Rhesus-conflict between mother and fetus during pregnancy: table. Immune conflict of mother and fetus

Many factors affect the course of pregnancy. High risks carry the rhesus-conflict between the mother and the fetus. However, not everyone understands the causes of this phenomenon, which causes fear of suspense. Therefore, to know what is dangerous for the Rh factor and when there is a Rh-conflict "mother-fetus", every future mother is obliged.

Rhesus-conflict - what is it?

To understand the essence of the problem, it is important first of all to understand the importance of the Rh factor. It is a special protein located on the surface of red blood cells. This protein is present in the blood of 85% of all people, and the rest is absent. Therefore, the first of them are considered to possess positive Rh factor, and the second negative.

Thus, it determines the immunological characteristics of the body and does not affect human health at all. Rhesus factor is usually designated Rh + and Rh-. For the first time this term was introduced in 1940 by scientists Alexander Wiener and Karl Landsteiner. Rhesus-conflict between mother and fetus is an immunological incompatibility in the Rh factor of blood in the case when it is negative in the mother and the fetus is positive. The danger of Rhesus conflict is that it can cause fetal death, stillbirth, miscarriage. This phenomenon can appear in a future mother with a negative Rh both in the process of bearing the fetus, and during labor. The immune conflict between the mother and the fetus is manifested if the fetus inherits Rh + from the father.

Causes of rhesus-conflict between mother and fetus

For the future mother's body, the blood of a baby with Rh + poses a serious threat, so it produces antibodies that react to the red blood cells of the fetus and destroy them. Rhesus-conflict of the mother and fetus is explained by transplantent penetration of red blood cells of the fetus with a positive Rh factor in the mother's blood with a negative index.

Immunological conflict is largely due to the outcome of the first pregnancy of a woman. During gestation of the fetus, Rh-conflict can be caused by blood transfusions, in which the Rh factor was not taken into account, prior abortions, miscarriages. Also, the Rh-incompatible blood of a child can enter the mother's bloodstream during delivery, so the mother organism becomes susceptible to a negative Rh factor, and the likelihood of a rhesus conflict during the second pregnancy increases. The risk of isoimmunization increases with caesarean section. The incompatibility of blood can be triggered by bleeding during pregnancy and childbirth as a result of placental damage.

Probability of Rhesus Conflict by Blood Group

Rhesus factor is a genetically determined and dominant inherited trait. If the mother has a negative Rh, and the father has a positive homozygousity, the child always receives Rh +. In this case, the risk of conflict over the blood group is very high. And in the case of heterozygosity of the father, the probability of a negative or positive Rh transfer to the fetus is equal.

During the eighth week of fetal development, hematogenesis occurs, during which red blood cells are most likely to enter the bloodstream of the mother. This protects the immune system of the mother, since the fetal antigen is considered to be foreign. Therefore, the body of a pregnant woman produces antiresusive antibodies, which causes a rhesus-conflict between the mother and the fetus. The risk of an immunological conflict during gestation is small enough and is only 0.8%, but it is very dangerous, therefore it requires special study and attention. To reveal approximately Rh of the future child by analyzes of the blood group of the parents will allow prediction on the Rh rhesus-conflict during pregnancy. The table clearly illustrates the probability of incompatibility of blood.

Consequences and threats in the Rh rhesus conflict during pregnancy

The immune conflict between the mother and the fetus is fraught with serious consequences for the child. Antigens produced by the mother's body, discovering a foreign body with an incompatible Rh factor, penetrate the fetal blood flow through the hematoplacental barrier and destroy the process of hematopoiesis of the child, inhibiting the formation of red blood cells.

This behavior of antibodies can cause an extremely dangerous condition for the fetus that threatens the life of a future child, which is characterized by acidosis, hypoxia, anemia. In the body of the baby accumulates an excessive amount of fluid and there is a disruption in the development of virtually all systems and organs. If the measures are not taken in a timely manner, there is a serious threat of miscarriage, fetal death of the fetus, stillbirth, the birth of a child with hemolytic disease that will continue to progress in connection with the accumulation in the baby's body of antiresusive antibodies, the development of which caused conflict between the mother and fetus during pregnancy . It can also cause developmental pathologies, which are expressed in excessive increase of internal organs, brain, heart, toxic CNS damage.

Symptoms

Rhesus-conflict between mother and fetus during pregnancy has no clinical manifestations and specific symptoms. Identify the problem is possible only through a laboratory blood test, which shows the presence of antibodies to the negative Rh factor.

In the fetus, the incompatibility of blood is manifested in the development of hemolytic disease of internal organs and body systems, which can lead to its death in the period from 20-30 weeks of pregnancy, as well as to miscarriage, stillbirth, premature birth.

In addition, a full-term baby can manifest edematic, icteric and anemic form of hemolytic pathology. Rhesus-conflict in the fetus is manifested in the appearance in the blood of immature red blood cells, pathologies of development of internal organs. The symptomatology is determined by the number of antibodies produced by the mother's body. In severe form, the disease occurs with the appearance of swelling of the fetus - there is an increase in the size of internal organs, the appearance of ascites, an increase in the placenta and the volume of amniotic fluid. The weight of a child can be increased up to two times, the disease is often accompanied by dropsy.

Laboratory research

Rhesus-conflict "mother-fetus" during pregnancy can prevent early diagnosis, primarily in the form of revealing the Rh factor of the father and mother before the onset of a future pregnancy or on its early terms.

