According to the blood group, the conflict is what to do. Hemolytic disease of the newborn - physiological jaundice. Possible complications in the development of AB0-conflict

The time of bearing a child is one of the most beautiful in a woman's life. Every expectant mother wants to be calm for the health of the baby, enjoy the period of waiting for the addition. But every tenth lady, according to statistics, has Rh-negative blood, and this fact worries both the pregnant woman herself and the doctors who observe her.

What is the possibility of a Rh conflict between mother and baby, and what is the danger, we will tell in this article.

What it is?

When a woman and her future peanut have different blood counts, immunological incompatibility can begin, it is she who is called the Rh conflict. Representatives of mankind who have a Rh factor with a + sign have a specific protein D, which contains red blood cells. A person with Rh negative value of this protein does not have.

Scientists still don't know for sure why some people have a specific Rhesus macaque protein while others don't. But the fact remains - about 15% of the world's population have nothing in common with macaques, their Rh factor is negative.

Between the pregnant woman and the child there is a constant exchange through the uteroplacental blood flow. If the mother has a negative Rh factor, and the baby has a positive one, then the D protein that enters her body is nothing more than a foreign protein for the woman.

The mother's immunity very quickly begins to react to an intruder, and when the protein concentration reaches high values, the Rh conflict begins. This is a merciless war that the pregnant woman's immune defense declares to the child as a source of a foreign antigen protein.

Immune cells begin to destroy the baby's red blood cells with the help of special antibodies that he produces.

The fetus suffers, the woman experiences sensitization, the consequences can be quite sad, up to the death of the baby in the womb, the death of the crumbs after the birth or the birth of a disabled child.

Rhesus conflict can occur in a pregnant woman with Rh (-) if the baby has inherited her father's blood characteristics, that is, Rh (+).

Much less often, incompatibility is formed according to such an indicator as a blood type, if the men and women have different groups. That is, a pregnant woman, whose own Rh factor has positive values, has nothing to worry about.

There is no reason to worry and families with the same Rh negative, but this coincidence happens infrequently, because among the 15% of people with "negative" blood - the vast majority of the fair sex, men with such blood characteristics are only 3%.

Own hematopoiesis in peanuts in the womb begins around 8 weeks gestation. And from that moment on, in maternal blood tests, no a large number of fetal erythrocytes. It is from this period that the possibility of an Rhesus conflict arises.

Probability tables

From the point of view of genetics, the probability of inheriting the main characteristics of the blood - the group and the Rh factor from the father or mother is estimated equally at 50%.

There are tables that allow you to assess the risks of Rh conflict during pregnancy. And timely weighted risks give doctors time to try to minimize the consequences. Unfortunately, medicine cannot completely eliminate the conflict.

By Rh factor

By blood group

Causes of the conflict

The likelihood of developing an Rhesus conflict is highly dependent on how and how the woman's first pregnancy ended.

Even a “negative” mother can quite safely give birth to a positive baby, because during the first pregnancy, the woman’s immunity does not yet have time to develop a killer amount of antibodies to the D protein. life saving situations.

If the first pregnancy ended in a miscarriage or abortion, then the likelihood of a Rh conflict during the second pregnancy increases significantly, since in the woman's blood there are already ready to attack on the very early term antibodies.

In women who had a caesarean section during the first birth, the probability of conflict during the second pregnancy is 50% higher compared to women who gave birth to their first child naturally.

If the first birth was problematic, the placenta had to be separated manually, there were bleeding, then the likelihood of sensitization and conflict in a subsequent pregnancy also increases.

Danger for future mother from negative Rh factor blood are also diseases during the period of bearing a baby. Influenza, SARS, preeclampsia, diabetes in history can provoke a violation of the structure chorionic villi, and mother's immunity will begin to produce antibodies that are detrimental to the baby.

After childbirth, the antibodies that were developed in the process of bearing the crumbs do not disappear anywhere. They represent the long-term memory of the immune system. After the second pregnancy and childbirth, the amount of antibodies becomes even greater, as after the third and subsequent ones.

Danger

The antibodies that maternal immunity produces are very small, they can easily cross the placenta into the bloodstream of the baby. Once in the blood of the child, the protective cells of the mother begin to inhibit the hematopoietic function of the fetus.

The child suffers, experiences an oxygen deficiency, since decaying red blood cells are the carriers of this vital gas.

