Why does rhesus conflict occur during the first orsecond pregnancy

Update: October 2018

Most women who are preparing to become moms have heard of
�”Terrible and terrible” Rh-conflict in the period of gestation. But
This problem concerns only those representatives of the weaker sex
whose blood is Rh – negative.

Rhesus-conflict during pregnancy threatens only those pregnant and
planning pregnancy, in which the negative rhesus of blood, and
This is not 100% of the time.

We will deal with the Rh factor

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

The Rh factor is a D protein that is an antigen and
localized on the surface of red blood cells. A significant part
People Rh factor is, then their blood is called
rhesus positive. For example:

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

If the D-protein is not detected, then such people are called
rhesus negative. Rhesus factor is genetically determined, just
as the color of hair or eyes, it remains for life and does not change.
There is no benefit or harm the presence or absence of the rhesus factor
does not carry, it is just a characteristic feature of each person.

And what is this – rhesus conflict?

Click to enlarge

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

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

To prevent sticking, the mother’s immunity is activated.
the immune system begins to intensively synthesize antibodies that
bind to the antigen – Rh factor and prevent sticking.
These antibodies or immunoglobulins can be of two types, like IgM,
so and igg.

  • Rhesus-conflict during the first pregnancy

It almost never arises, due to the production
immunoglobulins of the first type. IgM are very large, and
They cannot cross the placenta to enter the bloodstream of the fetus.
And in order for the erythrocytes of the unborn child and the antibodies
met, they need to “collide” in the interval between the uterine
wall and placenta. The first pregnancy almost completely eliminates
a similar situation, which also prevents the development of Rh-conflict
situations.

  • If a woman becomes pregnant again Rh-positive
    the fruit

In this case, his red blood cells, penetrating into the vascular system
mothers “launch” an immune response, during which they begin
produced by igg. The sizes of these antibodies are small, they are easy
overcome the placental barrier, penetrate into the bloodstream of the baby, where
red blood cells begin to destroy it, that is, cause hemolysis.

In the process of destruction of the red blood cells of the fetus from them
bilirubin is formed, which in significant quantities is
poisonous to the child. Over-education
bilirubin and its action contributes to the development of such a formidable
pathology, like hemolytic disease of the fetus and newborn.

What leads to rhesus conflict?

For the development of Rhesus conflict, you need two conditions:

  • First, the fetus must have Rh-positive blood, and
    means to inherit her father with a positive rhesus
  • Secondly, the mother’s blood should be sensitized, i.e.
    have antibodies to the D-protein.

Mostly antibody production is due to previous
pregnancies, no matter how they ended. The main thing was
a meeting of maternal and fetal blood, after which they developed
IgM antibodies. These could be:

  • previous childbirth (in the process of expelling the fetus of contact with his
    blood can not avoid a woman)
  • cesarean section
  • ectopic pregnancy
  • abortion (regardless of the way, and
    surgical and medical abortion are equally dangerous)
  • spontaneous miscarriage
  • premature placental abruption
  • separation of the placenta by hand.

Antibody production is also possible after invasive
procedures during gestation, for example, after cordocentesis
or amniocentesis. And this reason is not excluded, although it is rather
nonsense like Rh transfusion of positive blood to a woman in
past that has a rhesus negative factor.

Equally important are the diseases of the woman who wears
baby Gestosis during pregnancy, diabetes, ARVI and flu
damage to the villi, and, consequently, the vessels of the chorion, and blood
mother and future baby are mixed.

But следует знать, что кроветворение у плода начинает
configured with 8 weeks of embryogenesis, which means that abortions,
produced up to 7 weeks are safe in terms of development
rhesus conflict in the future.

Rh-conflict manifestations

External, that is, the visible manifestations of the Rh-conflict is not
exists. Incompatibility of maternal and fruit blood
way does not affect the state of the pregnant. As described
выше, «созревает» резус-конфликт при second pregnancy, а с
each subsequent risk of this condition
is increasing.

The incompatibility of the blood of the child and the expectant mother of the Rh factor
very adversely affects his condition and health in
the future. To find out what destructive damage inflicted to the baby
rhesus conflict, ultrasound of the fetus. During the ultrasound
studies are well visualized by the following signs:

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  • the contour of the head becomes double, which indicates
    edema
  • the placenta and umbilical vein swell and increase in
    diameter
  • in the abdomen, heart bag and chest
    fluid accumulates
  • the size of the belly of the fetus exceeds the norm
  • splenohepatomegaly develops (an increase in liver size and
    spleen), fetal heart is above normal
  • the baby in the uterus takes a certain position in which the legs
    divorced because of the big belly – this is called the “posture of the Buddha”

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

  • jaundiced
  • swollen
  • and anemic

The most unfavorable and severe is the edematous form.
The icteric form is the second largest. Child have
whose high rates of bilirubin in the bloodstream after birth
very sluggish, apathetic, has a poor appetite, constantly
spit up (see causes of regurgitation in the newborn), has
reduced reflexes, he has frequent convulsions and vomiting.

