How does the Rh factor influence when planning a child?

The Rh factor is one of many blood group antigens found on the surface of red blood cells (RBCs). Most people have proteins on the surface of their red blood cells called the Rh factor. If you have this antigen, then you are considered Rh positive; if you do not have the antigen, you are Rh negative.

It is impossible to determine which of the rhesus factors is more important, they are simply different. The Rh factor is important for an Rh negative woman if she becomes pregnant. People with a positive Rh factor may not remember it, but women with a negative one should be aware of the conflict. If foreign red blood cells carrying proteins of the Rh system get into the blood of such a person, they will be perceived by his immune system as foreign. The body will begin to produce antibodies. A Rhesus conflict will arise.

This is an unpleasant phenomenon - Rh sensitization (or conflict) can occur when transfusion of Rh-incompatible blood occurs in a pregnant woman with negative Rh, if the blood of the fetus is positive.

Rh factor, Rh incompatibility, Rh conflict: understanding the concepts

Rh factor is a protein on the surface of red blood cells. If it is present in a person’s blood, they speak of positive Rh (85% of people); if not, they speak of negative Rh (15%).

The influence of the parents' Rh factor on pregnancy is significant only in one case: the expectant mother is Rh negative, and the future father is Rh positive, and the child inherits the father's Rh, that is, positive. In other words, we are talking about a situation where an Rh-negative woman is carrying an Rh-positive child. Moreover, in 75% of cases, the expectant mother and fetus will be Rh incompatible .

It is worth noting that if a pregnant woman is Rh positive, then regardless of the Rh factor of her husband and child, incompatibility cannot develop - there is no cause for concern.

How does a mother’s negative Rh factor affect the unborn baby? When fetal red blood cells, which carry the Rh factor protein, enter the blood of a pregnant woman, her immune system identifies them as foreign and tries to fight them by actively producing antibodies that destroy the baby’s red blood cells. This is called Rhesus conflict .
It is dangerous because it causes anemia, acidosis and hypoxia of the fetus, dropsy and even its death.

Features of pregnancy management in Rh-negative women

When managing pregnancy in women with Rh-negative blood, it is necessary to determine the titer of anti-Rhesus antibodies monthly. In their absence, at 28 weeks of pregnancy, rhesus conflict is prevented by administering anti-rhesus immunoglobulin .

The second stage of prevention is carried out in the early postpartum period (within 72 hours after birth), if a positive Rh factor is detected in the newborn.

Prescription of anti-Rhesus immunoglobulin to Rh-negative women in the absence of antibodies in their blood is necessary after carrying out procedures accompanied by the danger of blood getting from the child to the mother:

artificial termination of pregnancy or spontaneous miscarriage;
ectopic pregnancy;
invasive diagnostics;
bleeding during pregnancy;
closed abdominal injury of a pregnant woman;
external rotation of the fetus during breech presentation.

All women with Rh-negative blood should be aware of the need for prophylactic use of anti-Rh immunoglobulin in the first 72 hours after childbirth, abortion, miscarriage, and ectopic pregnancy from an Rh-positive partner.

Is it possible to get pregnant if partners have different Rhesus numbers?

Different Rh factors of partners do not affect the possibility of conception. However, Rh conflict, which may develop subsequently, jeopardizes pregnancy and childbirth. Therefore, when planning conception, it is recommended to determine the Rh factors of partners in order to know in advance about the possible risk.

As a rule, the first pregnancy in such couples passes without complications. While antibodies have not yet been developed in the woman’s blood (this takes time), Rh conflict with the fetus does not develop. If the expectant mother has previously had Rh-incompatible pregnancies, that is, the mechanism for the formation of antibodies has already been launched, they will begin to be produced very quickly.

With each pregnancy, the number of antibodies in the blood increases. The likelihood of Rh conflict also increases if there have been previously interrupted or ectopic pregnancies, as well as blood transfusions. Therefore, no later than 3 days after termination of pregnancy or blood infusion, women with a negative Rh factor are injected intramuscularly with human anti-Rhesus immunoglobulin. This will minimize the risk of complications in the future - during the next pregnancy.

