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

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Many factors affect the course of pregnancy. Rh-conflict between mother and fetus carries high risks. However, not everyone understands the reasons for this phenomenon, which causes fear of the unknown. Therefore, every expectant mother is obliged to know why the Rh factor is dangerous and in what cases the Rh-conflict "mother-fetus" occurs.

Rhesus conflict - what is it?

To understand the essence of the problem, it is important first of all to understand how important the Rh factor is. 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 have a positive Rh factor, and the second negative.

Thus, it determines the immunological characteristics of the organism and does not affect human he alth at all. The Rh factor is commonly referred to as Rh+ and Rh-. This term was first introduced in 1940 by scientists Alexander Wiener and Karl Landsteiner. Rhesus conflict between mother and fetus is an immunologicalincompatibility by the Rh factor of the blood in the event that the mother is negative and the fetus is positive. The danger of Rhesus conflict lies in the fact that it can cause intrauterine death of the fetus, stillbirth, miscarriage. This phenomenon can appear in an expectant mother with a negative Rh both during gestation and during childbirth. The immune conflict between the mother and the fetus is manifested if the fetus has inherited Rh + from the father.

Causes of Rhesus conflict between mother and fetus

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

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

Probability of Rh-conflict by blood type

The Rh factor is a genetically determined and dominant inherited trait. If the mother is Rh negative and the father is homozygous positive, the child always gets Rh+. In this case, the risk of a blood type conflict is very high. And in the case of a heterozygous father, the probability of passing a negative or positive Rh to the fetus is equal.

At the eighth week of fetal development, hematopoiesis occurs, during which red blood cells are more likely to enter the mother's bloodstream. In this case, the protection of the mother's immune system is triggered, since the antigen of the fetus is considered foreign. Therefore, the body of a pregnant woman produces anti-Rhesus antibodies, which causes the Rhesus conflict of the mother and fetus. The risk of immunological conflict during gestation is quite small and is only 0.8%, but it is very dangerous, and therefore requires special study and attention. To identify approximately the Rh of the unborn child by analyzing the blood type of the parents will allow forecasting for the Rh conflict during pregnancy. The table clearly illustrates the likelihood of blood incompatibility.

Consequences and threats of Rhesus conflict during pregnancy

Immune conflict between mother and fetus is fraught with serious consequences for the child. Antigens produced by the mother's body, having detected a foreign body with an incompatible Rh factor, penetrate into the blood stream of the fetus through the hematoplacental barrier and destroythe 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, threatening the life of the unborn child, which is characterized by acidosis, hypoxia, anemia. An excessive amount of fluid accumulates in the baby's body and there is a violation of the development of almost all systems and organs. In the event that measures are not taken in a timely manner, there is a serious threat of miscarriage, intrauterine fetal death, stillbirth, the birth of a child with hemolytic disease, which will continue to progress due to the accumulation of anti-Rhesus antibodies in the baby's body, the production of which was caused by the conflict between mother and fetus during pregnancy. It can also cause developmental pathologies, which are expressed in an excessive increase in internal organs, brain, heart, toxic damage to the central nervous system.

Symptoms

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

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

In addition, a full-term baby may show edematous, icteric and anemicform of hemolytic pathology. Rhesus conflict in the fetus is manifested in the appearance of immature red blood cells in the blood, pathologies in the development of internal organs. Symptoms are determined by the amount of antibodies produced by the mother's body. In a severe form, the disease occurs when fetal edema appears - 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 the child can be increased up to two times, the disease is often accompanied by dropsy.

Laboratory studies

Rh-conflict "mother-fetus" during pregnancy helps to prevent early diagnosis, primarily in the form of identifying the Rh factors of the father and mother before the onset of a future pregnancy or at its early stages.

Prediction of Rhesus 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 makes it possible to reliably identify the risk of isoimmunization.

Laboratory blood tests to determine anti-Rh bodies and titer are carried out for all women with suspected Rhesus conflict during pregnancy. Tests should also be taken by the father of the child. If the likelihood of a Rh conflict is high, a pregnant woman should be tested every month. From the 32nd week, laboratory tests are carried out twice a month, and from the 36th - every week until delivery. If identifiedRhesus conflict during pregnancy, 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 the Rh conflict accumulates over time.

