in a newborn. As a rule, only on the 3-6th day of life does icteric discoloration of the child’s skin begin to appear, which is often stated as physiological jaundice, and only in severe forms of hemolytic disease, which is observed in one case per 200-256 births, is the correct diagnosis made in a timely manner. Such untimely diagnosed forms of hemolytic disease of newborns according to the ABO system often leave consequences in children.
Hemolytic disease of the 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.
All people have red blood. It is made by red blood cells - erythrocytes.
This is what red blood cells look like under a microscope
But, despite the same color, it is different. And the same red blood cells make it this way. Because of this, blood conflicts arise, since different types of blood exhibit incompatibility when mixed. This negative interaction also occurs during pregnancy.
Why is blood different in people?
There are dozens of different systems, each of which describes differences in the blood in its own way. different people. The most popular of them are the ABO system and the Rh system.
ABO groups taking into account the Rh factor AVO system
On the cell membrane of the erythrocyte there are antigens A and B. In the blood plasma in which the erythrocytes are located, agglutinins (antibodies) α and β are present. As a result, four combinations of antibodies and antigens are possible. Each of these combinations determines a person’s blood type.
- If there is a combination that includes α and β, the person’s blood is of the first group or zero – 0 (I).
- The combination of A and β gives the second group - A (II).
- The third group is formed when B and α – B (III) are present.
- The fourth group is obtained from the combination of A and B - AB (IV).
Why are only these combinations possible? Because antibodies and antigens of the same name, for example, B and β, cannot be found in human blood. They come into contact with each other, which leads to the death of red blood cells.
Rh system
Rhesus in the coordinates of this system is the D antigen (protein) located on the cell membrane of the erythrocyte. People who have this protein have Rh positive blood. It is usually denoted Rh+. When the protein is absent, the status is Rh negative (Rh-).
How does a child inherit blood?
AVO system
There is a common misconception that a child will have either the mother's or the father's blood type. Tables are published with the help of which it is supposedly possible to find out the group of the child based on the groups of the father and mother. However, they do not describe a pattern, but a probability. In fact, it could be any group.
Rh system
An accurate prognosis is only possible when both parents are Rh negative. The child will have Rh negative status. In other cases, Rh can be either positive or negative.
Two types of conflict
Rh blood group conflict is possible during pregnancy only when the mother has Rh- blood. How many people are there in the world with negative Rh factor? Much less than Rh-positive (Europeans - 15%, Africans - 7%, Asians - 1%). Therefore, conflicts due to different Rh factors do not occur often.
Conflict between the blood group of mother and child is a dangerous phenomenon. However, it should be noted that Rhesus conflict has more severe consequences for a child than a blood type conflict.
Blood group conflict during pregnancy (table)
A conflict with the fourth blood group during pregnancy, as the table shows, is impossible when it has expectant mother. In all other cases, conflict is likely. Blood type incompatibility between mother and child is most pronounced when women with the first group carry a fetus with the second or third group.
| mother | child |
| 0(I) | A(II) |
| 0(I) | B(III) |
| 0(I) | AB(IV) |
| A(II) | B(III) |
| A(II) | AB(IV) |
| B(III) | A(II) |
| B(III) | AB(IV) |
How does conflict between the blood type of mother and child work?
When fetal blood enters the mother’s blood, her body begins to react to the detected foreign antigen, that is, to the one that the child has, but not the mother. The reaction is that antibodies begin to be produced according to the blood type during pregnancy, designed to destroy foreign antigens and thereby protect the mother’s body.
Maternal antibodies enter the fetal blood and begin to destroy red blood cells. Red blood cell shortage turns oxygen starvation for a child. When red blood cells die, toxins are formed. These factors negatively affect the fetus’s body and give rise to hemolytic disease.
When does blood type conflict occur?
It is possible during pregnancy itself, during childbirth and during breastfeeding child.
Placental abruption During pregnancy
If the pregnancy proceeds normally, mixing of the blood of mother and child does not occur, since there is a placental barrier. The essence of this barrier is that a healthy placenta has the ability to pass some substances from mother to child, but not others.
But sometimes the blood mixes, and a blood group conflict occurs during pregnancy. This happens, for example, with placental abruption.
Symptoms of placental abruption look like this:
- bleeding from the genital tract;
- tense state of the uterus and pain on palpation;
- disruption of the child's heart.
The danger to the baby’s health depends on the degree of pathology. If one-third to one-half of the placenta detaches, the baby dies. At the slightest suspicion of placental abruption, a pregnant woman should immediately consult a doctor.
The most significant conflict in the group occurs in the early stages of pregnancy. Prolonged release of antibodies causes more damage to the child than when it occurs during later or during childbirth.
During childbirth
During childbirth, the placenta is naturally destroyed and the blood of the mother and baby comes into contact.
- The risk of unwanted complications in the form of hemolytic disease is low if childbirth occurs according to a normal scenario.
- However, if they become protracted, after a certain period of time the newborn may develop hemolytic disease.
If a woman with the first group or with a negative Rh factor gives birth, blood must be taken for analysis from the umbilical cord vein to find out the child’s group, its Rh status and bilirubin level.
A high level of bilirubin indicates that there is increased destruction of red blood cells in the baby’s blood. If the bilirubin level is not normal, repeat tests are performed during treatment.
