Humanity consists of men and women, blondes and brunettes, tall and short, and also of those who have a protein in their red blood cells called Rh antigen and those who do not. Everything would be fine - owners of positive and negative Rhesus live very friendly and often form couples, but some combinations of Rhesus parents during pregnancy can lead to Rh conflict between mother and baby.

What is it? How dangerous? Is it possible to prevent Rh conflict and how to treat its consequences? Are they allowed? breast-feeding? Elena TELINA, obstetrician-gynecologist, deputy chief physician for obstetrics and gynecology at the AVICENNA Medical Center of the Mother and Child Group of Companies, tells the story.

What is Rh conflict?

First, let's figure out what the Rh factor is. This is a special protein - Rh antigen, which is located (or not located) on the surface of erythrocytes - red blood cells. If this protein is present in the blood, then Rh is considered positive, and if it is not present, it is considered negative. In 1940, doctors K. Landsteiner and A. Wiener helped discover the Rh antigen from rhesus monkeys - this protein was first isolated from their red blood cells. The Rh factor got its name in honor of these monkeys.

About 85% of the European population of the planet have a positive Rh factor, about 15% have a negative Rh factor. The largest percentage of people with a negative Rh factor is found among the Basques. Interestingly, among Asians, Africans and the indigenous population of North America, negative Rh is extremely rare - approximately 1% of cases, so Rh conflict is very rare for them.

” A negative Rh factor does not affect a person’s life in any way; such a difference cannot be determined by eye. However, during pregnancy, a discrepancy between the Rh factors of mother and baby can cause a rather serious complication - Rh conflict.

“Rh-positive” and “Rh-negative” blood are incompatible. The entry of the Rh antigen into the blood of a person with negative Rh causes a strong immune response - the body perceives the foreign protein as a serious disease that must be destroyed. An entire army of antibodies is urgently produced that attack and destroy “positive” antigens.

What will happen if the source of such “foreign” antigens appears inside the body and firmly settles there for 9 months? The concentration of antibodies will constantly increase, they will increasingly attack proteins that are unsafe for them, trying to completely destroy their source. This is what happens when the mother has a negative Rh factor, and the baby has a positive Rh factor. Mom's body protects itself by attacking unfamiliar antigens. This condition is called Rhesus conflict.

” The risk of developing Rh conflict exists if the mother is Rh negative and the father is Rh positive. Other combinations will not provoke such a conflict.

Expert commentary

Rh conflict is the incompatibility of the blood of mother and fetus according to the Rh factor. This condition can only develop in a pregnant woman who is Rh negative and has an Rh positive fetus (and the father is Rh positive).

Rhesus conflict and first pregnancy

As a rule, during the first pregnancy, the concentration of antibodies in the mother’s blood is relatively low and the fetus develops calmly, practically without experiencing them harmful influence. However, each subsequent pregnancy with this combination causes increasingly active formation of antibodies, increasing the risks.

Expert commentary

The risk of developing Rh conflict during the first pregnancy is not common (specifically the 1st pregnancy, and not childbirth, since all pregnancies interrupted at a short period may not produce laboratory markers, but antibodies will accumulate with each subsequent pregnancy).

Analysis for Rh factor and antibodies

You can find out whether there is a risk of Rh conflict for a given pregnancy using blood tests. At the beginning of pregnancy, a woman is tested to determine her blood type and Rh factor.

If Rh is negative, then the doctor prescribes the following test to determine the level of antibodies to the positive Rh factor. In the future, it is recommended to take this analysis monthly - this is the only reliable way to timely monitor possible sensitization and prevent the occurrence of serious complications.

Recently, pregnant women with negative Rhesus have another opportunity - non-invasive determination of the Rh factor of the fetus using the mother's blood. The disadvantages of this analysis are that it is not widespread in Novosibirsk and is expensive.

Examples of the cost of such analysis in Novosibirsk clinics:

    "Ultrasound studio": Determination of the Rh factor of the fetus using the mother's blood using the PRENETIX method, cost - 12,000 rubles.

    "Avicenna": Non-invasive determination of the Rh factor of the fetus. price - 7,800 rubles.

Expert commentary

The penetration of fetal Rh antibodies into the mother’s blood and, accordingly, the emergence of a conflict is possible from the 9th week of pregnancy, when the uteroplacental blood flow begins to actively work (during physiological pregnancy, fetal red blood cells penetrate the placenta in 3% of women in the 1st trimester, in 15% in the 2nd trimester). , and in 45% in the 3rd trimester). From 9 weeks of pregnancy, we can use a special laboratory test to determine the blood type and Rh factor of the child from the mother’s blood. The test has high specificity and gives the correct result. In the future, knowing about the negative Rh of the baby, we can no longer control the presence of Rh antibodies during pregnancy - they cannot be, but if we get a Rh-positive blood type of the child, control of Rh antibodies should be done once a month (mother’s blood test for Rh antibodies).

If the baby is Rh-positive, conflict may not arise in the first pregnancy, but traces of “conflict”, “alert” cells will always remain, which can manifest themselves more actively in subsequent pregnancies with a Rh-positive child and cause clinical manifestations already in the baby form of development of hemolytic disease.

Anti-Rhesus immunoglobulin

The development of Rh conflict or sensitization reaction can be prevented by injection of anti-Rh immunoglobulin. In fact, it represents a dose of ready-made antibodies that bind to the baby’s antigens entering the mother’s bloodstream. In this way, “foreign elements” are neutralized and the mother’s body does not need to produce its own army of antibodies.

” Anti-Rhesus immunoglobulin is administered to women with a negative Rh, pregnant with a “positive” fetus at 28-32 weeks and within 72 hours after birth.

Rh conflict, that is, a rare increase in the concentration of antibodies to the Rh antigen, is triggered when Rh-positive red blood cells enter the bloodstream of a Rh-negative mother. Therefore, all situations associated with bleeding during a potentially “conflict” pregnancy and delivery also require immediate administration of anti-Rhesus immunoglobulin.

Factors that increase the risk of Rh conflict:
. artificial termination of pregnancy;
. miscarriage;
. ectopic pregnancy;
. childbirth and caesarean section;
. gestosis;
. bleeding during pregnancy;
. invasive procedures during pregnancy: cordocentesis, amniocentesis, chorionic villus biopsy;
. abdominal injuries during pregnancy;
. history of blood transfusion without taking into account the Rh factor.

It is important to understand that sensitization can occur without injury - the penetration of fetal red blood cells through the placenta into the mother’s bloodstream is possible even during the physiological course of pregnancy.