In addition to hypoxia, fetal hemolytic disease may develop. and subsequently the newborn. It is accompanied by severe anemia. In the fetus, internal organs increase - the liver, spleen, brain, heart and kidneys. The central nervous system is affected by bilirubin, which is formed during the breakdown of red blood cells and is toxic.

If doctors do not start taking measures in time, then the baby may die in utero, be born dead, be born with severe damage to the liver, central nervous system, kidney. Sometimes these lesions are incompatible with life, sometimes they lead to deep lifelong disability.

Diagnosis and symptoms

The woman herself cannot feel the symptoms of the developing conflict of her immunity with the blood of the fetus. There are no symptoms by which the expectant mother could guess about the destructive process that takes place inside her. However, laboratory diagnostics can detect and track the dynamics of the conflict at any time.

To do this, a pregnant woman with Rh-negative blood, regardless of which group and Rh factor of the father's blood, take a blood test from a vein for the content of antibodies in it. The analysis is done several times during pregnancy, the period from 20 to 31 weeks of pregnancy is considered especially dangerous.

About how severe the conflict is, says the antibody titer obtained as a result of a laboratory study. The doctor also takes into account the degree of maturity of the fetus, because the older the baby in the womb, the easier it is for him to resist the immune attack.

In this way, a titer of 1:4 or 1:8 at 12 weeks of gestation is a very alarming indicator, and a similar antibody titer for a period of 32 weeks will not cause panic in the doctor.

When a titer is detected, the analysis is done more often to observe its dynamics. In a severe conflict, the title grows rapidly - 1: 8 can turn into 1: 16 or 1: 32 in a week or two.

A woman with antibody titers in the blood will have to visit the ultrasound diagnostic room more often. By ultrasound, it will be possible to monitor the development of the child, this research method provides quite detailed information about whether the child has hemolytic disease, and even about what form it has.

With the edematous form of fetal hemolytic disease in a child, an ultrasound will reveal an increase in size internal organs and the brain, the placenta thickens, the amount of amniotic fluid also increases and exceeds normal values.

If the estimated weight of the fetus is 2 times higher than normal, this is an alarming sign.- dropsy of the fetus is not excluded, which can be fatal even in the mother's womb.

Hemolytic fetal disease associated with anemia cannot be seen on ultrasound, but can be diagnosed indirectly on CTG, since the number of fetal movements and their nature will indicate the presence of hypoxia.

Damage to the central nervous system will become known only after the birth of a child; this form of hemolytic disease of the fetus can lead to a developmental delay in the baby, to hearing loss.

Doctors in the antenatal clinic will be engaged in diagnostics from the very first day of registering a woman with a negative Rh factor. They will take into account how many pregnancies there were, how they ended, whether children with hemolytic disease were already born. All this will enable the doctor to assume the possible likelihood of a conflict and predict its severity.

A woman will have to donate blood during the first pregnancy once every 2 months, during the second and subsequent - once a month. After 32 weeks of pregnancy, the analysis will be done every 2 weeks, and from 35 weeks - every week.

If an antibody titer appears, which can occur at any time after 8 weeks, additional research methods may be prescribed.

With a high titer that threatens the life of the child, a cordocentesis or amniocentesis procedure may be prescribed. The procedures are carried out under ultrasound guidance.

During amniocentesis, an injection is made with a special needle and a certain amount of amniotic fluid is taken for analysis.

During cordocentesis, blood is taken from the umbilical cord.

These tests make it possible to judge which blood type and Rh factor the baby has inherited, how severely his red blood cells are affected, what is the level of bilirubin in the blood, hemoglobin, and determine the sex of the child with 100% probability.

These invasive procedures are voluntary, a woman is not forced to do them. Despite the current level of development of medical technology, interventions such as cordocentesis and amniocentesis can still cause miscarriage or premature birth, as well as death or infection of the child.

The obstetrician-gynecologist who leads her pregnancy will tell the woman about all the risks during the procedures or refusing them.

Possible consequences and forms

Rhesus conflict is dangerous both during the period of bearing a baby, and after it is born. The disease with which such children are born is called hemolytic disease of the newborn (HDN). Moreover, its severity will depend on the amount of antibodies attacked the blood cells of the crumbs during pregnancy.

This disease is considered severe, it is always accompanied by the breakdown of blood cells, which continues after birth, edema, jaundice of the skin, severe bilirubin intoxication.

edematous

The edematous form of HDN is considered the most severe. With her, the little one is born very pale, as if "bloated", edematous, with multiple internal edema. Such crumbs, unfortunately, in most cases are born already dead or die, despite all the efforts of resuscitators and neonatologists, they die in the shortest possible time from several hours to several days.

icteric

The icteric form of the disease is considered more favorable. Such babies, a couple of days after their birth, "acquire" a rich yellowish skin color, and such jaundice has nothing to do with the common physiological jaundice of newborns.