Pregnant women with a high risk of Rh conflict must be monitored by doctors: the woman must regularly undergo a blood test, which allows monitoring the presence of antibodies to fetal red blood cells. It is now common practice in many countries to give an injection of anti-Rhesus immunoglobulin at 28 weeks for most Rh-negative women. Sometimes this procedure is repeated at 32 weeks.

Risk factors for the development of Rh conflict

Of course, Rh conflict does not always develop. Often, antibodies in the mother’s blood are either absent or their amount does not pose a danger to the fetus.

During the first pregnancy, the likelihood of developing Rh conflict is the least. That is why women with a negative Rh factor need to be very careful about issues of protection from unwanted pregnancy: its artificial termination - especially more than 7 weeks - sharply increases the risk of developing a Rh conflict in the future.

In addition to induced abortion, there are other risk factors.

Factors associated with previous pregnancies:

ectopic pregnancy, pregnancy interruptions (spontaneous miscarriage, antenatal fetal death);
invasive procedures during previous pregnancies (amniocentesis, cordocentesis);
bleeding during previous pregnancies;
features of delivery (caesarean section, manual separation of the placenta, etc.);
carrying out prophylaxis of Rh immunization during previous pregnancies.

Factors not related to pregnancy:

blood transfusions without taking into account the Rh factor,
using one syringe when using drugs.

Let's sum it up

When conceiving a child, the compatibility of the parents according to the Rh factor does not matter, but this is one of the important criteria that affects the successful course of pregnancy. Therefore, it is so important to thoroughly prepare the female body for bearing a child.

Pregnoton, which contains folic acid, iodine, vitamins E, C, B6, and zinc, will help with this. It eliminates the lack of micronutrients important for conception and early pregnancy, and also normalizes the functioning of the reproductive system, reduces prolactin levels in hyperprolactinemia, increases the thickness of the endometrium in women with thin endometrium and increases the likelihood of pregnancy (more information about the product can be found here).

THIS IS NOT AN ADVERTISING. THE MATERIAL WAS PREPARED WITH THE PARTICIPATION OF EXPERTS.

Conflicting rhesus and conception

What should women with negative Rh blood factor keep in mind when planning pregnancy? Readers' questions are answered by a gynecologist at the Research Institute of Obstetrics and Gynecology named after. BEFORE. Otta RAMS in St. Petersburg Marina Vladislavovna BONDARENKO.

We recommend that you read the article on our website: “Conceiving with a negative Rh factor”

“I have negative Rh blood, and my husband is positive. Is Rh conflict a threat to our unborn child? “Lidiya K, Pyatigorsk

— A conflict can arise if the mother has a negative Rh factor, the father has a positive Rh factor, and the baby has inherited a positive Rh factor from his father. And if during pregnancy the fetal red blood cells enter the mother’s blood, then her immune system destroys them as “foreign”. Such exposure may occur during childbirth, abortion, or miscarriage. So women with negative Rhesus need to do an appropriate blood test before conception. And based on its results, engage in family planning.

If this is your first pregnancy, you should regularly check your blood for Rh antibodies. Standard deadlines have been developed for this. In the first half of pregnancy, antibody testing should be carried out once a month. In the second half - 2 times a month. After 36 weeks of pregnancy, antibodies in the blood are determined once a week, and immediately before childbirth - once every 3 days. This allows you to understand in time whether your unborn child is at risk of Rh conflict and take action.

“Is it possible to carry out some kind of prophylaxis during pregnancy to prevent Rh conflict from developing, and for what period? What affects the formation of antigen?”Natalia, Cherepovets

— Various complications during pregnancy can trigger the production of Rh antibodies. For example, placental abruption and any other violation of its integrity, gestosis, infections or abdominal injuries. In all these cases, fetal red blood cells can also enter the mother's blood and trigger a response from her immune system. Antibodies can appear if a woman has been transfused with Rh-incompatible blood in the past.