Expert commentary

Today, in the world and in our country, a special anti-Rhesus immunoglobulin is used, which prevents the development of Rh conflict. This drug is administered intramuscularly during pregnancy 28-32 weeks and within 72 hours after birth, if the newborn has a laboratory confirmed Rh positive blood type. At the birth of a Rh negative child, repeated administration of anti-Rhesus immunoglobulin is not advisable. The administration of anti-Rhesus globulin is also indicated in patients with an interrupted pregnancy (abortion, miscarriage, ectopic pregnancy) because the volume of fetal blood in the mother's bloodstream increases with increasing pregnancy and reaches about 30-40 ml with any termination of pregnancy, with the accumulation of Rh antibodies in the woman.


Risks and consequences of Rhesus conflict

The concentration of antibodies dangerous to the fetus in most cases increases with each “conflict” pregnancy. These antibodies can freely penetrate the fetal bloodstream and begin to increasingly damage positive red blood cells and hematopoietic organs. As a result, the baby develops hemolytic disease, which, if left untreated, can lead to very serious consequences.

Risks of pregnancy with Rhesus conflict:

  • premature birth, miscarriage;
  • hemolytic disease of the fetus;
  • hemolytic jaundice.

Women have heard that during pregnancy there is a Rh conflict if the father of the child has different blood.

Most people know that this is a dangerous condition, but few understand why it occurs. The lack of necessary information about what Rh conflict is often leads to unnecessary worries for the pregnant woman.

Classmates

Most people have a special protein on the surface - agglutinogen (Rh positive). And only a small group of people (about 15%) do not have a protein compound on their red blood cells (negative Rh). If a person with a negative Rh factor is transfused with Rh-positive blood, then in the body, in response to the ingestion of protein, a special substance begins to be synthesized - hemolysin, which provokes the destruction of red blood cells.

A similar situation occurs when groups are incompatible. There are 4 options for combining agglutinins A and B with aglutinogens a and b. When agglutinins and aglutinogens of the same name “meet”, agglutination occurs, accompanied by hemolysis. The destruction of blood cells can lead to hemorrhagic shock.

When a small amount of blood with other parameters enters the bloodstream, relatively few red blood cells are destroyed, and the body begins to produce specific immune complexes. They persist for life, therefore, upon repeated contact with hemorrhagic fluid that has similar characteristics, the immune defense is activated and begins to actively produce antibodies.

During pregnancy, a similar situation arises. The female body perceives the child's blood with other characteristics as foreign and begins to synthesize antibodies. This leads to dangerous consequences.

Blood type table

Women, if the father of the child has a different Rh factor, are constantly afraid of pregnancy complications. The proposed table will allow you to calculate the approximate risk of conflict development.

Table 1. Risk of Rh conflict depending on the Rh factor of the child’s parents

As you can see, a conflict of Rh factors occurs relatively rarely. In addition to Rh incompatibility, group incompatibility often occurs. When maternal and fetal blood, which have different characteristics, meet, antibodies may also be produced. A table of blood types will allow you to find out the risk of complications during pregnancy.

Table 2. Risk of blood type incompatibility

motherfatherfetusincompatibility
0 (I)0 (I)0 (I)-
A (II) 0 (I) or A (II)-
B (III) 0 (I) or B (III)-
AB (IV) A (II) or B (III)-
0 (I)A (II)0 (I) or A (II)-
A (II) 0 (I) or A (II)50/50
B (III) Any of the four50/50
AB (IV) Second, third or fourth-
0 (I)B (III)0 (I) or B (III)50/50
A (II) Any50/50
B (III) 0 (I) or B (III)-
AB (IV) First, third or fourth-
0 (I)AB (IV)A (II) or B (III)Always
A (II) Second, third or fourth50/50
B (III) Second, third or fourth50/50
AB (IV) Second, third or fourth-

In case of incompatibility of groups, as well as in case of Rhesus incompatibility, antibodies are produced in the mother's body during pregnancy.

The proposed table allows you to determine the degree of possible compatibility between mother and fetus. But even if the likelihood of Rh conflict is high, this does not mean that couples will not be able to have children. Modern techniques make it possible to carry a child to term even if incompatibility occurs.

Why does sensitization occur during the first pregnancy?

Rh conflict by blood group and Rh almost never occurs during the first pregnancy. This is due to the fact that the mother’s body produces few antibodies and they are large in size. Immune complexes do not pass through the placental barrier, which means they hardly harm the developing child in utero.

Despite the fact that Rh conflict is rare during the first pregnancy, women are at risk. In order to promptly notice dangerous violations, expectant mothers undergo examinations more often.

Rhesus conflict during second pregnancy

After childbirth, antibodies do not disappear from the body, continuing to circulate in the bloodstream. This leads to the fact that the genetic memory, when conceiving a fetus with similar blood parameters, includes immune defense and smaller antibodies begin to be synthesized, which enter the blood of the child through the placenta.

Rhesus conflict almost always develops during the second pregnancy. The exception is when the fetus has blood similar to the mother's. But even if the second gestation went well, the immune complexes do not disappear and a conflict will arise when conceiving a baby with different blood characteristics.

Second pregnancy and antigens

What are the consequences for the child?

The conflict of Rh factors is accompanied by hemolysis of red blood cells. Red blood cells are responsible for transporting nutrients. When destroyed, the fetus appears:

  • oxygen starvation;
  • developmental delay due to lack of nutrients;
  • violation of organ formation.

In severe cases, the child dies, and the pregnancy stalls or a miscarriage occurs. Why you can’t get pregnant - read.

The consequences of Rhesus conflict for the child persist after birth. Maternal immune complexes circulate in the baby’s bloodstream for some time, which is why hemolytic disease of the newborn develops. Hemolysis can provoke various complications.

  • bilirubin level increases;
  • hypoxia develops (due to the destruction of red blood cells);
  • swelling appears.

The heart, liver, kidneys and nervous tissue suffer most from increased accumulation of bilirubin.

The consequences of Rh conflict during pregnancy are severe for the baby. With severe hemolysis, the newborn may die from hypoxia or internal edema. There are 3 forms of hemolytic lesions in a newborn:

  1. Edema. Occurs when immune complexes begin to be synthesized early. Happens when frequent pregnancies. With pathology, the permeability of the vascular wall is increased and fluid and protein compounds leak from the bloodstream into the surrounding tissues. The accumulation of liquid secretions leads to swelling internal organs.
  2. Anemic. leads to a deterioration in the supply of oxygen to tissues. The baby has pale skin and develops tachycardia. The child is lethargic and sucks poorly.
  3. Jaundice. Due to increased bilirubin skin turn yellow, hepatosplenomegaly appears. In severe cases, bilirubin encephalopathy develops. Defeat of the central nervous system accompanied by an increase in muscle tone and inhibition of reflexes, convulsions are possible.