The baby has a slightly enlarged liver and spleen, blood tests show the presence of anemia. The level of bilirubin in the blood rises rapidly. If doctors fail to stop this process, the disease can turn into kernicterus.

Nuclear

The nuclear type of HDN is characterized by lesions of the central nervous system. The newborn may have seizures, he can involuntarily move his eyes. The tone of all muscles is reduced, the child is very weak.

When bilirubin is deposited in the kidneys, a so-called bilirubin infarction occurs. A greatly enlarged liver cannot normally perform the functions assigned to it by nature.

Forecast

In prognosis for HDN, doctors are always very careful, since it is almost impossible to predict how damage to the nervous system and brain will affect the development of the crumbs in the future.

Children are given detoxification injections in intensive care, very often there is a need for a replacement transfusion of blood or donor plasma. If on the 5-7th day the child does not die from paralysis of the respiratory center, then the forecasts change to more positive ones, however, they are rather conditional.

After hemolytic disease of newborns, children suckle poorly and sluggishly, their appetite is reduced, sleep is disturbed, and there are neurological abnormalities.

Quite often (but not always) such children have a significant lag in mental and intellectual development, they get sick more often, hearing and vision impairments can be observed. Cases of anemic hemolytic disease end most safely, after the level of hemoglobin in the blood of the crumbs can be raised, it develops quite normally.

The conflict, which developed not because of the difference in Rh factors, but because of the difference in blood types, proceeds more easily and usually does not have such devastating consequences. However, even with such incompatibility, there is a 2% chance that the baby will develop quite serious disorders of the central nervous system after birth.

The consequences of the conflict for the mother are minimal. She will not be able to feel the presence of antibodies in any way, difficulties can arise only during the next pregnancy.

Treatment

If a pregnant woman has a positive antibody titer in the blood, this is not a reason for panic, but a reason for starting therapy and taking it seriously on the part of the pregnant woman.

It is impossible to save a woman and her baby from such a phenomenon as incompatibility. But medicine can minimize the risks and consequences of the influence of maternal antibodies on the baby.

Three times during pregnancy, even if antibodies do not appear during gestation, the woman is prescribed courses of treatment. At 10-12 weeks, at -23 weeks and at 32 weeks, the expectant mother is recommended to take vitamins, iron supplements, calcium supplements, metabolic enhancers, and oxygen therapy.

If the titers are not detected before 36 weeks of gestational age, or they are low, and the development of the child does not cause concern to the doctor, then the woman is allowed to give birth naturally on her own.

If the titers are high, the child's condition is severe, then delivery can be carried out ahead of time by caesarean section. Doctors try to support the pregnant woman with medications until the 37th week of pregnancy so that the baby has the opportunity to “ripen”.

Unfortunately, this possibility is not always available. Sometimes you have to decide on an earlier caesarean section in order to save the little one's life.

In some cases, when the baby is clearly not yet ready to come into this world, but it is very dangerous for him to remain in the mother’s womb, an intrauterine blood transfusion is performed on the fetus. All these actions are performed under the control of an ultrasound scanner, each movement of the hematologist is verified so as not to harm the baby.

In the early stages, other methods of preventing complications can be used. So, there is a technique for sewing a piece of the skin of her husband to a pregnant woman. The skin flap is usually implanted on the lateral surface of the chest.

While the woman's immunity throws all its strength into rejecting a skin fragment that is foreign to itself (and this is several weeks), the immunological load on the child is somewhat reduced. Scientific disputes do not subside about the effectiveness of this method, but the reviews of women who have gone through such procedures are quite positive.

In the second half of pregnancy, with an established conflict, plasmapheresis sessions can be prescribed for the expectant mother, this will slightly reduce the number and concentration of antibodies in the mother's body, respectively, the negative load on the baby will also temporarily decrease.

Plasmapheresis should not frighten a pregnant woman, there are not so many contraindications to it. Firstly, it is SARS or another infection in the acute stage, and, secondly, the threat of miscarriage or premature birth.

There will be about 20 sessions. Approximately 4 liters of plasma are cleared in one procedure. Together with the infusion of donor plasma, protein preparations are administered, which are necessary for both mother and baby.