When feeding
Modern medicine believes that hemolytic disease can appear during breastfeeding in very rare cases, since maternal antibodies die in the child’s stomach. But twenty years ago, mothers with the first group or with a negative Rh factor were prohibited from feeding their children for several days. Doctors believed that during this time the mother's body stopped producing antibodies.
What factors increase the risk of conflict?
The risk is lowest when a woman gives birth for the first time.
- The risk of conflict increases if the woman has undergone a blood transfusion.
- Abortions or miscarriages are also considered negative factors.
- Another factor is the second, third and subsequent pregnancies.
- If a woman has already given birth, and the children had various kinds of health problems, for example, hemolytic disease of the newborn, mental disorders, then there is a serious threat of conflict in the group.
Blood group and Rh factor analysis How can you find out about a conflict in advance?
If conception is not accidental, before it it is advisable to find out the compatibility of the group and Rh factors that the potential mother and father have. Tests can be taken at public medical institutions and private clinics, for example in the Invitro network. The requirements for preparing for the test for the group and the Rh factor are somewhat different.
- When determining the group, it is recommended not to eat for four hours before starting the analysis.
- The requirements for preparing for the Rh factor test are stricter. In particular, it is forbidden to eat fatty foods the day before taking a sample and not to smoke half an hour before.
You can take two tests at once. Blood is taken either from a finger or from a vein.
Knowing the group and Rh factors of both parents, it is possible to determine risky combinations with a certain degree of accuracy.
Risk information can be obtained from the following table.
| mother | father |
| 0 (I) | A(II), B(III), AB(IV) |
| A(II) | B(III), AB(IV) |
| B(III) | A (II), AB (IV) |
However, it is worth paying attention to the relative reliability of these combinations. They indicate that the risk of conflict within the group is probable, but not obligatory.
Ultrasound during pregnancy Preventive measures
The conflict between mother and fetus based on blood types is dangerous because the woman may not be aware of it. Its presence does not worsen her well-being. Therefore, you need to monitor the level of antibodies (titer) in it.
The standard analysis schedule is as follows:
- up to 32 weeks – once a month:
- from 32 to 36 weeks - twice a month;
- after this period - every week.
However, in case of deviations from the norm, it is necessary to take tests more often; if the titer is determined to be high, then the pregnant woman will be admitted to the hospital for a thorough examination.
- It includes ultrasound examination(ultrasound) of the placenta, amniotic fluid, condition of the fetal liver and spleen. Excessive amount of amniotic fluid, abnormally enlarged liver and spleen of the baby, thickened placenta indicate the development of a conflict regarding the blood type and Rh factor.
- In certain situations, when the safety of the fetus is of concern to doctors, a procedure called amniocentesis (analysis of amniotic fluid) may be performed. The high density of amniotic fluid indicates the process of destruction of red blood cells. Amniocentesis allows you to accurately determine the baby's blood type and the number of antibodies.
- Another procedure is cordocentesis. During this procedure, blood from the umbilical cord is taken for analysis. The procedure is done using a needle, which is inserted into the uterus through a puncture in the anterior abdominal wall. This analysis allows you to assess the severity of hemolytic disease.
- If there is a conflict regarding the Rh factor, a Rh immunoglobulin vaccination is performed.
Therapy for conflict
What may be included in the course of treatment?
- Intravenous administration of vitamins and glucose is performed. Immunoglobulin injections are prescribed.
- Plasmapheresis may be used to reduce the number of antibodies in pregnant women. During this procedure, blood is drawn from a vein (250-300 ml). The cell mass is then separated from the plasma and diluted special solutions and returned back to the vein.
The first disadvantage of plasmapheresis is that no more than a fifth of the plasma is removed in one procedure. harmful substances, so you have to do several sessions.
The second disadvantage is that useful substances (immunoglobulins, fibrinogen, prothrombin) are removed along with antibodies and other undesirable components.
Plasmapheresis is contraindicated in cases of poor blood clotting and low protein content.
- When the titer increases, a purification method known as hemosorption is also used. In this case, the blood is purified with sorbents that retain toxic impurities, including antibodies.
What you need to know about hemolytic disease
If, despite all the measures taken, the child is born with it, parents should not panic.
Edema form of hemolytic disease Clinical forms
There are three forms of this pathology:
- edematous;
- icteric;
- anemic.
- The first form is rare, but has the most severe consequences. It is called this because the child is born in very poor condition, with severe swelling and severe anemia.
- In the second form of the disease, an increased level of bilirubin in the baby’s blood gives it a yellow color (newborn jaundice), which is observed, for example, with hepatitis A.
- The disease progresses most easily in the anemic form. External signs no, or they are mild, diagnosed with a laboratory blood test.
Blue light treatment Treatment
- In severe cases, replacement blood transfusion, hemosorption and plasmapheresis are practiced.
- If the disease in a newborn is mild (or after severe therapy), intravenous infusions of proteins and glucose are prescribed. Medicines and vitamins are prescribed to improve liver function. White or blue light therapy is used to oxidize indirect bilirubin in the newborn's skin.
What awaits the baby? His future depends on the severity of the pathology. With adequate therapy, the prognosis is generally positive.