Swelling of internal organs is considered the most dangerous form. Due to edema, the liver, spleen and intestines become enlarged. Babies die during childbirth or a few hours after birth. With a moderate increase in bilirubin, the prognosis is favorable: jaundice disappears, and the liver and spleen gradually return to normal.

Does it show any symptoms?

Having learned how dangerous a Rh conflict is for a baby, the expectant mother wants to promptly notice developing deviations. But visible symptoms of Rh conflict do not appear during pregnancy. Despite the fact that immune complexes are actively produced in the body, the woman does not feel unwell.

Signs of fetal Rh conflict on ultrasound:

  • splenomegaly;
  • liver enlargement;
  • expansion of the umbilical vein;
  • bloating;
  • thickening of the placenta.

The woman exhibits polyhydramnios and the presence of characteristic immune complexes.

During the second and subsequent pregnancies, when antibody titers are high, the woman develops symptoms of gestosis:

  • swelling;
  • blood pressure surges;
  • dizziness with a sudden change in body position.

A woman should not rely on her well-being during pregnancy to determine the Rh conflict. Most expectant mothers feel well, but note that the intrauterine activity of the fetus is reduced. If there is a risk of developing group or rhesus incompatibility, you need to undergo a timely examination. This will allow you to bear a healthy baby.

Signs of gestosis

Treatment

The conflict of Rh factors cannot be cured due to the fact that it is impossible to change the composition of the fetal blood. To prevent developmental disorders or intrauterine death, use:

  1. Blood transfusion. If the fetus is in serious condition, blood is transfused through the umbilical cord. This will stabilize the course of pregnancy and reduce the risk of postpartum complications.
  2. Plasmapheresis. It is not taken from a pregnant woman large number blood (200-250 ml) and passed through filters, and then returned to the bloodstream. Nowadays this procedure is almost never carried out. In addition to the fact that beneficial antibodies and cells are removed along with specific immune complexes, it is impossible to clear all hemorrhagic fluid. Several sessions are required.
  3. Anti-Rhesus immunoglobulin. At 28 weeks of pregnancy, a woman may be offered a vaccine to reduce the risk of developing a Rhesus conflict.

The main treatment method is intrauterine blood transfusion. Transfusion of hemorrhagic fluid allows the fetus to develop normally until due date. If the woman's antibody titres are high, delivery is carried out early by cesarean section.

Prevention

IN antenatal clinic determine the group not only of the mother, but also of the father. When a possible incompatibility is identified, the woman is told how the child’s Rh conflict manifests itself and whether there is a need to take preventive measures.

Prevention of Rh conflict during pregnancy is as follows:

  1. Antibody testing. The first test is taken when a woman registers for pregnancy. The study is repeated at 18-20 weeks, and then the analysis is done monthly until 32 weeks. The analysis is carried out every 2 weeks before the baby is born.
  2. Administration of anti-Rhesus immunoglobulin. The serum destroys the red blood cells that have entered the bloodstream from the child and the synthesis of antibodies stops. The injection is given at 28 weeks and again (if indicated) at 32 weeks.
  3. Inpatient treatment. If a Rhesus conflict is detected, the woman is sent for preservation at any stage of pregnancy. In an inpatient setting, the pregnant woman is examined and therapy is selected to reduce the risk of fetal development disorders.

Immediately after delivery, the newborn’s group and Rh. If they differ from the maternal ones, then to prevent Rh incompatibility during re-pregnancy, the woman is given an anti-Rh vaccine within 3 days after birth, which destroys the fetal red blood cells remaining in the bloodstream. This will prevent the production of immune complexes and reduce the likelihood of Rh conflict during a subsequent pregnancy. Similar prophylaxis is done after an abortion or miscarriage.

Conclusion

  1. Couples with different Rh and groups should consider the possibility of Rh incompatibility during pregnancy.
  2. The risk of Rh conflict is not a reason to abandon children.
  3. Regular testing for antibodies and compliance with medical prescriptions when immunocomplexes are detected will allow a Rh-negative woman to bear a child.

For many years, Rh incompatibility during pregnancy was a mystery to obstetricians and the cause of many seemingly unexplained pregnancy problems and hemolytic disease of the newborn (a condition in which the fetus's red blood cells, the oxygen-carrying red blood cells, are destroyed). And only about 60 years ago, with the help of rhesus monkeys, scientists discovered a system of proteins in human erythrocytes (red blood cells), which were the main cause of incompatibility between mother and fetus. These antigen proteins are called the Rh system. Later it was proven that it is the incompatibility of the blood of mother and fetus for these antigens that leads to hemolytic disease of newborns.

First, it’s worth understanding what the Rh factor is, who has it, and under what conditions it becomes a problem for a developing baby.

What is the Rh factor?

This is a special protein that is located on the surface of red blood cells. It is found in almost all people - they are considered Rh-positive, and only 15% of the white population does not have it; this small group is Rh-negative. The Rh factor is denoted by two Latin letters – Rh – and plus and minus signs.

The presence of the Rh factor is not a disease, just like its absence, it is simply one of the characteristics of blood. Just like we all are different.

Why does Rh conflict occur?

Rh conflict occurs if an Rh negative woman is pregnant with an Rh positive fetus. In this case, in the late stages of pregnancy, fragments of Rh-positive erythrocytes of the fetus penetrate into the mother’s bloodstream, are perceived as foreign and cause a protective reaction in her body, the essence of which is the formation of anti-Rh antibodies. These are the ones that, penetrating back to the baby through the placenta, can cause the destruction of the red blood cells of his blood. This process is called hemolysis. When red blood cells are destroyed, large quantities of bilirubin begin to form in the fetal blood. It has a toxic effect. The amount of bilirubin in the baby’s blood helps determine the severity of the Rh conflict.