Babies who have had hemolytic disease are shown regular examinations by a neurologist, massage courses in the first months after birth to improve muscle tone, as well as vitamin therapy courses.

Prevention

A pregnant woman at 28 and 32 weeks is given a kind of vaccination - an anti-Rhesus immunoglobulin is injected. The same drug must be administered to a woman in labor after childbirth no later than 48-72 hours after the birth of the crumbs. This reduces the likelihood of conflict in subsequent pregnancies to 10-20%.

If the girl has a negative Rh factor, she should know about the consequences of an abortion during the first pregnancy. It is desirable for such representatives of the fair sex save the first pregnancy at all costs.

Blood transfusion without taking into account the Rh affiliation of the donor and the recipient is not permissible, especially if the recipient has his own Rh with a “-” sign. If such a transfusion takes place, anti-Rhesus immunoglobulin should be administered to the woman as soon as possible.

A complete guarantee that there will be no conflict can only be given by a Rh-negative man, moreover, preferably with the same blood type as his chosen one. But if this is not possible, you should not postpone pregnancy or abandon it just because a man and a woman have different blood. In such families, planning for a future pregnancy plays an important role.

A woman who wants to become a mother needs to take blood tests to detect antibodies to protein D before the onset of an “interesting situation”. If antibodies are found, this does not mean that the pregnancy will have to be terminated or that it is impossible to become pregnant. Modern medicine does not know how to eliminate the conflict, but it knows very well how to minimize its consequences for the child.

The introduction of anti-Rhesus immunoglobulin is relevant for women whose blood does not yet have antibodies that are not sensitized. They need to give such an injection after an abortion, after even a slight bleeding during pregnancy, for example, with a slight placental abruption, after surgery for ectopic pregnancy. If you already have antibodies, then you should not expect a special effect from vaccination.

Common Questions

Is it possible to breastfeed a child?

If a Rh-negative woman has a baby with a positive Rh factor, and there is no hemolytic disease, then breastfeeding is not contraindicated.

Babies who have experienced an immune attack and were born with hemolytic disease of the newborn are not recommended to eat breast milk for 2 weeks after the introduction of immunoglobulin to their mother. In the future, the decision to breastfeed is made by neonatologists.

Breastfeeding is not recommended in severe hemolytic disease. To suppress lactation, a woman after childbirth is prescribed hormonal preparations, which suppress the production of milk to prevent mastopathy.

Is it possible to bear a second child without conflict if there was a conflict during the first pregnancy?

Can. Provided that the child inherits a negative Rh factor. In this case, there will be no conflict, but antibodies in the mother's blood can be detected throughout the entire gestation period, and in a fairly high concentration. They will not affect the baby with Rh (-) in any way, and you should not worry about their presence.

Before getting pregnant again, mom and dad should visit a geneticist who will give them comprehensive answers about the likelihood of their future children inheriting one or another blood characteristic.

Dad's rhesus unknown

When a future mother is registered in a antenatal clinic, immediately after her negative Rh is detected, the father of the future baby is also invited to the consultation for a blood test. Only in this way can the doctor be sure that he knows exactly the initial data of the mother and father.

If the father's Rh is unknown, and for some reason it is impossible to invite him to donate blood, if the pregnancy came from IVF with donor sperm, then a woman will have a blood test for antibodies a little more often than other pregnant women with the same blood. This is done in order not to miss the moment of the beginning of the conflict, if it takes place.

And the doctor's proposal to invite her husband to donate blood for antibodies is a reason to change the doctor to a more competent specialist. There are no antibodies in the blood of men, since they do not become pregnant and do not have any physical contact with the fetus during the wife's pregnancy.

Is there a fertility effect?

Such a connection does not exist. The presence of a negative Rh does not mean that it will be difficult for a woman to get pregnant.

Fertility levels are affected by completely different factors - bad habits, caffeine abuse, excess weight and diseases of the genitourinary system, burdened history, including a large number of abortions in the past.

Are medical or vacuum abortions dangerous for terminating a first pregnancy in an Rh-negative woman?

This is a common misconception. And, unfortunately, often such a statement can be heard even from medical workers. The technique of carrying out an abortion does not matter. Whatever it is, the baby's red blood cells still enter the mother's bloodstream and cause the formation of antibodies.

If the first pregnancy ended in an abortion or miscarriage, how high are the risks of conflict in the second pregnancy?

