Complications during pregnancy about different blood groups. What does blood type conflict mean during pregnancy? Forms of hemolytic pathology

All expectant mothers are well aware that there is a contradiction between the Rh factors of the father and mother, which can negatively affect the fetus and the course of pregnancy itself. But for many, it is a shock to learn that there is a risk of a blood group conflict during pregnancy. This occurs in cases where the unborn child inherits blood from his father that does not fit well with the mother’s blood type.

The immunological contradiction between the blood of the mother and the fetus is called a conflict according toblood group This phenomenon is noted if the fetus receives the paternal blood type, which does not coincide with the maternal one and conflicts with it. Most often this happens if the mother has blood group I, and the fetus has blood group II or III, but there may be other combinations.

The severity of incompatibility is not as great and dangerous for the fetus and mother as in case of disorders of the Rh factor combination, however, in some cases it can harm the health of both.

Despite the fact that the direct mixing of the blood of the fetus and the mother does not occur, but a small amount of it still enters the mother's circulatory system. Her immunity perceives the ingress of fetal blood with a different group as a foreign protein and attacks it.

In the mother's body, they begin to be produced to the blood of the fetus, that is, there is a threat that the mother's body can reject the pregnancy, and the fetus risks suffering by getting hemolytic disease of the newborn.

In contrast to the conflict of Rh factors, with incompatibility of blood groups, the first pregnancy is the least risky, since in its process the body only adapts to "foreign" blood, it becomes sensitized. Therefore, the first child from one husband is the least threatened, but with subsequent pregnancies from the same man, the risk level constantly increases. Such pregnant women need constant monitoring.

Causes of the problem

A blood group conflict occurs when conflicting O± and OI antibodies and A and B antigens occur in the blood of the mother and fetus.

In a healthy pregnancy, the blood of the mother and child does not combine due to the flawless functioning of the placental barrier. It is located between two layers of the placenta - fetal and maternal. In a normal state, the placental barrier serves as a faithful guardian of the health and safety of the fetus. But with various pathologies, for example, with, the blood of the mother and fetus mixes.

In the mother's body, fetal blood cells are formed, they enter the fetal bloodstream and cause the destruction of its blood cells. When they decay, toxins are formed that affect vital organs - the brain, etc.

Dropsy of the brain is also possible, since when blood cells are destroyed, a large amount of “excess” fluid appears. A characteristic manifestation of conflict is also. But such grave consequences are still more the exception than the rule.

The possibility of incompatibility is detected during, especially if the woman has risk factors in the form of previous blood transfusions, miscarriages, or children born with hemolytic disease of the newborn, jaundice, or various pathologies.

A blood test detects the presence of antibodies, the pregnant woman is closely monitored, and, if necessary, sent for treatment to a hospital.

If you fall into the high-risk category, a woman should be regularly tested for antibody titers. But the presence of a potential threat does not necessarily mean defeat. In most cases, with a successful pregnancy, the conflict does not manifest itself or does not give dangerous consequences.

Danger to the fetus

The greatest danger to the fetus is a blood group conflict in the following cases:

• Mother with group I or II - fetus with group III.
• Mother with group I or III - fetus with group II.
• Mother with group I, II or III - fetus with group IV.

The most risky form is the combination of the first blood group in the mother and the second or third in the child. After the first pregnancy, subsequent children are at risk of developing hemolytic disease increases significantly.

It can be said that women with blood type I are more at risk of getting an immunological problem when conceiving a child from a man with any other blood type. In this case, the Rh factor does not play a decisive role. Women with other blood groups are well compatible with carriers of their own and group I.

Even if no signs of incompatibility were found throughout the entire pregnancy, this does not mean that the fetus is not at risk of developing neonatal hemolysis.

During childbirth, the placental barrier ceases to operate and ceases its protective function. The placenta separates, and the mother's blood can easily mix with the fetal blood, provoking a conflict. If the birth proceeds quickly, the disease in the newborn may manifest itself in a weak form or not at all affect his condition and health.

Long, protracted labor increases the risk of incompatibility, and the baby may get sick some time after birth, so a thorough examination and careful monitoring of the condition of both the mother and the child is required. Immediately after birth, a blood sample is taken from the newborn. If a hemolytic problem is identified, action will be taken immediately.