The destructive effect of Rh-positive fetal red blood cells does not occur immediately. First, anti-Rhesus immunoglobulins M are formed in the blood of a Rh-negative woman, which means that she is pregnant with a Rh-positive child and the so-called acquaintance of two organisms has occurred, as a result of which the sensitivity of the cells and tissues of the mother’s body increases (this process is called sensitization). This is not yet a Rh conflict, since immunoglobulins M are not able to penetrate the placenta due to their large sizes and, accordingly, cannot harm the growing fetus. Then, after about 8-9 weeks, and in some women after 6 months, immunoglobulins G appear. This means that sensitization has occurred and now a Rh conflict is possible, since these immunoglobulins are not so large and can already penetrate back from mother to baby through the placenta. After 28 weeks of pregnancy, blood flow between the woman and the fetus increases, which leads to an increase in the number of anti-Rhesus antibodies in the baby’s body and an increase in their damaging effect. They cause the fetal red blood cells to stick together, which without proper treatment can lead to such a serious complication as hemolytic disease of the newborn.

Subsequently, during a second pregnancy with an Rh-positive fetus, the mother’s body immediately begins to produce immunoglobulin G, and this is the reason for the earlier onset of the Rh conflict and its stronger manifestation.

Risk factors for the development of Rh conflict

If the expectant mother has a negative Rh factor, and the baby’s father has a positive Rh factor, then the risk factors for the development of Rh conflict will be:

  • second and subsequent pregnancies from this partner – both uterine and ectopic;
  • miscarriages and abortions from this partner;
  • arterial hypertension in the expectant mother;
  • C-section performed during a previous pregnancy, and pregnancy-related invasive gynecological procedures: termination of pregnancy, ectopic pregnancies, miscarriages performed without the administration of anti-Rhesus immunoglobulin.

Diagnostics

Diagnosis for Rh conflict is aimed not only at identifying this condition, but also at assessing the baby’s condition. What kind of research will need to be done? to the expectant mother?

Determination of Rh factor and. When registering, all pregnant women, regardless of the type of pregnancy, are examined for blood type and Rh factor.

Determination of anti-Rhesus antibodies. This test is carried out upon registration for all expectant mothers; Rh-negative women are given a second referral for this test at 18–20 weeks, regardless of the partner’s Rh factor. If the partner has Rh-positive blood, the determination of anti-Rhesus antibodies is repeated monthly until 32 weeks of pregnancy (starting from 18–20 weeks), from 32 to 35 weeks of pregnancy the analysis is carried out twice a month, from the 35th week of pregnancy - weekly to determine delivery tactics. The presence of these antibodies in large quantities (or, as doctors say, titer) and/or their rapid and massive increase indicate the presence of a Rh conflict. In such cases, the pregnant woman is observed together with the doctors of the perinatal center, where she is given a referral to the antenatal clinic.

Ultrasound examination of the fetus at 18–20 weeks of pregnancy. Rhesus conflict can be suspected by the following ultrasound signs:

  • swelling and accumulation of fluid in the cavities of the fetus;
  • unnatural fetal position - the so-called Buddha position, when due to the large amount of fluid in the tummy the baby is forced to spread his legs to the sides;
  • double head contour;
  • thickening of the placenta.

Subsequent ultrasound examinations of the fetus are usually carried out over time to assess the condition of the baby at 24–26, 30–32 and 34–36 weeks.

Doppler measurements and cardiotocography also make it possible to understand how the baby is feeling and whether he needs active therapeutic measures.

According to indications, invasive diagnostic methods are performed:

Amniocentesis- this is a study in which a small amount is taken through a puncture in the membranes amniotic fluid for analysis to determine bilirubin levels.

Cordocentesis is a test in which a small amount of fetal blood is taken through a puncture of the umbilical cord to determine the amount of bilirubin.

Complications of Rhesus conflict

Why do doctors pay so much attention to the Rh factor of the expectant mother? The fact is that Rh conflict can adversely affect the course of pregnancy and the condition of the fetus. It is dangerous due to the following complications:

  • miscarriage;
  • the development of hemolytic disease of the newborn (HDN) is the most common complication of Rh conflict. The disease can occur in three different forms: edematous, icteric and anemic. The most dangerous form of HDN is edematous, since edema prevents the baby’s organs from functioning normally. Such babies often require resuscitation measures immediately after birth and long-term treatment. The second most dangerous form is the icteric form, since a large amount of bilirubin damages the baby’s organs - the brain, kidneys. And in third place is the anemic form, which is not so dangerous, but requires control and restoration of hemoglobin levels;
  • intrauterine

However, expectant mothers do not need to be upset and panic, because currently, thanks to the actions of doctors, in 90–97% of cases, complications of Rh conflict are avoided.

During the first pregnancy, the risk of developing Rh conflict is approximately 10%, with repeat pregnancies this risk remains the same if no antibodies were detected, or increases with each subsequent pregnancy if antibodies were developed. The increase in risk depends on how the pregnancy progressed, what the titer (amount) of antibodies was and whether vaccination was carried out. After termination of pregnancy or miscarriage in an Rh-negative woman pregnant with an Rh-positive fetus, the risk of developing an Rh conflict is approximately 3–5%.

Management of pregnancy during Rhesus conflict

The main goal of a gynecologist is to prevent the development of complications, since it is impossible to cure the Rh conflict itself.

Since the main cause of a baby’s suffering during Rh-conflict is hypoxia, most manipulations and medications are aimed at eliminating it. A woman’s main task is to follow all her doctor’s recommendations as accurately as possible. After all, this is the only way to avoid serious consequences for this and, importantly, for subsequent pregnancies.

If anti-Rhesus antibodies are detected in the blood of the expectant mother, then it is necessary to carry out treatment that will prevent an increase in their number. For this purpose, nonspecific and specific methods are used.

Non-specific drugs include those aimed at strengthening the blood vessels of the placenta, which helps reduce the amount of antibodies penetrating through it to the fetus. This includes vitamin therapy, oxygen therapy, UV irradiation sessions, and plasmapheresis.

Specific treatment consists of the administration of anti-Rhesus immunoglobulin. This drug prevents an Rh-negative woman from becoming sensitized to Rh-positive fetal red blood cells. It is administered twice - at the 28th week of pregnancy and after childbirth, provided that the child was born with a positive Rh factor. To achieve a protective effect, this must be done within 48, maximum 72 hours after birth. It is worth remembering that a low level of anti-Rhesus antibodies in the mother’s blood is not a reason to refuse vaccination. After all, the introduction of anti-Rhesus immunoglobulin helps to significantly reduce the complications of Rh-conflict in subsequent pregnancies, but does not exclude Rh-conflict in principle. And in some cases, re-vaccination may be required. Also, an Rh-negative woman requires a vaccine during abortion, blood transfusion, and obstetric invasive procedures.

How to help a baby with Rhesus conflict?

