Rh factor (D-antigen) is a protein located on the surface of red blood cells. 10-15% of the world’s population lacks this protein, they are considered to be Rh-negative.
When a woman is Rh-negative and the spouse is Rh-positive and the child inherits the father’s rhesus, antibodies against antigen D are produced in a pregnant woman’s body.
During the first pregnancy in a woman’s body immunoglobulins M (antibodies) are produced, which do not penetrate through the placenta and do not adversely affect the fetus. This is called rhesus sensitization. This can happen with miscarriages, blood transfusions. With repeated pregnancy, immunoglobulins G are produced, which penetrate through the placenta and have a harmful effect on the fetus and lead to the development of hemolytic disease of the fetus.
When the mother’s antibodies enter the fetus, they react with the re-positive fetus erythrocytes and destroy the fetus erythrocytes, causing hemolysis. Fetus develops anemia.
In addition, the liver and spleen, as blood-forming organs, begin to intensively produce new red blood cells and increase in size (hepatosplenomegaly). In severe cases, when the liver and spleen do not cope, fetal death occurs.
The following forms of hemolytic disease of the fetus are distinguished:
Anemic form – the easiest, most favorable variant of the course, manifests immediately after birth.
The icteric form is a moderate form, when bilirubin, decomposition product of hemoglobin, accumulates and appears as anemia and jaundice in the fetus.
The edematous form is the most severe variant, severe anemia leads to hypoxia, edema of all organs and tissues, accumulation of fluid in the body cavities, which leads to cardiopulmonary insufficiency.
Treatment of hemolytic disease of the newborn (HDN) is aimed at detoxifying the body from high levels of bilirubin, removing maternal antibodies, and treating anemia. Moderate and severe forms require blood transfusion for the newborn.
To avoid the appearance of antibodies in a mother with Rh-negative blood in the first pregnancy, when there is no sensitization of the body (there are no antibodies to the Rh factor in the mother’s blood) the woman should be given an anti-rhesus gamma globulin at the 28th week of pregnancy.
And after the birth of the first child, if the baby has Rh positive blood affiliation, the mother should be given within 72 hours after the birth of the second dose of Rh immunoglobulin D. This will avoid the Rh-conflict in subsequent pregnancies.
The introduction of antirusus gammaglobulin D to the Rh-negative woman is recommended after miscarriages, abortions, obstetric manipulations, blood transfusions.
Conducting pregnancy by women who already have sensitization of the body is reduced to the continuous determination of the level of antibodies during pregnancy, the fetal ultrasound dynamics, doplerometry, and, if necessary, amniocentesis to determine the level of bilirubin in the amniotic fluid. Conducting intrauterine replacement perilatation of blood to the fetus in specialized perinatal centers.
And timely delivery of the fetus with not yet aggravated condition.