The presence of a negative Rh factor in a future mother can be a serious problem if the future father is Rh-positive: the child can inherit the father of the Rh factor, and the possible result of such an inheritance is Rh-conflict, which is potentially dangerous for the baby and mom. The development of antibodies begins in the mother’s body by the middle of the first trimester, it is in this period that a manifestation of Rh-conflict can occur.
How is the diagnosis of Rh-negative mothers, and is it possible to treat Rh-conflict in the process of bearing a baby?
The content of the article:
- When and how are tests for classes of antibodies handed down?
- Rhesus-conflict treatment of mother and fetus
- How to avoid Rhesus-conflict?
Diagnosis of Rhesus Conflict in Pregnancy – When and how do they pass tests for titers and antibody classes?
The doctor learns about the number of antibodies in the mother’s blood with the help of tests called “titers”. Indicators of the test demonstrate – whether there were “meetings” of the mother’s body with “foreign bodies,” for which the body of Rh-negative Mom takes a Rh-positive fetus.
This test is also needed to assess the severity of fetal hemolytic disease, if it occurs.
Definition of titers is carried out through a blood test, which is taken without any special training of a woman, on an empty stomach.
The following methods can also be included in the diagnosis:
- Amniocentesis . Or sampling of amniotic fluid, carried out directly from the bladder with mandatory ultrasound control. The procedure determines the blood group of the baby’s future, the water density, and also the titre of the antibodies of the mother to rhesus. High optical density of the studied waters can speak of the breakdown of red blood cells of the baby, and in this case, the specialists decide how to conduct further pregnancy.
- Cordocentesis . The procedure involves taking blood from the umbilical vein while monitoring the ultrasound sensor. The diagnostic method allows you to determine the titer of antibodies to rhesus, the presence of anemia in the fetus, the rhesus and blood group of the future baby, as well as the level of bilirubin. If the result of the study confirms the fact of negative rhesus in the fetus, then from the further observation “in dynamics”, the mother is released (with a negative Rhesus of the baby, there is never a rhesus-conflict).
- ultrasound . This procedure assesses the size of the baby’s organs, the presence of swelling and / or free fluid in the cavities, as well as the thickness of the placenta and the umbilical vein. In accordance with the state of the future mother, ultrasound can be carried out as often as required by the situation – right up to the daily routine.
- Doppler . This method allows you to assess the performance of the heart, the level of blood flow in the umbilical cord and vessels of the baby, and so on.
- Cardiotocography . Using the method, it is determined whether fetal hypoxia is present and also evaluate the reactivity of the cardiovascular system of the baby.
It should be noted that procedures such as cordocentesis and amniocentesis themselves can lead to an increase in antibody titers.
When are antibodies analyzed?
- At the 1st pregnancy and in the absence of miscarriages / abortions: once a month from the 18th to the 30th week, twice a month from the 30th to the 36th week, and then once a week until the very birth.
- At the 2nd pregnancy: from the 7th to 8th week of pregnancy. When titres are detected no more than 1 to 4, this analysis is repeated once a month, and when the growth rate of the titer is 2-3 times more often.
The norm for “conflict” pregnancy experts consider a titer with an indicator of up to 1: 4 .
Critical indicators include titles 1:64 and higher .
Treatment Rh-conflict of the mother and fetus
If the antibodies were not detected at all until the 28th week in the mother’s body, or if the value does not exceed 1: 4, then the risk of developing Rh-conflict does not go anywhere – antibodies can show themselves later, and in quite a lot.
Therefore, even with a minimal risk of Rhesus Conflict, specialists are reinsured and administered prophylactically to a future mother at the 28th week of pregnancy an antiresusive immunoglobulin D so that the female body stops producing antibodies capable of destroying the baby’s blood cells.
The vaccine is considered safe and does not harm mother and baby.
Re-injection is done after the birth, in order to avoid complications in subsequent pregnancies.
- If the blood flow is over 80-100, doctors prescribe an emergency cesarean section to avoid killing the baby.
- With the increase in the number of antibodies and the development of hemolytic disease, treatment is carried out, consisting of intrauterine blood transfusion. In the absence of such an opportunity, the issue of early childbirth is solved: the formed fetal lungs allow stimulation of labor.
- Purification of maternal blood from antibodies (plasmapheresis). The method is used in the second half of pregnancy.
- Hemosorption. The variant, in which by means of a special device of the mother’s mother, blood is passed through filters to remove toxic substances and purification from it, and then return (purified) back to the vascular channel.
- After giving birth, the baby is given blood transfusion, phototherapy or plasmapheresis in accordance with his condition.
вра After the 24th week of pregnancy, doctors can prescribe a series of injections that promote faster maturation of the baby’s lungs for independent breathing after emergency birth.
Usually Rh-negative mummies from a high risk group (note – with high antibodies, if a titer is detected in the early term, if there is a first pregnancy with Rh-conflict), watch in the LCD only until the 20th week, and then send in a hospital for treatment.
Despite the abundance of modern methods of protecting the fetus from the mother’s antibodies, delivery remains the most effective.
Regarding intrauterine blood transfusion, it is carried out in 2 ways:
- The introduction of blood in the control of ultrasound in the fetal abdomen followed by its absorption into the bloodstream of the child.
- Introduction of blood through a puncture with a long needle into the umbilical vein.
Prevention of Rh-conflict between mother and fetus – how to avoid Rhesus-conflict?
Today anti-Rhesus immunoglobulin D is used for the prevention of Rh-conflict, existing under different names and known for its effectiveness.
Preventive actions are carried out at a period of 28 weeks in the absence of antibodies in the mother’s blood, given that the risk of contact of its antibodies with the erythrocytes of the baby rises precisely in this period.
In case of bleeding during pregnancy, using methods such as cordo or amniocentesis, the administration of immunoglobulin is repeated to avoid rhesus sensitization during subsequent pregnancy.
Prevention of this method is carried out, regardless of the outcome of pregnancy. Moreover, the dose of the drug is calculated in accordance with blood loss.
- Blood transfusion to a future mother is possible only from a donor with the same rhesus.
- Rhesus negative women should choose the most reliable methods of contraception: any method of abortion is the risk of antibodies in the blood.
- After birth, it is necessary to determine the Rh rhesus in a baby. In the presence of positive rhesus, the administration of antiresus immunoglobulin is indicated, if the mother has low antibodies.
- Immunoglobulin is given to the mother within 72 hours of delivery.