On at the moment There is only one method with proven therapeutic effectiveness - intrauterine blood transfusion. It has been used since 1963 for severe forms of Rhesus conflict - fetal hydrops, severe hypoxia and the ineffectiveness of the above methods. At the moment, the procedure technique has been fully developed, and the risk of complications has greatly decreased. Intrauterine blood transfusion is performed under ultrasound guidance through a small puncture in the mother's abdomen. A mass of red blood cells is injected into the umbilical cord, which helps relieve intrauterine oxygen starvation of the fetus. Studies have shown that most babies who have undergone intrauterine blood transfusion grow and develop normally.

Subsequent pregnancies after Rhesus conflict

Many women planning to become a mother for the second time are concerned with the question: if the first pregnancy proceeded with an Rh conflict, does this mean that next time we should expect the same development of events? No, that's not true. But in order for everything to go well, the following conditions are necessary:

  • Of course, it would be ideal for a woman with Rh negative to become pregnant with an Rh negative child. But, unfortunately, we cannot influence this factor.
  • Timely administration of anti-Rhesus immunoglobulin during the first and current pregnancy - either at the 28th week of pregnancy or within 48-72 hours after.
  • Refusal of abortions and blood transfusions without the use of anti-Rhesus immunoglobulin.
  • Compliance with all prescriptions of your attending physician.

Childbirth with Rhesus conflict

Childbirth is the main “treatment” for Rh conflict. After the mother-fetus chain is broken, the woman’s body stops transmitting anti-Rhesus antibodies to the baby, which allows the baby’s body to recover. However, this does not happen immediately, since the antibodies are present in the newborn’s blood for several more days. Most births with Rhesus conflict occur naturally. But in some cases, a cesarean section is performed, since this option of delivery is considered more gentle for the fetus when the baby suffers from a lack of oxygen and is weakened.

The indication for premature delivery in case of Rhesus conflict is the deterioration of the condition of the fetus and the degree of maturity of its lungs.

Breastfeeding with Rhesus conflict

Of course, the question of whether it is possible to breastfeed a baby with Rh conflict worries many mothers. However, experts still do not have a consensus on this matter. According to the latest recommendations, breastfeeding is possible a few days after birth (usually 3-5 days), until most of the antibodies are removed from the mother’s body, and before breastfeeding it is recommended to express milk to establish lactation.

Some experts believe that no restrictions at all are needed for breastfeeding. In fact, everything is individual and depends on the condition of both mother and baby after childbirth.

In conclusion, I would like to note that at the moment, thanks to the development of medicine and doctors’ monitoring of the course of pregnancy accompanied by Rh conflict, it is quite possible to carry and give birth to a healthy baby.

Is it possible to determine the Rh factor of the fetus?

Of course, it would be convenient to know what Rh factor the unborn baby has - after all, it will immediately become clear whether the expectant mother needs to regularly donate blood for the presence of antibodies and whether there is a need to administer anti-Rh immunoglobulin. If the mother is Rh-negative, the baby also turns out to have Rh-negative blood factor, then all these precautions will not be necessary. However, until quite recently it was impossible to determine this in a safe and publicly accessible way for a developing child. But now expectant mothers have such an opportunity - they can determine the child’s Rh factor from the mother’s blood using the PCR method. The method is based on the fact that during pregnancy, the child’s DNA enters the mother’s bloodstream, which makes it possible to determine the Rh DNA of the unborn baby. This examination can be carried out starting from the 12th week of pregnancy.

Immunological incompatibility of the Rh factor in the blood of a Rh-negative mother and a Rh-positive fetus, characterized by sensitization of the maternal body. The cause of Rh conflict is the transplacental penetration of fetal red blood cells carrying a positive Rh factor into the bloodstream of a Rh-negative mother. Rh conflict can cause intrauterine fetal death, miscarriage, stillbirth and hemolytic disease of the newborn.

General information

Rh conflict can occur in women with negative Rh during pregnancy or during childbirth if the child has inherited a positive Rh father. The Rh factor (Rh) of human blood is a special lipoprotein (D-agglutinogen) in the Rh system, located on the surface of red blood cells. It is present in the blood of 85% of the human population who are Rh-positive Rh (+), and 15% who do not have the Rh factor belong to the Rh-negative group Rh (-).

Causes of Rh conflict

Isoimmunization and Rh conflict are caused by the entry of Rh-incompatible blood of the child into the mother’s bloodstream and largely depend on the outcome of the first pregnancy in an Rh (–) woman. Rh conflict during the first pregnancy is possible if the woman has previously received a blood transfusion without taking into account Rh compatibility. The occurrence of Rh conflict is facilitated by previous terminations of pregnancy: artificial (abortions) and spontaneous (miscarriages).

The entry of the baby's umbilical cord blood into the mother's bloodstream often occurs during childbirth, making the mother's body susceptible to the Rh antigen and creating the risk of Rh conflict in the next pregnancy. The likelihood of isoimmunization increases with delivery by cesarean section. Bleeding during pregnancy or childbirth due to abruption or damage to the placenta, manual separation of the placenta can provoke the development of Rh conflict.

After invasive prenatal diagnostic procedures (chorionic villus biopsy, cordocentesis or amniocentesis), Rh sensitization of the maternal body is also possible. A pregnant woman with Rh (-), suffering from preeclampsia, diabetes, who has had influenza and acute respiratory infections, may experience a violation of the integrity of the chorionic villi and, as a result, activation of the synthesis of anti-Rhesus antibodies. The cause of Rh conflict may be long-standing intrauterine sensitization of a Rh(-) woman, which occurred at birth from an Rh(+) mother (2% of cases).

The mechanism of development of Rh conflict

The Rh factor is inherited as a dominant trait, therefore, in an Rh (-) mother with homozygosity (DD) Rh (+) father, the child is always Rh (+), which is why the risk of Rh conflict is high. In the case of heterozygosity (Dd) of the father, the chances of having a child with positive or negative Rh are the same.

The formation of fetal hematopoiesis begins from the 8th week of intrauterine development; at this period, fetal red blood cells can be found in small quantities in the mother’s bloodstream. In this case, the Rh antigen of the fetus is foreign to the Rh (–) immune system of the mother and causes sensitization (isoimmunization) of the maternal body with the production of anti-Rh antibodies and the risk of Rh conflict.

Sensitization of Rh (–) women during the first pregnancy occurs in isolated cases and the chances of pregnancy during Rh conflict are quite high, since the antibodies formed during this process (Ig M) have a low concentration, penetrate the placenta poorly and do not pose a serious danger to the fetus.