Ultrasound and invasive fetal risk assessment

In order to diagnose the immunological conflict between the fetus and the mother in more detail, an ultrasound examination is performed at least four times from the 20th to the 36th week of pregnancy, and also before delivery. Ultrasound allows you to track the developmental features of the fetus, as well as identify the presence of pathologies.

In the course of the study, an assessment is made of the condition and size of the placenta, the volume of the abdomen of the fetus, amniotic fluid, dilated veins of the umbilical cord.

Additional research methods are ECG, cardiotocography, phonocardiography, which allow you to determine the level of hypoxia in the fetus during Rhesus conflict. Valuable information is provided by invasive assessment methods - the study of amniotic fluid by amniocentesis and umbilical cord blood by cordocentesis. Diagnosis of amniotic fluid allows you to determine the titer of anti-Rhesus bodies, the sex of the child, the maturity of the lungs of the fetus. The exact degree of pathology is diagnosed by cardiocentosis by blood type and Rh factor of the fetus in the umbilical cord blood. In addition, studies show the presence of serum protein, hemoglobin, bilirubin, reticulocytes, antibodies fixed on red blood cells.

Treatment

If a conflict between mother and fetus is detectedblood group, almost the only effective treatment is blood transfusion to the fetus through the umbilical vein inside the womb. The procedure is performed under ultrasound guidance. Such a measure makes it possible to alleviate the condition of the fetus, prolong the duration of pregnancy, reduce the manifestations of anemia and hypoxia.

To weaken the influence of the Rh conflict, oxygen therapy is also carried out, a course of non-specific therapy is prescribed, which includes vitamins, preparations containing iron, calcium, antihistamines. If the fetus has a serious condition, then a caesarean section is performed at 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 birth, the child is given a replacement blood transfusion to replace decayed erythrocytes and is prescribed treatment for hemolytic pathology - droppers that remove toxic substances from the body and reduce the level of erythrocyte decay, exposure to ultraviolet rays. Treatment requires an intensive course of therapy, observation of neonatologists, sometimes the child is placed in the intensive care unit. Breastfeeding is not recommended during the first 2 weeks after birth if hemolytic disease is detected.

Childbirth with Rhesus conflict

Most often, the outcome of pregnancy in the presence of Rhesus conflict is premature birth. Therefore, the task of doctors is to extend the period of bearing a child, to comprehensively monitor the process of its development. For diagnostics throughout the entire periodpregnancy, ultrasound, dopplerometry, CTG are performed. If further gestation poses a serious danger to the fetus, a decision is made to give birth prematurely.

In most cases, the bearing of the fetus with Rhesus conflict ends with a caesarean section. Childbirth in a natural way is extremely rare and only if the condition of the fetus is assessed as satisfactory and the life of the baby is not in danger. Caesarean section is considered the safest and most gentle for the fetus. During childbirth, the presence of a neonatologist is necessary for resuscitation, if necessary. Childbirth should be carried out in a room well equipped with all necessary medical equipment and under the supervision of highly qualified doctors.

Preventive measures

Mother-fetus conflict during pregnancy can have severe consequences for the baby. Therefore, preventive measures aimed at preventing Rhesus conflict and the development of isoimmunization are of great importance. When transfusing blood, it is important to take into account the compatibility with the donor, it is necessary to maintain the first pregnancy, as well as to prevent abortions. Careful planning of pregnancy is important. The study of blood group, Rh factor will prevent Rh conflict during pregnancy. The blood group compatibility table avoids problems in the future. You should be careful about the course of pregnancy. As a prophylaxis, an intramuscular injection of anti-Rhesus immunoglobulin from a blood donor is used in women.with a negative Rh factor and with increased susceptibility to a positive antigen. This drug destroys red blood cells that came from a carrier of a positive Rh factor, thereby reducing isoimmunization and the risk of Rh conflict.

Injections are given after abortion, miscarriage, surgery to prevent intrauterine pregnancy. Also, anti-Rhesus immunoglobulin is administered to pregnant women at risk at 28 weeks and at 34 again to reduce the likelihood of developing fetal hemolytic disease. And also injections are prescribed within 2-3 days after childbirth, which reduces the risk of Rh conflict in subsequent pregnancies. Immunoglobulin is administered with each pregnancy if the child is likely to be born with a positive Rh factor.

Thus, the Rh-conflict of mother and fetus is not a reason for termination of pregnancy. The likelihood of developing an Rhesus conflict is extremely small, so there is no reason to despair. Thanks to modern achievements in immunology, it is always possible to bear a strong and he althy baby.