In fact, the magnitude of such risks is a rather relative concept. No one can say with an accuracy of a percentage whether there will be a conflict or not. However, doctors have certain statistics that estimate (approximately) the likelihood of sensitization of the female body after an unsuccessful first pregnancy:

• short-term miscarriage - + 3% to a possible future conflict;
• artificial termination of pregnancy (abortion) - + 7% to the likely future conflict;
• ectopic pregnancy and surgery to eliminate it - + 1%;
• delivery at term with a live fetus - + 15-20%;
• delivery by caesarean section - + 35-50% to a possible conflict during the next pregnancy.

Thus, if a woman's first pregnancy ended in an abortion, the second - in a miscarriage, then during the gestation of the third, the risks are estimated at about 10-11%.

If the same woman decides to give birth to another baby, provided that the first birth went well naturally, then the probability of the problem will be more than 30%, and if the first birth is completed caesarean section, then more than 60%.

Accordingly, any woman with a negative Rh factor who has decided to become a mother once again can weigh the risks.

Does the presence of antibodies always indicate that the child will be born sick?

No, this is not always the case. The child is protected by special filters that are in the placenta, they partially restrain aggressive maternal antibodies.

A small amount of antibodies will not cause much harm to the child. But if the placenta ages prematurely, if the amount of water is small, if a woman falls ill with an infectious disease (even a common ARVI), if she takes medications without supervision by the attending physician, then the likelihood of a decrease in the protective functions of the placental filters increases significantly, and the risk of giving birth to a sick baby will increase. .

It should be borne in mind that during the first pregnancy, antibodies, if they appear, have a fairly large molecular structure, it can be difficult for them to “break through” the protection, but during a second pregnancy, the antibodies are smaller, mobile, fast and “evil”, so the immunological attack becomes more probable.

Is there a conflict during pregnancy, contrary to all forecasts and tables, in two negative parents?

This cannot be excluded, despite the fact that all existing genetic tables and teachings indicate that the probability tends to zero.

Someone from the three mom-dad-child may be a chimera. Chimerism in people sometimes manifests itself in the fact that once transfused blood of a different group or Rhesus “takes root”, and a person is a carrier of genetic information about two types of blood at once. This is a very rare and little-studied phenomenon, although experienced doctors will never discount it.

Everything related to genetics has not yet been studied well enough, and any “surprise” can be obtained from nature.

There are several cases in history when a mother with Rh (-) and a father with a similar Rh had a child born with positive blood and hemolytic disease. The situation requires careful study.

For more information about the likelihood of a Rh conflict during pregnancy, see the following video.

The uniqueness of each person's blood type is special. There are four of them: 0, A, B, AB (first, second, third, fourth). Also, every inhabitant on Earth has only one - positive or negative. These blood data are important in medical interventions, in blood donation, during gestation in women. They are no less important at the very beginning of the formation of the fetus. In modern maternity practice, there are cases of incompatibility of the blood type of mother and child. In a situation where, for example, the Rh factors with the fetus are different, the mother needs close medical supervision.

The woman is Rh positive. It is possible that earlier she was given or injected with some therapeutic drugs that are based on components of blood cells. As a result, sensitization could begin in tissues and cells - increased sensitivity of cells or tissues to an introduced irritant, the Rh factor - something like an allergy. For this reason, the body begins to carry out protective reactions and produce, which are absolutely safe for the mother's body, but potentially harmful to the baby.

An important point is the possibility of increasing sensitivity only when the mother and the child are positive. If the polarities are reversed, then it is no better. The female body will start a defensive reaction in any of the cases, destroying the red blood cells in the baby's blood, which can lead to severe anemia or, worse, hemolytic disease.

Since ancient times, weak or completely dead children were born. Modern medicine can solve this problem - scientists have developed a drug and isolated immunoglobulin. It is an immunostimulating component of our blood. Having made such an injection at the 28th week of pregnancy, the risk of childbirth is reduced to almost zero. When the child has a positive Rh factor, the need for injections disappears.

Rh incompatibility

From the paragraphs above it follows that in both cases there is a polar discrepancy between the Rhesus of the mother and the child. Such a deviation can be fraught with the baby. The fact is that female body begins to "defend" against the fetus: the formed antibodies in the child's blood destroy his red blood cells, changing the structure of the blood. With each successive pregnancy, the risk gets higher and higher. Doctors do not advise women suffering from Rh incompatibility of blood to give birth more than twice because of the high probability of miscarriage.