The likelihood of isoimmunization during delivery is greater, which can lead to Rh conflict in subsequent pregnancies. This is due to the formation of a population of long-lived immune memory cells, and in the next pregnancy, upon repeated contact with even a small volume of Rh antigen (no more than 0.1 ml), a large number of specific antibodies (Ig G) are released.

Due to their small size, IgG is able to penetrate into the fetal bloodstream through the hematoplacental barrier, causing intravascular hemolysis of Rh (+) erythrocytes of the child and inhibition of the hematopoietic process. As a result of Rh conflict, a severe, life-threatening condition for the unborn child develops - hemolytic disease of the fetus, characterized by anemia, hypoxia and acidosis. It is accompanied by damage and excessive enlargement of organs: liver, spleen, brain, heart and kidneys; toxic damage to the child’s central nervous system - “bilirubin encephalopathy.” Without timely preventive measures, Rh conflict can lead to intrauterine fetal death, spontaneous miscarriage, stillbirth, or the birth of a child with various forms of hemolytic disease.

Symptoms of Rh conflict

Rh conflict does not cause specific clinical manifestations in a pregnant woman, but is detected by the presence of antibodies to the Rh factor in her blood. Sometimes Rh conflict can be accompanied by functional disorders similar to gestosis.

Rh conflict is manifested by the development of hemolytic disease of the fetus, which, with early onset, can lead to intrauterine death from the 20th to 30th week of pregnancy, miscarriage, stillbirth, premature birth, as well as the birth of a full-term child with an anemic, icteric or edematous form of this disease. Common manifestations of Rh conflict in the fetus are: anemia, the appearance of immature red blood cells in the blood (reticulocytosis, erythroblastosis), hypoxic damage to important organs, hepato- and splenomegaly.

The severity of the manifestations of Rh conflict can be determined by the amount of anti-Rh antibodies in the mother’s blood and the degree of maturity of the child. An edematous form of hemolytic disease of the fetus can be extremely difficult in case of Rh conflict - with an increase in the size of the organs; severe anemia, hypoalbuminemia; the appearance of edema, ascites; thickening of the placenta and increased volume of amniotic fluid. With Rh conflict, hydrops fetalis, edematous syndrome of the newborn, and an increase in the child's weight by almost 2 times can develop, which can lead to death.

A small degree of pathology is observed in the anemic form of hemolytic disease; the icteric form is expressed by icteric discoloration of the skin, enlargement of the liver, spleen, heart and lymph nodes, and hyperbilirubinemia. Bilirubin intoxication during Rh conflict causes damage to the central nervous system and is manifested by the child's lethargy, poor appetite, frequent regurgitation, vomiting, decreased reflexes, convulsions, which can subsequently lead to a delay in his mental and mental development, and hearing loss.

Diagnosis of Rhesus conflict

Diagnosis of Rh conflict begins with determining the Rh affiliation of a woman and her husband (preferably before the onset of the first pregnancy or at its earliest stage). If the expectant mother and father are Rh negative, there is no need for further examination.

To predict Rh conflict in Rh (-) women, important are data on past blood transfusions without taking into account Rh status, previous pregnancies and their outcomes (presence spontaneous miscarriage, medical abortion, intrauterine fetal death, birth of a child with hemolytic disease), which may indicate possible isoimmunization.

Diagnosis of Rh conflict includes determination of the titer and class of anti-Rh antibodies in the blood, which is carried out during the first pregnancy for women who are not sensitized for Rh - every 2 months; sensitized - up to 32 weeks of gestation every month, from 32 -35 weeks - every 2 weeks, from 35 weeks - weekly. Since there is no direct dependence of the degree of fetal damage on the titer of anti-Rhesus antibodies, this analysis does not give an accurate idea of ​​the condition of the fetus in case of Rh-conflict.

To monitor the condition of the fetus, an ultrasound examination is carried out (4 times in the period from 20 to 36 weeks of pregnancy and immediately before birth), which makes it possible to observe the dynamics of its growth and development. In order to predict Rh conflict, ultrasound evaluates the size of the placenta, the size of the fetal abdomen (including the liver and spleen), and identifies the presence of polyhydramnios, ascites, and dilation of the umbilical cord veins.

Carrying out electrocardiography (ECG), fetal phonocardiography (FCG) and cardiotocography (CTG) allows the gynecologist caring for pregnancy to determine the degree of fetal hypoxia in case of Rh conflict. Important data are provided by prenatal diagnosis of Rh conflict using amniocentesis (study of amniotic fluid) or cordocentesis (study of umbilical cord blood) over time under ultrasound control. Amniocentesis is carried out from the 34th to the 36th week of pregnancy: the titer of anti-Rhesus antibodies, the sex of the unborn child, the optical density of bilirubin, and the degree of maturity of the fetal lungs are determined in the amniotic fluid.

Cordocentesis, which helps determine the fetal blood type and Rh factor from the umbilical cord blood of the fetus, can accurately determine the severity of anemia in case of Rh conflict; levels of hemoglobin, bilirubin, serum protein; hematocrit, reticulocyte count; antibodies fixed on fetal red blood cells; blood gases.

Treatment of Rhesus conflict

To alleviate the Rh conflict, all Rh (–) pregnant women at 10-12, 22-24 and 32-34 weeks of gestation are given courses of nonspecific desensitizing therapy, including vitamins, metabolic agents, calcium and iron preparations, antihistamines, and oxygen therapy. At a gestation period of more than 36 weeks, in the presence of Rh-sensitization of the mother and satisfactory condition of the fetus, independent delivery is possible.

If, due to Rh conflict, a serious condition of the fetus is noted, a planned caesarean section is performed at 37 - 38 weeks. If this is not possible, the fetus, under ultrasound control, undergoes an intrauterine blood transfusion through the umbilical vein, which makes it possible to partially compensate for the phenomena of anemia and hypoxia and prolong pregnancy.

In case of Rh conflict, it is possible to prescribe plasmapheresis to a pregnant woman in the second half of gestation in order to reduce the titer of antibodies to Rh (+) fetal red blood cells in the mother’s blood. In case of severe hemolytic damage to the fetus, immediately after birth, the child undergoes a replacement transfusion of single-group Rh-negative blood or plasma or red blood cells of group I; begin treatment for hemolytic disease of the newborn.

Within 2 weeks after birth, breastfeeding a child with signs of hemolytic disease is not allowed, so as not to worsen the baby’s condition. If the newborn has no symptoms of this disease during a Rhesus conflict, then after injection of anti-Rhesus immunoglobulin into the mother, breastfeeding is carried out without restrictions.