More information about what Rhesus conflict is can be found in the video:

Severe manifestations of the disease are quite rare, within one case per 200-250 births in risky pregnancies. In order to timely identify a potential risk, not only the expectant mother, but also the father donates blood for antibodies and blood type.

Throughout pregnancy, a woman needs to be wary of various interventions that can lead to the connection of the blood of the fetus and mother. Puncture of the amniotic sac for testing amniotic fluid or taking blood from an unborn baby can lead to a sharp increase in antibodies.

Treatment, possible consequences and prognosis

Modern medicine has not yet been able to fully cope with or prevent a blood type conflict, but there are ways to reduce the dangerous manifestations of the disease in newborns. Timely determination of the presence allows you to quickly start treatment, start cleaning the mother's blood. She is prescribed activated carbon and Enterosgel.

During childbirth, a child is carried out and, in the presence of antibodies, phototherapy is immediately carried out - they are placed under a special lamp, the radiation of which contributes to a rapid decrease in the level. If the antibody titer is very high and the level of bilirubin rises rapidly, then even timely phototherapy may not help. In such a situation, one has to resort to blood transfusion, hemosorption or plasmapheresis in order to improve the condition of the newborn. A sharp increase in bilirubin levels leads to a negative effect on cells and the development of jaundice, an enlarged spleen and. To avoid this, prescribe drugs that can bind bilirubin and remove it from the body, enterosorbents and choleretic agents.

In the event of a potential blood conflict, breastfeeding is not recommended to avoid the transfer of antibodies from mother to child.

Previously, this was not known or practiced, but now in modern maternity hospitals they are not allowed to feed colostrum to a newborn, since it also contains antibodies, and in large enough quantities to intensify or provoke a conflict. In cases of severe damage, breastfeeding can be stopped altogether, immediately after birth the baby is selected with a special diet that provides him with nutrients without risk to health.

Since severe manifestations of hemolytic disease with blood conflict are much less common than with incompatibility of Rh factors, the prognosis for normal, problem-free development of pregnancy is positive. The risk is minimal, and with proper control dangerous consequences can be stopped at the earliest stages. This cannot harm the baby in any way. In the rarest cases, a newborn may develop jaundice or anemia, or some other diseases that, with timely treatment, will not adversely affect the child’s health.

When the initial stages of hemolysis are detected, the newborn is placed under a blue lamp, and this simple action is often enough to reduce the level of bilirubin and avoid severe intoxication. Subsequently, the blood picture and the state of other systems and organs are balanced and the newborn develops in the same way as all other babies of his age. In a critical situation, the baby can be saved by blood transfusion or purification.

Having registered at the antenatal clinic, every pregnant woman receives a lot of referrals for tests, among which there is a mandatory test to determine the blood group and Rh of both spouses. In most cases, everyone is concerned about the presence or absence of this very Rh factor, since everyone knows about the likelihood of the development of Rh conflict in mother and child. At the same time, few people are aware of the existing possibility of an immunological conflict between blood groups.

Why does an immunological conflict occur?

The first blood group does not contain antigens A and B in erythrocytes, but there are α and β antibodies. All other groups have such antigens, and therefore the first blood group, having encountered antigens A or B that are foreign to it, begins to “enmity” with them, destroying red blood cells containing these antigens. It is this process that is the immunological conflict in the AB0 system.

Who should be afraid of a blood type conflict?

Theoretically, this problem can arise if the mother and the unborn baby have different blood types:

• a woman with blood group I or III - a fetus with type II;
• a woman with blood group I or II - a fetus with III;
• a woman with group I, II or III - a fetus with IV.

The most dangerous combination is considered to be if a woman with blood group I carries a child with blood group II or III. It is this situation that most often leads to the development of all signs of conflict between mother and fetus and the occurrence of hemolytic disease in the newborn. Women at risk also include:

• have received blood transfusions in the past;
• survivors of several miscarriages or abortions;
• who previously gave birth to a child who developed hemolytic disease or mental retardation.

The possibility of developing a group immunological conflict according to the AB0 system exists in married couples with the following combinations of blood groups:

• woman with group I + man with group II, III or IV;
• woman with group II + man with group III or IV;
• woman with III + man with II or IV.

What contributes to the development of conflict?