Bilirubin intoxication negatively affects the child still
intrauterine and fraught with the development of mental and mental
inferiority. When anemic form of the fetus is present
lack of red blood cells, which causes its oxygen starvation
(hypoxia) and in large quantities in the blood are present immature
red blood cells (erythroblasts, reticulocytes).

Diagnostics and dynamic monitoring

In the diagnosis of the described pathology is of great importance
early appearance of women in female consultation, especially if
second, third and so on
diagnosed with either antibody sensitization, or that much
unfavorable, hemolytic disease of the fetus / newborn in
anamnesis

  • When registering for dispensary registration for all pregnant women without
    exceptions determine blood type and rhesus affiliation.
  • If the mother is diagnosed with Rh negative blood, in this
    The case shows the definition of the group and the Rh factor for the father.
  • If he has a positive Rh factor to a woman under 20
    weeks of pregnancy every 28 days prescribed tests for titer
    antibodies.
  • It is important to determine the type of immunoglobulins (IgM or
    IgG).
  • After the pregnancy has passed in the second half
    (after 20 weeks) a woman is sent to be observed in
    specialized center.
  • After 32 weeks, a blood test for antibody titer is performed every 14
    days, and after 35 every 7 days.
  • The forecast depends on the period of gestation (see calculator
    gestational age), in which antibodies were detected. He is
    adversely than before immunoglobulins were diagnosed
    Rh factor.

When antibodies are detected, especially if the second pregnancy and
chances of occurrence of rhesus conflict increase, assess the state
fetus, which is carried out both non-invasive and invasive
by methods.

Non-invasive ways to determine the state of the future
baby:

  • Ultrasound

Ultrasound следует проводить на сроках гестации 18, 24 – 26, 30 – 32,
34 – 36 weeks and on the eve of childbirth. The position of the child is determined,
swelling of tissues, dilated umbilical veins, as it grows and
developing baby.

  • Dopplerometry

Estimated blood flow velocity in placental vessels and in
future child.

  • Cardiotocography (CTG)

Allows you to determine the condition of the heart and
vessels system in the fetus and diagnose the lack of oxygen
(hypoxia).

Invasive methods:

  • Amniocentesis

During the amniocentesis, amniotic fluid is collected at
punctation of the membranes and determined their content
bilirubin. Amniocentesis назначается при титре антител 1:16 и выше и
held at 34 – 36 weeks. Negative points should also be considered.
this procedure. Holding an amniocentesis is fraught with infection,
amniotic fluid leakage premature outpouring of water
bleeding and placental abruption.

  • Cordocentesis

The essence of the procedure consists in puncturing the umbilical vein and
blood sampling from it. Highly informative diagnostic method
hemolytic disease, moreover, it allows blood to be transfused
fetus intrauterinely. Cordocentesisу присущи те же негативные моменты,
that the amniocentesis, as well as the formation of a hematoma in place
puncture or bleeding from it. Held this
manipulation with antibody titer of 1: 32 and in the case of hemolytic
fetal / newborn disease in a previous child or his
doom

Methods of confrontation Rhesus-conflict

Today, there is only one way to make it easier.
condition of the fetus and improve its situation – it is intrauterine
blood transfusion through cordocentesis. This way
reduces the likelihood of premature labor and development
hemolytic disease severe after birth. All others
the methods have no significant effect or are completely useless.
(desensitization treatment, skin graft transplant
husband’s mother and others).

Rodozresreszhayut woman, as a rule, ahead of time. Preference
given abdominal delivery, as in this case
reduced risk of complications. But в некоторых ситуациях
(lack of hypoxia, gestational age more than 36 weeks, not the first
childbirth) independent delivery is also possible.

To prevent Rhesus conflict during the next
pregnancy to the first-born woman within 72 hours after birth
the child is injected with antirhesus immunoglobulin, which will destroy
erythrocytes of the child entering the maternal blood that
предотвратит образование к ним antibodies.

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

Rhesus conflict and breastfeeding

On the issue of breastfeeding during rhesus conflict, there is no single
opinions. Doctors assess the state of the baby and the possible risks
some cases immediately after delivery do not recommend breast
sufficient for breeding for several days
antibodies from the mother’s body.

However, there is the opposite opinion of doctors that
no such restriction is necessary. Due research in this
There are no areas confirming this or that position.

What does the rhesus conflict predict?

The effects of pregnancy with rhesus conflict are very
unfavorable. A huge amount of blood in a child
bilirubin affects the state of its internal organs and
brain (damaging effect of bilirubin).

Often develops hemolytic disease of the newborn,
the child has a mental retardation
death, both in the womb and after birth. Besides
Moreover, Rhesus-conflict is the cause of abortion and
habitual miscarriage.

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