Prevention of Rhesus conflict

To avoid very serious consequences for the child during an Rh-incompatible pregnancy, the primary task in gynecology is to prevent the development of Rh immunization and Rh conflict. Of great importance for the prevention of Rh conflict in an Rh (-) woman is taking into account Rh compatibility with the donor during blood transfusion, mandatory preservation of the first pregnancy, and the absence of a history of abortions.

An important role in preventing Rh conflict is played by pregnancy planning, with examination of the woman for blood type, Rh factor, and the presence of anti-Rh antibodies in the blood. The risk of developing a Rh conflict and the presence of antibodies to Rh in a woman’s blood are not a contraindication to pregnancy or a reason to terminate it.

A specific prevention of Rh conflict is an intramuscular injection of anti-Rhesus immunoglobulin (RhoGAM) from donor blood, which is prescribed to women with Rh (-) who are not sensitized to the Rh antigen. The drug destroys Rh (+) red blood cells that may have entered the woman’s bloodstream, thereby preventing her isoimmunization and reducing the likelihood of Rh conflict. For high efficiency To prevent the preventive action of RhoGAM, it is necessary to strictly adhere to the timing of drug administration.

Administration of anti-Rhesus immunoglobulin Rh (-) to women to prevent Rh conflict is carried out no later than 72 hours after transfusion of Rh (+) blood or platelet mass; artificial termination of pregnancy; spontaneous miscarriage, surgery associated with ectopic pregnancy. Anti-Rhesus immunoglobulin is prescribed to pregnant women at risk of Rh conflict at 28 weeks of gestation (sometimes again at 34 weeks) to prevent hemolytic disease of the fetus. If a pregnant woman with Rh (-) experienced bleeding (due to placental abruption, abdominal trauma), invasive manipulations were performed with the risk of developing a Rh conflict, anti-Rh immunoglobulin was administered at the 7th month of gestation.

In the first 48 – 72 hours after birth, in the case of the birth of an Rh (+) child and the absence of antibodies to Rh in the mother’s blood, the RhoGAM injection is repeated. This allows you to avoid Rh sensitization and Rh conflict in the next pregnancy. The effect of immunoglobulin lasts for several weeks and with each subsequent pregnancy, if there is a possibility of the birth of an Rh (+) child and the development of Rh conflict, the drug must be administered again. For Rh (-) women already sensitized to the Rh antigen, RhoGAM is not effective.

Incompatibility of mother and fetus, which is based on the protective reaction of the female body: positive Rh of the child’s blood cannot exist with negative Rh of the mother. This is a very serious phenomenon, since Rh conflict leads to fetal death, artificial termination of pregnancy and the birth of a stillborn child.

The Rh factor of human blood is determined by the presence of D-agglutinogen in the Rh system. This special type of lipoprotein is located on the top of red blood cells. This element is present in the blood of 85% of the planet's inhabitants, but 15% do not have such a lipoprotein, and therefore are Rh-negative. Experts have developed a classification system for the Rh factor depending on the blood type and its Rh factor; a positive Rh factor is designated Rh (+), and a negative Rh factor is designated Rh (-).

Rh conflict during pregnancy occurs exclusively in women with a negative Rh factor. A child can inherit Rh positive paternal blood, which is where all subsequent problems arise. The mother's body perceives the child as a virus and directs all its forces to fight it. Rh conflict between mother and fetus is not observed when the patient has Rh (+), and the pregnant child and his father have Rh (-). The decisive role is played by the indicators of the maternal Rh factor of the blood.

Rhesus conflict during the first pregnancy does not pose a great threat to the life of the baby, because the maternal immune system does not yet produce enough rhesus bodies, but problems can arise during pregnancy. later pregnancy. With each subsequent conception of a child, the immune system will increase the amount of antibodies in relation to the Rh factor of the fetus. It is these antibodies that penetrate the child’s blood and provoke a phenomenon called Rh conflict.

Today's advances in the field of immunology significantly reduce the risks associated with incompatibility between a woman and her baby.

What is Rh conflict during pregnancy?

The process of Rh-positive and Rh-negative red blood cells sticking together is called agglutination. It is precisely this phenomenon that is fought by antibodies connected to the Rh protein - immunoglobulins. These antibodies have only two types: IgM and IgG.

Contact of maternal antibodies with the baby’s red blood cells is observed in the cavity between the placenta and the uterine wall. Initially, during a hematological collision, antibodies of the IgM type are produced, which are large enough to prevent them from penetrating to the fetus through the placenta. Therefore, Rh conflict during the first pregnancy is quite rare. But when the baby’s positive molecules re-enter the woman’s blood, the active production of type 2 antibodies begins - IgG. Their size is much smaller, so they can easily penetrate the placenta and destroy the baby’s red blood cells. The presence of such processes in the body causes the development of hemolytic disease of the newborn. Therefore, Rh conflict during the second pregnancy poses a serious threat to the life of the child.

If the first pregnancy proceeded without complications, and immunoglobulin was introduced into the body on time, then there should be no problems during the second pregnancy. You should not be afraid ahead of time and worry about a negative Rh factor, since it is not a contraindication for conceiving a child. It’s just that a Rh-conflict pregnancy should proceed under the supervision of specialists, and the expectant mother should be extremely careful in everything.

Causes of Rh conflict

The following factors can provoke this phenomenon:

  1. Blood with a positive Rh factor of the child enters the mother's blood of negative Rh factor at the time of the birth of the child, which activates the further production of antibodies in the female body. Once formed, antibodies remain in the body for life.
  2. The blood of the patient and the fetus, incompatible with Rh factors, can combine during a pathological course of pregnancy: the development of a fertilized egg outside the uterus, surgery, spontaneous abortion, bleeding, Rh positive blood transfusion. All of the above factors are possible reason the occurrence of serious problems during subsequent pregnancy.
  3. The production of antibodies in the female body is influenced by early prenatal tests: amniocentnesis, chorionic villus biopsy. To obtain the test material, intrauterine intervention is necessary, which creates the possibility of Rh-positive fetal blood entering the mother’s blood.

Experts also identify a group of risk factors not related to pregnancy and childbirth, which significantly increases the chance of Rh conflict between mother and child:

  • production of antibodies during blood transfusion of positive Rh factor;
  • immunization for intravenous drug use with one needle for everyone.

Symptoms of Rh conflict during pregnancy

Rhesus conflict between mother and child does not have clearly defined symptoms. The presence of hemolytic disease can be detected by undergoing an ultrasound. During the examination, the doctor will be able to identify the accumulation of fluid in the abdominal cavity, which provokes an uncharacteristic enlargement of the tummy. There may also be an abnormal enlargement of vital organs: liver, spleen, heart. The manifestation of certain symptoms indicates the development of a certain form of hemolytic disease in the child. Experts distinguish three types of disease: edematous, icteric, anemic.