A properly functioning and healthy placenta protects against the development of blood group conflict. Its special structure does not allow the blood of the mother and fetus to mix, in particular, due to the placental barrier. However, this can still happen if the integrity of the blood vessels of the placenta is violated, its detachment and other damage or, most often, during childbirth. Fetal cells that enter the maternal bloodstream, if they are foreign, cause the production of antibodies that have the ability to penetrate the fetal body and attack its blood cells, resulting in hemolytic disease. The toxic substance bilirubin, formed as a result of such exposure in large quantities, can damage the child’s organs, mainly the brain, liver and kidneys, which can have serious consequences for the physical and mental health of the baby.

Manifestations of group conflict, its treatment and prevention

A pregnant woman will not feel any signs of developing a blood type conflict. A blood test will help to find out about its occurrence, which will show a high titer of antibodies in the woman's blood. With the development of hemolytic disease of the fetus and newborn, the following can be observed:

• swelling,
• jaundice,
• anemia,
• enlargement of the spleen and liver.

Prevention of serious complications is the regular donation of blood for analysis and the detection of specific antibodies in it - hemolysins. If they are found, the pregnant woman is placed under observation. If, as a result of repeated tests, the antibody titer continues to rise steadily, and the condition of the fetus worsens, then premature delivery or intrauterine blood transfusion to the fetus may be required.

Some gynecologists routinely prescribe a test for group antibodies to pregnant women with the first blood group if there are prerequisites for this. In fact, this happens very rarely, due to the fact that the conflict in the AB0 system usually does not entail serious consequences and causes jaundice only in born child, practically without affecting the fetus in the womb. Therefore, there are no such mass studies as in the pregnancy of an Rh-negative woman.

Hemolytic disease of the newborn requires mandatory treatment in order to avoid the development of severe complications. The more pronounced the symptoms, the more intense the conflict, to confirm which a blood test is performed for an increased content of bilirubin. The meaning of the treatment is to remove antibodies, damaged red blood cells and excess bilirubin from the child's blood, for which phototherapy and other symptomatic treatment are performed. In the event that this does not help, or the level of bilirubin in the blood rises very quickly, then they resort to the procedure of blood transfusion to the newborn.

Future parents who are at risk of developing such a conflict need to know that, firstly, the likelihood of a real conflict in blood types is very small in practice, and secondly, it most often proceeds much easier than the Rh conflict, and cases of severe are relatively rare, so the conflict according to the AB0 system is considered less dangerous for the health of the baby.

Oksana Krutsenko

When registering with a antenatal clinic, a future mother receives many referrals for tests. One of the analyzes is the determination of the group and the Rh factor not only of the pregnant woman, but also of her spouse.

If earlier the main emphasis was on determining the Rh factor to avoid Rh conflict, now they are trying to minimize the possibility of an immunological conflict between blood groups. Incompatibility occurs because the 1st blood group has α and β antibodies in its composition, and the A and B antigens in the erythrocytes of the rest. As soon as foreign antigens meet each other, they begin to destroy foreign erythrocytes. A blood type conflict arises.

Dangerous conditions

It is worth fearing the occurrence of incompatibility by blood group during pregnancy if the mother and child have the following combinations:

• in the fetus, group IV - in the mother, all the others;
• in the fetus II – in the mother I or III;
• in the fetus III - in the mother I or II.

A dangerous condition almost always occurs if a woman with blood group I develops a fetus with II or III. In case of repeated pregnancy, such a combination requires mandatory monitoring, since there is a risk of hemophilia in the newborn.

Compatibility of blood groups during pregnancy is most difficult to achieve for women with group I, regardless of the Rh factors. If a man belongs to another group, then there is already a high risk of an immunological conflict.

Women with other groups are compatible with men of their "category" and those with group I.

Future mothers who have had miscarriages or non-developing pregnancies in the past, have children with pathologies: mental retardation or diseases of the circulatory system should be under special supervision. The risk of a dangerous condition increases in women who have had blood transfusions in the past.

Negative and positive blood group during pregnancy

It is believed that if the mother has a negative blood type, carrying a pregnancy is always problematic. This is far from true.

If both partners do not have a mismatch in the Rh factor or the Rh factor is the same in the blood of the child and mother, no conflict is observed, and it is possible to endure the baby without complications - from this side.

There is no trouble when the mother has a positive status, and the fetus has a negative one.