The beginning of the impact of two blood groups on each other falls on the twelfth week of pregnancy, since it is at this age that the fetus begins to form its own blood. The child begins to progress erythrocytic insufficiency, hypoxia () of tissues and organs, which entails a serious deviation in metabolism. For the mother, this is not a significant threat, but for the child, this is theoretically a mortal danger.

As mentioned earlier, the danger with such a deviation mainly threatens the child. Even if he is born and survives, he may have serious illnesses. The most common case is when a newborn is born with various forms and dies within a few hours. If the disease has not yet progressed, then this will slightly delay the death of the baby. Such cases are extremely rare, because such children have defective blood and its circulation does not occur properly.

One of the most common diseases of newborns with incompatibility of blood and Rhesus is the icteric form. It is characterized by the fact that some internal organs increase in volume, and in itself it is very difficult and progresses rapidly. Such symptoms can be noticed already in the first days of life. The child literally "explodes", which negatively affects only the mother's body. The breakdown of red blood cells stimulates the growth of bilirubin, which has a very bad effect on the functioning of internal organs, but if it is processed in the blood “depot”, then this is not dangerous either for the child or for the mother.

Abortion in case of incompatibility

A woman with absolutely any Rh factor cannot have an abortion - this fact is stated by modern medicine. To date, there is medical intervention at various levels, allowing even a sick fetus to save life. The main thing to remember is that abortions with incompatibility of blood and Rh factors are unacceptable.

group conflict

In addition to the considered incompatibility, there is also a group conflict between the blood of the mother and the child. With different mother and child, special cells begin to be produced in the body first, causing the destruction of the child's blood cells. Such incompatibility of the blood of mother and child is more common than Rhesus incompatibility.

Reasons for incompatibility

When foreign cells and bacteria enter the body, it begins to fight them and produce antibodies, while remembering them and developing further immunity to them. This is also the case with maternal and infant blood types.

The reason for the incompatibility of mother and child in terms of the Rh factor and blood group is the fusion of initially different parental blood. This is the answer to the question: why does incompatibility occur.

Pregnancy planning

The first step before conceiving a fetus should be Rh factors! It is not worth detracting from the importance of blood in a person’s life - the above paragraphs contain weighty arguments confirming its significance.

Do not be afraid to plan a pregnancy, because the birth of a child is the most important step in life. Do not forget to seek medical help if necessary.

An analysis for the blood type and Rh factor is included in the list of mandatory studies during pregnancy. Often, expectant mothers assume that only a mismatch between the Rh factors in the mother and father causes complications when carrying a child. However, a conflict in blood type can also lead to illness in the unborn baby.

By checking the blood type and Rh factor in pregnant women and future fathers, doctors not only make a note in the documents in case of an emergency blood transfusion, but also predict the course of pregnancy and the specifics of caring for a newborn.

It is known that Rhesus conflict before the invention of immunoglobulin therapy often led to miscarriage. Rh-negative women were urged not to terminate the pregnancy, as this could interfere with future plans for healthy offspring.

This is probably why society is so well aware of the impact of the Rh factor on pregnancy. However, antibodies are also produced if the blood type does not match.

When transfusing blood from a donor to a recipient, doctors must take into account whether the Rh factor also matches. During pregnancy, the red blood cells of the mother and the unborn baby are also found in the process prenatal development, as with the introduction of donor material. If the types of blood cells do not match, the mother's body "turns on" the protective reaction of immunization.

Red blood cells contain A or B antigens, and plasma contains α or β antibodies. The blood of the first group does not contain antigens, the fourth - antibodies. Antigens and antibodies are distributed as follows:

• group I (O) - antibodies α, β, antigens are absent;
• second II (A) - antigen A, antibodies β;
• third III (B) - B and α;
• fourth IV (AB) - A and B, no antibodies.

Antigens and antibodies named with the same letter (A and α, B and β) should not be together. The combination of antibodies and antigens of the same name leads to the destruction of erythrocytes, disrupting the system of oxygen transfer to tissues. This is a blood type conflict (or ABO conflict).

Is the mismatch of blood types of future parents dangerous?

In accordance with the laws of inheritance, when the blood types of the parents are the same, this type of hemolytic disease either does not develop or has a low probability of manifestation. An ABO conflict is most likely if the mother's body is characterized by the first blood type, and the baby inherits a different variant from the father. In such a situation, the antigens found in the blood of the fetus, placental blood and in amniotic fluid, cause a response in the body of a pregnant woman.

Antibodies are produced in the blood that destroy foreign red blood cells, releasing hemoglobin (the process of hemolysis). Most often, the main “hit” occurs during childbirth, but occasionally blood hemolysis can begin directly during pregnancy.