The development of this disease has serious consequences and can cause the death of a child in the womb from the 20th week of pregnancy.

Symptoms of complicated Rh conflict during pregnancy

The degree of complexity of hemolytic disease depends on the number of produced anti-Rhesus bodies with Rh (-) in the mother’s blood and on the level of development of the fetus. A serious complication is the formation of hydrops fetalis, the development of edematous syndrome in the baby and a pathological increase in the weight of the fetus, which leads to its death.

Diagnosis of Rhesus conflict

Diagnosis consists of examining the female body and identifying risk factors possible development hemolytic disease. When registering, every pregnant woman and the father of the unborn child must undergo a blood test that determines her group and Rh factor. If a woman has a negative Rh factor and the father has a positive one, it is necessary to donate blood once a month to study antibodies and monitor their development.

When antibodies are initially detected, their class of manifestation must be determined. After the 20th week of pregnancy, the patient must be examined by a specialist, who will determine the method and date of the upcoming birth.

After the 18th week of pregnancy, the condition of the fetus is examined using ultrasound. You can assess the child’s condition and level of development using the following methods:

  1. Non-invasive:
    • An ultrasound examination is performed to determine the presence of pathologies in the fetus, the size of its organs, the diameter of the umbilical vein, and the thickness of the placenta are studied. In a normal pregnancy, ultrasound is performed 3 times: at 18-20 weeks, 30-32 weeks and just before birth at 34-36 weeks. If the child’s condition is not normal or the baby has had a blood transfusion, then an ultrasound examination can be performed every day;
    • Dopplerometry; a method that evaluates the functionality of the heart muscle, indicators of blood supply to large vessels and the umbilical cord;
    • cardiotocography; is aimed at examining the cardiovascular system, which also helps to timely determine the lack of oxygen in the fetus.
  2. Invasive:
    • amniocentesis: intervention in the amniotic sac to obtain amniotic fluid material for further examination in the laboratory. To assess the general condition of the child, the presence of bilirubin is examined. The method is very accurate, but, unfortunately, carries great danger: an infection can get into the amniotic sac, intervention can lead to premature birth and bleeding. Amniocentesis is prescribed to women whose previous births were accompanied by hemolytic disease of the baby.
    • cordocentesis: blood sampling that involves puncture of the umbilical cord. This method used in cases where it is necessary to give a blood transfusion to a child and determine the severity of hemolysis as accurately as possible. Complications after the procedure are the same as with amniocentesis, however, a hematoma may develop on the umbilical cord, and bleeding may occur at the site of umbilical cord puncture. Cordocentesis is prescribed to women who have had Rh conflict during previous pregnancies. If at ultrasound examination symptoms of hemolytic disease were detected, and the amount of antibodies produced exceeds the norm, then it is also necessary to perform cordocentesis.

Complications after using invasive methods for diagnosing Rhesus conflict between mother and fetus can be very serious, so everything possible must be done to avoid intrauterine intervention. The woman must be counseled and explained the risk to which the fetus is exposed. The doctor cannot be held responsible for the behavior of the female body and the successful implementation of the procedure, so often the patient gives her agreement in writing for the further use of the procedures.

Treatment of Rh conflict during pregnancy

Modern therapeutic techniques make it possible to effectively and quickly eliminate the threat to life for the fetus, preserving its life and supporting normal indicators pregnancy. The most effective method What remains is a fetal blood transfusion, which is prescribed if the child develops anemia. The intervention occurs exclusively during inpatient treatment, and after the procedure the woman still long time remains in storage, under the careful supervision of obstetricians. Blood transfusion improves the condition of the fetus and prevents premature birth, and the risk of developing a hemolytic disease in the newborn is also significantly reduced.

Women whose antibodies were detected on early stages or a previous pregnancy was accompanied by Rh conflict between mother and fetus, belong to a group with an increased risk of complications. Until the 20th week, patients must regularly visit the women's office, and after that they are sent to inpatient treatment.

Treatment may also be based on the purification of maternal blood. For this purpose, procedures such as plasmapheresis or hemosorption are used. The patient’s immunity can be weakened using desensitizing therapy and immunoglobulin treatment. However, statistics indicate the ineffectiveness of these methods, so they were actually completely abandoned.

It is possible to achieve normalization of the child’s condition only by stopping the access of antibodies of the maternal immune system, therefore, as soon as medical indicators allow the child to survive outside the mother’s womb, delivery is carried out. Rhesus conflict pregnancy usually ends premature birth, since in the last stages the anti-Rhesus bodies coming to the child are produced in larger quantities. The methods and timing of delivery depend on the individuality of the female body and the severity of the fetal condition. Caesarean section is considered the most gentle method, which is why it is the most common way of giving birth to a baby. If the patient has reached 36 weeks of pregnancy, then obstetricians can induce labor, which will take place naturally, but a little earlier than planned.

Prevention of Rh conflict during pregnancy

To prevent the development of hemolytic disease, the expectant mother is given anti-Rhesus immunoglobulin D. This is very effective drug, which has undergone a number of studies and is produced at enterprises in the USA, France and the Russian Federation. The drug is administered at the twenty-eighth week of pregnancy, because it is at this period that there is an increase in the risk of developing Rh conflict between mother and fetus. Repeated use of the drug must be carried out within three days after delivery.

The injection can be prescribed regardless of the initial result: childbirth, artificial termination of pregnancy, abortion, ectopic pregnancy, etc. If during any of the operations the patient has lost a large amount of blood, the dose of immunoglobulin should be increased.

When registering, a woman undergoes tests to determine the Rh factor of the blood; if the results show that it is negative, then it is necessary to establish the Rh factor and the father of the child. If a man has a positive Rh factor, then the fetus may inherit his Rh factor, which can provoke an Rh conflict with the mother. In this case, the pregnant woman is regularly examined and the amount of anti-Rhesus bodies produced is checked. If antibodies are not detected, then the child is not in danger. Immediately after birth, the baby's blood is taken for analysis and determination of the blood type and Rh factor. If the result indicates that the baby has Rh positive blood, the mother is also given immunoglobulin D to prevent the possibility of Rh conflict occurring during future pregnancies.

Most experts are inclined to believe that immunoglobulin should also be administered after a blood transfusion with a positive Rh factor or platelet mass, placental abruption, injury to the expectant mother, or chorionic villus biopsy.