If the situation is reversed, then antibodies may begin to be produced in the mother's blood to destroy foreign proteins and there will be a threat of termination of pregnancy.

Treatment is necessary. Injections of anti-D immunoglobulin will help stop the Rh conflict. Despite the fact that during gestation they try not to prescribe any medications, such therapeutic measures are necessary to stabilize the condition. The therapy does not have a negative effect on fetal development.

If it was possible to convey the pregnancy, but the necessary therapeutic measures were not taken, the process launched by the production of antibodies continues after the birth of the baby.

Hemolytic disease appears, in which the work of the hematopoietic system is disrupted.

Blood type conflicts

Hemolytic disease in a newborn also occurs with the development of an immunological conflict between blood groups. But - unlike Rhesus conflict - this condition appears much less frequently. The placental barrier protects the bloodstream of the fetus from the penetration of antibodies. The risk of foreign proteins being introduced increases during childbirth.

Suspicion of an immunological conflict arises if the newborn has severe anemia, swelling is visually visible, an ultrasound examination notes that the liver and spleen are enlarged, and jaundice does not go away for a long time.

To prevent hemolytic disease immediately after childbirth, women with a negative Rhesus or a positive blood type, if no treatment was carried out during pregnancy, take blood from a large vessel of the umbilical cord for analysis. They find out the status of the child and compare it with the status of the mother, and at the same time determine the level of bilirubin.

If necessary, treatment is prescribed. Sometimes blood samples from the baby are taken within a few hours during the first day to determine changes in dynamics during the adaptation period.

Special group

Gynecologists very carefully monitor women with IV negative blood group during pregnancy.

Since carriers of this group are quite rare - especially in combination with a negative Rh factor - an immunological conflict often arises. If incompatibility is detected from the very beginning, then observation is established immediately and at the first symptoms of blood incompatibility with the embryo, the necessary therapy begins.

However, it can only achieve success during the first pregnancy - doctors do not advise carriers of this blood group with a negative Rh factor to tempt fate and try to get pregnant again. Incompatibility threatens not only the health of the baby, but also his mother, and repeated births can result in serious problems for her.

However, no one can prevent a woman from giving birth, and if she is registered from the very beginning and the condition is monitored over time, there is a possibility of giving birth to a healthy baby. True, if the baby is female, the possibility of transmitting “dangerous blood” to him increases.

Blood type conflicts during pregnancy cause confusion among expectant parents. After all, the more well-known risk factor is the Rh conflict, which has quite serious consequences, but at the same time has been better studied.

Let's consider what an immunological conflict between mother and fetus is, how you can find out about the presence of such a problem and how to avoid health problems.

What causes the conflict, who is at risk

When registering for pregnancy, each woman receives a whole list of necessary tests. This rather large list includes a referral for blood testing of the expectant mother and father. Blood groups and Rhesus affiliation are determined.

For future parents, the possibility of a Rh factor conflict is not a secret. It can negatively affect the course of pregnancy, the woman’s health during pregnancy and the condition of the newborn.

But the conflict between the blood groups of mother and child causes bewilderment, and therefore fear of uncertainty. What is it, and what could be the consequences?

Looking at blood by group, we can state obvious facts. The first blood group 0 (I) does not have A and B antigens in its erythrocytes, but has α and β antibodies. All other groups “can boast” of such antigens. Consequently, having encountered foreign antigens, antibodies of the first group begin to destroy them. This is what a blood group conflict looks like in immunology.

According to theory, the development of such a problem can be observed in the following cases:

• the mother has blood type I or III - the baby has blood type II;
• the mother has blood type I or II - the baby has III;
• the mother has group I, II or III - the baby has group IV.

The greatest likelihood of a blood type conflict is for a woman with the first group when she is pregnant with a baby who has inherited the second or third from the father.

The risk of this happening increases if:

1. Before pregnancy, a woman underwent blood transfusion for any reason.
2. There used to be abortions or miscarriages.
3. This is the second and subsequent pregnancies.
4. Previously born children had mental health problems or were born with neonatal hemolysis.

During the pregnancy of the first child, there are practically no antibodies in the maternal blood, so the risk of developing a conflict according to the AB0 system is minimal. For all subsequent children, the relevance of this problem increases.

To be fair, it must be said that blood type conflict occurs quite rarely and does not have such obvious symptoms for both the mother and the unborn baby. If the problem is detected early and treated appropriately, there are virtually no consequences.