The prognosis of Rh-conflict is based on data on previous blood transfusions, the course and outcome of the first pregnancy, the presence of abortions, miscarriages, fetal death inside the mother's womb, hemolytic disease of the child, which allows to accurately identify the probability of risk of isoimmunization.

Laboratory blood tests for the determination of antiresusive bodies and titre are performed for all women with suspected rhesus-conflict during pregnancy. Analyzes should be handed over to the father of the child. If the probability of occurrence of Rh-conflict is great, a pregnant woman should take tests every month. Since the 32nd week, laboratory tests are performed twice a month, and from the 36th week, every week until delivery. If there is a rhesus-conflict in pregnancy, the studies will determine the content of antibodies in the mother's body. The earlier the pathology is diagnosed, the lower the risk of complications, since the effect of Rh-conflict accumulates over time.

Ultrasound and invasive methods of risk assessment for the fetus

In order to more fully diagnose the immunological conflict between the fetus and the mother, ultrasound is performed at least four times from the 20th to the 36th week of pregnancy, as well as before the delivery. Ultrasound can track the development of the fetus, as well as identify the presence of pathologies.

In the course of the study, the condition and dimensions of the placenta, the volume of the fetal abdomen, amniotic fluid, and the dilated veins of the umbilical cord are assessed.

Additional methods of investigation are ECG, cardiotocography, phonocardiography, which allow to determine the fetal level of hypoxia in the Rh-conflict. Valuable information is provided by invasive methods of evaluation - amniocentesis and umbilical cord blood by means of cordocentesis. Diagnosis of amniotic fluid allows to determine the titre of antiresusive bodies, the sex of the child, the maturity of the lungs of the fetus. The exact degree of pathology is diagnosed by means of cardocenosis in the blood group and Rh factor in the umbilical cord blood. In addition, studies show the presence of whey protein, the content of hemoglobin, bilirubin, reticulocytes, antibodies fixed on red blood cells.

Treatment

If there is a conflict between the mother and fetus in the blood group, the only effective method of treatment is to transfusion the fetus through the umbilical vein inside the mother's womb. The procedure is controlled by ultrasound. Such a measure makes it possible to alleviate the condition of the fetus, prolong the period of pregnancy, reduce the manifestations of anemia, hypoxia.

To reduce the impact of Rh-conflict, oxygen therapy is also conducted, a course of non-specific therapy is prescribed, which includes vitamins, preparations with iron, calcium, antihistamines. If the fetus has a severe condition, then a caesarean section is performed for 37-38 weeks of pregnancy. Also, a pregnant woman is prescribed plasmapheresis, which allows to reduce the content of antibodies in the blood to the red blood cells of the fetus.

After the birth, the child is given a replacement blood transfusion to replace the decayed erythrocytes and prescribes the treatment of hemolytic pathology - droppers that remove toxic substances from the body and reduce the level of erythrocyte decay, irradiation with ultraviolet rays. Treatment requires a strengthened course of therapy, observation of neonatology doctors, sometimes the child is placed in the intensive care unit. Breastfeeding of the baby is not recommended during the first 2 weeks after birth in case of hemolytic disease.

Childbirth with Rh-conflict

Most often the outcome of pregnancy in the presence of Rh-conflict - premature birth. Therefore, the task of doctors is to extend the period of bearing the child, to fully monitor the development of the child. For diagnosis throughout the term of pregnancy, ultrasound, dopplerometry, CTG. If further bearing represents a serious danger to the fetus, a decision is made about the birth before the term.

In most cases, the bearing of the fetus in case of Rhesus conflict results in the cesarean section. Births naturally pass extremely rarely and only if the condition of the fetus is assessed as satisfactory and the life of the baby is not endangered. Caesarean section is considered to be the most safe and sparing for the fetus. During childbirth, the presence of a neonatologist is necessary to carry out resuscitation if necessary. The obstetrics should be carried out in a well-equipped room and under the supervision of highly qualified doctors.

Preventive measures

The mother-to-child conflict during pregnancy can cause serious consequences for the child. Therefore, preventive measures aimed at preventing Rhesus-conflict and development of isoimmunization are of great importance. With blood transfusion it is important to consider compatibility with the donor, it is necessary to save the first pregnancy, and also to prevent abortions. Careful planning of pregnancy is of no small importance. A study of blood type, Rh factor will prevent rhesus-conflict during pregnancy. The blood group compatibility chart helps to avoid problems in the future. Care should be taken in the course of pregnancy. As a prophylactic measure, intramuscular injection of antiresus immunoglobulin from a blood donor to women with a negative Rh factor and an increased susceptibility to a positive antigen is used. This drug destroys erythrocytes, which are from the carrier of a positive Rh factor, thereby reducing isoimmunization and the risk of occurrence of Rh-conflict.

Injections are performed after abortion, miscarriages, operations to prevent intrauterine pregnancy. Antirezus immunoglobulin is also administered to pregnant women at risk at week 28 and again to reduce the likelihood of fetal hemolytic disease. And also injections are prescribed within 2-3 days after delivery, which allows to reduce the risk of Rh-conflict in subsequent pregnancies. Immunoglobulin is given every pregnancy, if the probability of having a baby with a positive Rh factor is high.

Thus, the Rh-conflict between the mother and the fetus is not an occasion for abortion. The likelihood of developing Rh-conflict is extremely small, so there is no reason to despair. Thanks to the modern achievements of immunology, there is always the opportunity to endure a strong and healthy baby.