The fight against excess hemoglobin is the function of the liver. Hemoglobin is converted into bilirubin and excreted from the body. If there is too much bilirubin, the liver is stressed, unable to cope with the cleaning function, and other organs of the child may be affected.

To check for the presence of antibodies, the doctor may prescribe tests starting at 30 weeks of pregnancy, repeating them every month until delivery. Symptoms are also being studied, indicating the consequences of an immunological mismatch of blood groups. When assessing the condition of the baby and the feto-placental complex on ultrasound, the doctor pays attention to the presence of placental edema, an increase in the size of the child's abdomen that does not correspond to age norms, physical activity, and tone.

Similar changes in development may indicate other diseases. Therefore, to diagnose an ABO conflict, procedures such as amniocentesis (taking amniotic fluid to calculate the amount of bilirubin) or cordocentesis (removal of blood from the umbilical cord under ultrasound control) can also be performed. After birth, one or a series of tests are performed on the newborn to track the dynamics of bilirubin production.

A positive difference between the ABO conflict and the Rh factor: in the following states of expectation of a baby, the chances of developing a disease do not increase, but decrease.

The most common manifestation of ABO conflict is expressed in hemolytic (or physiological) jaundice in a newborn. Its symptoms are manifested by staining of the skin and sclera of the eyes in yellow, and sometimes affect neurological status. Children become restless, noisy or, conversely, inactive, lethargic, sleep more than they should by age.

In severe cases, the bilirubin attack affects the brain and other vital organs of the newborn. But most often physiological jaundice disappears in 2-3 weeks with little support (and constant monitoring) of a neonatologist and pediatrician.

The main treatment is to help the body. As during pregnancy, if a high titer of group antibodies is detected, the doctor may prescribe intravenous infusions (or supplementation from a bottle) of glucose, taking vitamin complexes designed to facilitate the process of cleaning the blood by the liver. If a child has a high bilirubin content, do not resist the appointment of additional nutrition or medical procedures. As a rule, this does not interfere with breastfeeding, and timely assistance to the baby will alleviate his condition and help proper growth and development.

If necessary, the doctor may prescribe other medications, including those with the condition of hospitalization. If jaundice begins to affect the brain cells, treatment is carried out under constant medical supervision.

IN Lately often talk about the benefits of late cutting of the umbilical cord after childbirth. The tying of the umbilical cord is postponed until its pulsation stops, which allows the child to receive nutrients after birth. This is exactly the procedure that is prohibited if the mother's blood type is different from the father's blood type. Even if the chance that the baby has inherited the mother's blood type is higher than the possibility of blood type conflict, the cord should be cut immediately after birth. This will save the baby from possible problems.

However, the main thing with neonatal jaundice is prevention. During pregnancy, the mother does not feel discomfort from immunological incompatibility. Therefore, if there is a possibility of a conflict in the blood group, it is necessary to undergo research in a timely manner, plan the management labor activity with your doctor and remember the importance healthy lifestyle life.

Of course everyone's blood is different. But what is the difference, the differences are natural - you will say and you will be mistaken. The fact is that pregnant women with the 1st blood group do not have antigens A and B in the erythrocytes, but alpha and beta antibodies are present. Carriers of other blood groups have these antigens. It turns out that when a woman has the 1st blood group, and a child has any other, when foreign components come into contact between antigens and antibodies, a struggle occurs.

Who is at risk

Pregnant women who have diametrically opposite groups with a child can experience all the "charms" of the conflict by blood group:

• mother with the 1st or 3rd group - a child with 2;
• in a woman, the 1st or 3rd group - in the fetus 3;
• in a woman of 1-3 blood groups - in an infant 4.

The risk of a hemolytic disease occurs if the woman has the 1st group, and the fetus has the 2nd or 3rd. The following patients are also under close attention of the gynecologist:

• who have ever had a transfusion procedure;
• miscarriages and abortions are declared in the medical history;
• during the second pregnancy, if the first baby was born with a diagnosis of "hemolytic disease" or a mental retardation was diagnosed.

What factors develop conflict

The conflict in blood types is regulated by the placenta, which protects against mixing of different blood. But this is only possible if the placenta is healthy. If there is a violation of the integrity of the vessels of the placenta, it exfoliates or the diagnosis has established other deviations from the norm, the cells of the child enter the bloodstream of the pregnant woman.