Combination-inconsistency

By what indicators can one determine whether a group conflict between mother and child will develop even before conception?

Modern genetics has identified parental blood groups that can produce risky combinations:

• Mom has group 1 – dad has 2, 3 or 4;
• Mom has group 2 - dad has 3 or 4;
• Mom has group 3 - dad has 2 or 4.

Gynecologists pay special attention to expectant mothers with blood group IV and Rh negative. This is a rather rare combination, which is potentially dangerous in two respects: group and Rh conflict.

Such a woman is observed with special care; at the slightest suspicion of the development of a conflict, the pregnant woman is placed in a hospital under round-the-clock supervision of specialists and treatment begins immediately.

In the normal course of pregnancy, nothing should threaten either the mother or the baby, even with this combination of parental indicators. The placenta is an excellent natural protective barrier that protects the health and normal functioning of both.

But in the event of any disturbance in the body of a pregnant woman: the development of an infection, damage to the integrity of the placenta (premature abruption or other pathological conditions), a conflict may arise.

Also, the risk of developing this pathological condition increases during childbirth, when the placenta ceases to be a “guardian of law and order” and the blood of the mother and the newborn baby mixes. An “antigen-antibody” reaction occurs, and the destruction of the child’s red blood cells begins.

Treatment methods, consequences and prognosis

No matter how high the level of development of modern medicine is, effective methods of completely getting rid of such a problem as blood type conflict between mother and baby still do not exist.

However, there are ways that make it possible to reduce or completely eliminate the dangerous consequences for the child:

1. If antibodies are detected in the mother during pregnancy, she is prescribed drugs that purify the blood. It could be banal Activated carbon or Enterosgel.
2. Immediately after birth, the newborn is given a blood test. If a small amount of antibodies is detected, phototherapy sessions are used. A lamp with special radiation affects the baby and helps reduce the concentration of bilirubin. Often such therapy methods are sufficient.
3. If the antibody titer and bilirubin growth level are very high, phototherapy is powerless. Then the baby is given a blood transfusion, hemosorption or plasmaphoresis is performed.

An increase in bilirubin concentration can lead to disturbances in brain function. Jaundice and anemia also develop, and an enlarged liver or spleen is observed. To correct the condition and reduce bilirubin levels, enterosorbents, choleretic drugs, as well as agents that help bind and remove toxins from the baby’s body are prescribed.

In particularly severe cases of conflict during intrauterine development, a child is born with hemolytic disease of the newborn.

If a specialist identifies a risk of group conflict, then the mother is not recommended to breastfeed her baby.

In any case, recently in maternity hospitals it is not allowed to feed newborns with colostrum, since it contains a very large amount of antibodies, which can aggravate the health of the baby.

Breastfeeding may be permitted if:

• the future picture will be optimistic;
• phototherapy is effective;
• There will be no increase in bilirubin levels.

In case of worsening of the condition or other negative aspects, the baby is given specialized nutrition, and breast milk is prohibited altogether.

Blood type conflict is not as common as Rh conflict. However, it is necessary for future parents to know about its existence and the possibility of receiving “such a miracle”.

“He who is forewarned is forearmed.” Responsible adults will make a decision and strictly follow the doctor's instructions so that the miracle of motherhood becomes a joy and not a series of problems.

All people have red blood. It is made by red blood cells - erythrocytes.

This is what red blood cells look like under a microscope

But, despite the same color, it is different. And the same red blood cells make it this way. Because of this, blood conflicts arise, since different types of blood exhibit incompatibility when mixed. This negative interaction also occurs during pregnancy.

Why is blood different in people?

There are dozens of different systems, each of which describes differences in the blood of different people in its own way. The most popular of them are the ABO system and the Rh system.

AVO system

On the cell membrane of the erythrocyte there are antigens A and B. In the blood plasma in which the erythrocytes are located, agglutinins (antibodies) α and β are present. As a result, four combinations of antibodies and antigens are possible. Each of these combinations determines a person’s blood type.

1. If there is a combination that includes α and β, the person’s blood is of the first group or zero – 0 (I).
2. The combination of A and β gives the second group - A (II).
3. The third group is formed when B and α – B (III) are present.
4. The fourth group is obtained from the combination of A and B - AB (IV).