Increases the risk of a conflict situation and caesarean section. Even if antibodies are not detected in your blood, it is still worthwhile to prevent Rh conflict. This way you will protect yourself and your baby in case you want to become a mother again. It is carried out three times: at 10-12, 24-25 and 32-33 weeks of pregnancy. There are several drug regimens used for this purpose. The most effective combinations of ascorbic acid with glucose, sigetin, methionine, calcium gluconate, and rutin. Another regimen includes vitamin E, vitamin Bis and rutin. And at night it is recommended to take diphenhydramine.

“I heard that Rh conflict can lead to hemolytic disease in a child. What is this? “Anna Gromova, Arkhangelsk

— In hemolytic disease, bilirubin, a tissue poison, reaches the child through the blood. It disrupts the delivery of oxygen, damages the fetal brain, leads to hearing and speech impairment and turns the baby’s skin yellow. Such violations arise from which the child may die.

Currently, hemolytic disease can be diagnosed in utero. In particular, based on ultrasound examination. It shows an enlarged fetal liver, thickening of the placenta, and polyhydramnios. The diagnosis can be made by taking blood from the umbilical cord. It determines the level of bilirubin and hemoglobin in the fetus, which show how far the process has progressed. Bilirubin is also tested in amniotic fluid. The higher this indicator, the more severe the disease. The main method of treatment is intrauterine blood transfusion to the child. In this case, the “infected” blood is replaced with healthy one. Vitamins are an essential component of successful treatment.

“During the first pregnancy, no antibodies were found in the blood. I would like to become a mother two more times. How realistic is this? How many children can a woman with Rh incompatibility give birth to without risking their health? How often is it better to give birth? “G. Volkova, St. Petersburg

— There is no clear answer to the first two questions, because it is impossible to predict which parent’s Rh factor will be inherited by their next child. Only general patterns are known. During the first pregnancy, the level of Rh antibodies, if they appear, is usually not too high. This is due to the fact that the woman’s immune system encounters “foreign” cells for the first time.

In subsequent pregnancies, thanks to 'cellular memory', the woman's immune system produces antibodies much faster and in much larger quantities. This is why Rh-negative women are advised to avoid terminating their first pregnancy.

Keep in mind: once Rh antibodies have formed, it will not be possible to get rid of them once and for all. Therefore, the frequency of birth does not play a big role. If antibodies are already present, their number will not change between births. The only rule is that the birth of each new child must be approached responsibly and try to eliminate possible complications of pregnancy.

“I heard that a Rh-negative woman should be vaccinated with anti-Rh gamma globulin after every birth or abortion. Only then are her subsequent children protected from the consequences of Rh conflict. I'm going to have more than one child. What if antibodies are still detected in the blood during the next pregnancy?” Maria Menshova, Perm

— Anti-Rhesus gamma globulin must be administered to a woman after any manipulation of the uterus. Injection of this drug reliably protects against Rh conflict in subsequent pregnancies. It can be administered at 28 weeks of pregnancy or after childbirth. But this must be done within 72 hours. It doesn't make sense later.

In advance, ask the maternity hospital where you will give birth if it is available. If not, then buy gamma globulin at one of the city blood transfusion stations.

“Six years ago I had a daughter, after that there were three more pregnancies that ended in early miscarriage. Could this be due to the fact that I am Rh negative? Will I be able to have another child? “Gulnara V., 30 years old

— A test for Rh antibodies will help answer this question. It is done in any clinic. If they are discovered, it is possible that they were the cause of the miscarriage. Depending on the amount of antibodies in the blood, the doctor may suggest lowering their levels using plasmapheresis. During this procedure, the plasma is purified, and thus the risk of developing Rh conflict in subsequent pregnancies is reduced. This procedure is carried out before conception.

However, it is not only Rhesus conflict that can lead to miscarriage. Therefore, at the stage of pregnancy planning, it is necessary to undergo a full examination.

Elena DOPGANOVA Source: “Women's Health” Take the first step - make an appointment!

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