This causes an active process of formation of antibodies that penetrate the fetus and attack its cells. Hemolytic disease occurs. The situation is aggravated by the produced bilirubin with a toxic effect. It causes irreparable harm to the child, changing the structure of its internal organs. The brain, liver, kidneys are the first to suffer. It is impossible to predict whether a newborn will be born physically healthy or not.

What can be done in case of conflict between mother and child by blood group

The expectant mother does not feel the changes that occur with the fetus. An unusual process will be indicated by high antibody values. That is why testing must be done on time and be treated responsibly so as not to get a false result.

If the hemolysins in a pregnant woman are higher than normal and steadily continue to increase further, the gynecologist offers the woman the following options for getting out of a dangerous situation:

1. If the term is long, you can call premature birth. The baby is removed from the mother's abdomen and placed in special apparatus that keeps him healthy and alive. No one can give exact predictions and guarantees for 100% survival.
2. Intrauterine blood transfusion to the fetus.

Doctors advise pregnant women with the 1st blood group to be on the alert and tell the gynecologist about this feature even at an early stage of bearing a child.

How to help a newborn with hemolytic disease

If premature labor was induced or the woman still gave birth to the baby on time, the baby is treated as follows:

1. Spread under a special lamp, which significantly reduces bilirubin in the blood.
2. If this does not help, an urgent blood transfusion, hemosorption or plasmapheresis is prescribed.

The consequences of untimely assistance to an infant can cost him health, and even life. Complications that cause hemolytic disease:

• the skin of the baby swells;
• they turn yellow;
• worries about anemia;
• studies record a significant increase in the spleen and liver.

The doctor should prescribe the following drugs:

• binding bilirubin;
• removing bilirubin from the child's body;
• enterosorbents that prevent intoxication;
• choleretic drugs.

In order not to aggravate the situation, it is recommended to refuse breastfeeding. The mother will not be able to support and create strong immunity for the child, on the contrary, by breastfeeding, she will cause him even more harm. Scientists have determined the presence in the colostrum of antibodies foreign to the baby, which increase the conflict in the blood type. In general, with the skillful actions of the doctor, the prognosis for the baby is positive.

The conflict between the blood type of mother and child leads to hemolytic disease.

Why does immunological conflict occur?

So, if a pregnant woman and her baby different groups blood or Rh factors, it turns out that the child's blood contains an antigen that is not in the mother's blood. This antigen could have come from the father, whose blood type or Rh is different from the mother's.

Thus, the mother's body perceives the fetal blood cells as a foreign formation, and begins to produce antibodies aimed at destroying "foreign" cells.

Normally, the placental barrier prevents the mother's blood from mixing with the baby's blood, but in some pathological conditions (placental abruption, etc.), the functions of the barrier may be impaired.

What is the danger of a blood type conflict during pregnancy?

A blood type conflict can lead to kidney and liver problems, as well as brain damage.

The so-called hemolytic disease develops, the signs of which are anemia and jaundice.

But such serious consequences as disturbances in the functioning of the nervous system, which lead to a lag in the development of the baby in the future, are unlikely and are rare.

Who is at risk by blood type?

In addition, those future mothers who are pregnant not for the first time from the same man are at risk of getting a conflict in the blood type.

Rh factor:


Blood types:

First pregnancy with blood type incompatibility

After childbirth, antibodies produced to the baby's blood remain in the mother's body. Thus, in subsequent pregnancies from the same man, these antibodies will continue to be produced, their number will become significantly higher than in the first pregnancy.

Even if the first pregnancy was interrupted by an abortion or there was a premature birth, miscarriage, the female body has already managed to develop antibodies.

Manifestations of group conflict, its treatment and prevention

A blood test is taken from the newborn to find out if there is a group conflict. If it is, the child will have anemia - a low level of hemoglobin in the blood.

The baby may also develop hemolytic jaundice. Unlike physiological jaundice, which appears a few days after birth, is safe and resolves on its own, hemolytic jaundice is pathological condition. A baby can be born immediately with yellow skin, or it can turn yellow a little later. Even the whites of the baby's eyes can become yellow. This is caused by a huge excess of bilirubin in the blood, which puts a tremendous strain on the baby's liver.

To treat a child, he can be placed under a special lamp, which, with the help of radiation, will reduce the level of bilirubin. There are also various medicines for this purpose.

In extreme cases, the child may need a blood transfusion.

There is no special prevention against the conflict of blood groups. But to establish the likelihood of developing such a process, both parents take a blood test to determine the group and Rh factor.

Special IV blood group