Why are only these combinations possible? Because antibodies and antigens of the same name, for example, B and β, cannot be found in human blood. They come into contact with each other, which leads to the death of red blood cells.

Rh system

Rhesus in the coordinates of this system is the D antigen (protein) located on the cell membrane of the erythrocyte. People who have this protein have Rh positive blood. It is usually denoted Rh+. When the protein is absent, the status is Rh negative (Rh-).

How does a child inherit blood?

AVO system

There is a common misconception that a child will have either the mother's or the father's blood type. Tables are published with the help of which it is supposedly possible to find out the group of the child based on the groups of the father and mother. However, they do not describe a pattern, but a probability. In fact, it could be any group.

Rh system

An accurate prognosis is only possible when both parents are Rh negative. The child will have Rh negative status. In other cases, Rh can be either positive or negative.

Two types of conflict

Rh blood group conflict is possible during pregnancy only when the mother has Rh- blood. How many people are there in the world with negative Rh factor? Much less than Rh-positive (Europeans - 15%, Africans - 7%, Asians - 1%). Therefore, conflicts due to different Rh factors do not occur often.

Conflict between the blood group of mother and child is a dangerous phenomenon. However, it should be noted that Rh conflict has more severe consequences for the child than blood type conflict.

Blood group conflict during pregnancy (table)

A conflict with the fourth blood group during pregnancy, as the table shows, is impossible when it has future mom. In all other cases, conflict is likely. Blood type incompatibility between mother and child is most pronounced when women with the first group carry a fetus with the second or third group.

How does conflict between the blood type of mother and child work?

When fetal blood enters the mother’s blood, her body begins to react to the detected foreign antigen, that is, to the one that the child has, but not the mother. The reaction is that antibodies begin to be produced according to the blood type during pregnancy, designed to destroy foreign antigens and thereby protect the mother’s body.

Maternal antibodies enter the fetal blood and begin to destroy red blood cells. A lack of red blood cells results in oxygen starvation for the child. When red blood cells die, toxins are formed. These factors negatively affect the fetus’s body and give rise to hemolytic disease.

When does blood type conflict occur?

It is possible during pregnancy itself, during childbirth and during breastfeeding child.

During pregnancy

If the pregnancy proceeds normally, mixing of the blood of mother and child does not occur, since there is a placental barrier. The essence of this barrier is that a healthy placenta has the ability to pass some substances from mother to child, but not others.

But sometimes the blood mixes, and a blood group conflict occurs during pregnancy. This happens, for example, with placental abruption.

Symptoms of placental abruption look like this:

• bleeding from the genital tract;
• tense state of the uterus and pain on palpation;
• disruption of the child's heart.

The danger to the baby’s health depends on the degree of pathology. If one-third to one-half of the placenta detaches, the baby dies. At the slightest suspicion of placental abruption, a pregnant woman should immediately consult a doctor.

Most significant conflict in the group occurs in the early stages of pregnancy. Prolonged release of antibodies causes more damage to the baby than when it occurs later in pregnancy or during childbirth.

During childbirth

During childbirth, the placenta is naturally destroyed and the blood of the mother and baby comes into contact.

1. The risk of unwanted complications in the form of hemolytic disease is low if childbirth occurs according to a normal scenario.
2. However, if they become protracted, after a certain period of time the newborn may develop hemolytic disease.

If a woman with the first group or with a negative Rh factor gives birth, blood must be taken for analysis from the umbilical cord vein to find out the child’s group, its Rh status and bilirubin level.

A high level of bilirubin indicates that there is increased destruction of red blood cells in the baby’s blood. If the bilirubin level is not normal, repeat tests are performed during treatment.

When feeding

Modern medicine believes that hemolytic disease can appear during breastfeeding in very rare cases, since maternal antibodies die in the child’s stomach. But twenty years ago, mothers with the first group or with a negative Rh factor were prohibited from feeding their children for several days. Doctors believed that during this time the mother's body stopped producing antibodies.

What factors increase the risk of conflict?

The risk is lowest when a woman gives birth for the first time.

1. The risk of conflict increases if the woman has undergone a blood transfusion.
2. Abortions or miscarriages are also considered negative factors.
3. Another factor is the second, third and subsequent pregnancies.
4. If a woman has already given birth, and the children had various kinds of health problems, for example, hemolytic disease of the newborn, mental disorders, then there is a serious threat of conflict in the group.

How can you find out about a conflict in advance?

If conception is not accidental, before it it is advisable to find out the compatibility of the group and Rh factors that the potential mother and father have. Tests can be taken at public medical institutions and private clinics, for example in the Invitro network. Requirements for preparing for the test for the group and the Rh factor are somewhat different.

1. When determining the group, it is recommended not to eat for four hours before starting the analysis.
2. The requirements for preparing for the Rh factor test are stricter. In particular, it is forbidden to eat fatty foods the day before taking a sample and not to smoke half an hour before.

You can take two tests at once. Blood is taken either from a finger or from a vein.

Knowing the group and Rh factors of both parents, it is possible to determine risky combinations with a certain degree of accuracy.

Risk information can be obtained from the following table.

However, it is worth paying attention to the relative reliability of these combinations. They indicate that the risk of conflict within the group is probable, but not obligatory.

Preventive measures

The conflict between mother and fetus based on blood types is dangerous because the woman may not be aware of it. Its presence does not worsen her well-being. Therefore, you need to monitor the level of antibodies (titer) in it.

The standard analysis schedule is as follows:

• up to 32 weeks – once a month:
• from 32 to 36 weeks - twice a month;
• after this period - every week.

However, in case of deviations from the norm, it is necessary to take tests more often; if the titer is determined to be high, then the pregnant woman will be admitted to the hospital for a thorough examination.

1. It includes ultrasonography(ultrasound) of the placenta, amniotic fluid, conditions of the fetal liver and spleen. Excessive amount of amniotic fluid, abnormally enlarged liver and spleen of the baby, thickened placenta indicate the development of a conflict regarding the blood type and Rh factor.
2. In certain situations, when the safety of the fetus is of concern to doctors, a procedure called amniocentesis (analysis of amniotic fluid) may be performed. The high density of amniotic fluid indicates the process of destruction of red blood cells. Amniocentesis allows you to accurately determine the baby’s blood type and the number of antibodies.
3. Another procedure is cordocentesis. During this procedure, blood from the umbilical cord is taken for analysis. The procedure is done using a needle, which is inserted into the uterus through a puncture in the anterior abdominal wall. This analysis allows you to assess the severity of hemolytic disease.
4. If there is a conflict regarding the Rh factor, a Rh immunoglobulin vaccination is performed.

Therapy for conflict

What may be included in the course of treatment?

1. Intravenous administration of vitamins and glucose is performed. Immunoglobulin injections are prescribed.
2. Plasmapheresis may be used to reduce the number of antibodies in pregnant women. During this procedure, blood is drawn from a vein (250-300 ml). Then the cell mass is separated from the plasma, diluted with special solutions and returned back into the vein.

The first disadvantage of plasmapheresis is that no more than a fifth of harmful substances are removed in one procedure, so several sessions have to be done.

The second disadvantage is that useful substances (immunoglobulins, fibrinogen, prothrombin) are removed along with antibodies and other undesirable components.

Plasmapheresis is contraindicated in cases of poor blood clotting and low protein content.

1. When the titer increases, a purification method known as hemosorption is also used. In this case, the blood is purified with sorbents that retain toxic impurities, including antibodies.

What you need to know about hemolytic disease

If, despite all the measures taken, the child is born with it, parents should not panic.

Clinical forms

There are three forms of this pathology:

• edematous;
• icteric;
• anemic.

1. The first form is rare, but has the most severe consequences. It is called this because the child is born in very poor condition, with severe swelling and severe anemia.
2. In the second form of the disease, the increased content of bilirubin in the baby’s blood gives it yellow(newborn jaundice), which is observed, for example, with hepatitis A.
3. The disease progresses most easily in the anemic form. There are no external signs, or they are mild, diagnosed with a laboratory blood test.

Treatment

1. In severe cases, replacement blood transfusion, hemosorption and plasmapheresis are practiced.
2. If the disease in a newborn is mild (or after severe therapy), intravenous infusions of proteins and glucose are prescribed. Medicines and vitamins are prescribed to improve liver function. White or blue light therapy is used to oxidize indirect bilirubin in the newborn's skin.

What awaits the baby? His future depends on the severity of the pathology. With adequate therapy, the prognosis is mostly positive.