Complications during pregnancy about different blood groups. Hemolytic disease of newborns - physiological jaundice. In what cases does incompatibility occur?

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:

Before pregnancy, a woman underwent blood transfusion for any reason.
There used to be abortions or miscarriages.
This is the second and subsequent pregnancies.
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 remove dangerous consequences for a child:

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.
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.
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.

Blood group conflict during pregnancy occurs most often when a woman has the first blood group 0 (I), and the fetus has the second A (II) or the third B (III). Blood type incompatibility is not as severe as Rh incompatibility, but also leads to hemolytic disease of the newborn.

Although the blood of the mother and child does not mix, even with a healthy pregnancy, a small reflux of fetal blood (a tenth of a milliliter is enough) into the maternal bloodstream can occur, as a result of which an active immunological reaction occurs to produce antibodies to the child’s blood. Thus, the female body is protected from foreign protein.

Why is blood type conflict dangerous during pregnancy?

A blood type conflict during pregnancy is dangerous for the child, not for the mother. Antibodies to A- and B-antigens penetrate into the baby’s body, then they interact with the red blood cells of the fetus, resulting in hemolysis (destruction of red blood cells) and anemia (decrease in hemoglobin in the blood). Then indirect toxic bilirubin is formed and dissolves in the cells of the baby’s brain, liver and spleen. Therefore, the extremely severe degree of HDN (hemolytic disease of the newborn) is hydrocele in a child, as if he is completely filled with water. But severe cases of HDN due to incompatibility of the blood type of mother and child are very rare.

A distinctive feature of the isoserological conflict according to the ABO system is the late manifestation of hemolytic disease of the newborn; this can occur several days after birth; the baby’s skin becomes yellow, the so-called jaundice of newborns.

In modern medical centers, a woman in labor with a high titer of antibodies in the blood, when a child is born with HDN, is not allowed to put the baby to the breast for some time, and may even be completely prohibited from breastfeeding. The fact is that colostrum also contains antibodies, and the attack on the child’s body continues.

First pregnancy with blood type incompatibility

More often, the first pregnancy when the blood of the fetus and mother is incompatible is not dangerous, because during it sensitization occurs ( acquisition by the body of specific sensitivity to foreign substances - allergens) of the mother's body to blood that is foreign to her gradually and mainly during the birth itself. In the delivery room, the newborn’s blood is taken for analysis and in the event of a conflict, the necessary measures are taken.

In most cases, pregnancy and childbirth go well; severe forms of hemolytic disease occur once every 200-256 births. It is also important to register at the clinic on time during your first pregnancy, take all the necessary tests, and monitor whether the antibody titer is growing. The baby's father must also donate blood to determine the group and Rh factor, because if he has 0(I) blood - the first, then there will be no conflict regarding the blood type.

For women with a possible blood type conflict during pregnancy, it is important to be very careful with invasive procedures (amniocentesis, cordocentesis). When the mother's belly is pierced for the purpose of sampling amniotic fluid or a fetal blood test, then after these manipulations the level of antibodies increases.

Nowadays, there are methods for treating and preventing hemolytic disease. If antibodies to A- and B-antigens increase in maternal blood, then doctors take the necessary measures, purify the blood, prescribe treatment, and recommend taking enterosgel and activated carbon.

How to determine conflict based on blood types

Immunological incompatibility occurs more often when a woman has the first blood group 0 (I), and a man has a different group, but conflicts occur more often when the fetus inherits the second A (II) blood group. In this case, a woman’s blood is taken to determine antibodies to red blood cells using the ABO system. This analysis determines:

complete anti-A antibodies;
complete anti-B antibodies;
incomplete anti-A antibodies;
incomplete anti-B antibodies;
natural antibodies alpha-hemagglutinins;
natural antibodies beta-hemagglutinins.

Natural antibodies alpha-hemagglutinins and beta-hemagglutinins are formed in early childhood, both of these types are present in people with the first blood group 0(I), natural antibodies alpha-hemagglutinins are present in people with the third blood group B(III), and, accordingly, natural antibodies beta-hemagglutinins are found in people with the second blood group A (II). The fourth group AB (IV) contains A and B antigens, so the natural antibodies described above are not formed. Such antibodies belong to Ig(M) immunoglobulins; they are “large” and do not pass through the placenta, therefore they do not harm the red blood cells of the fetus.

Full antibodies also belong to the Ig(M) immunoglobulins, so they do not pass through the placenta, but in the event of a small placental abruption or other unpleasant situations, when they enter the bloodstream of the fetus, they block its red blood cells. Complete antibodies are retained in the female body due to immunological memory; they do not play a major role in the development of intrauterine hemolytic disease.

Partial antibodies belong to Ig(G) immunoglobulins, so they can penetrate the placental barrier. These antibodies are the cause of hemolytic disease. It is very important to monitor the antibody titer, although these numbers cannot always reliably indicate the severity of sensitization. If the titer drops sharply without drug treatment, this may mean that there has been a massive penetration of antibodies into the fetal bloodstream.

It is interesting to know that incompatibility by blood and Rh factor at the same time is much better than separately. This is explained by the fact that two incompatibilities “compete” with each other.

Oksana Krutsenko

When registering at the antenatal clinic, the expectant mother receives many referrals for tests. One of the analyzes is to determine the group and Rh factor of not only the pregnant woman, but also her husband.

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 blood group 1 contains antibodies α and β, and the red blood cells of the others contain antigens A and B. As soon as foreign antigens meet each other, they begin to destroy foreign red blood cells. A blood type conflict arises.

Dangerous conditions

You should be wary of blood type incompatibility 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 type I develops a fetus with type II or III. In case of repeated pregnancy, such a combination requires mandatory monitoring, as there is a risk of hemophilia in the newborn.

Blood group compatibility during pregnancy is most difficult to achieve for women with group I, regardless of 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 already had miscarriages or undeveloped pregnancies in the past, or 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's blood type is negative, pregnancy is always problematic. This is far from true.

If both partners do not have a discrepancy in the Rh factor or the Rh factor is the same in the blood of the child and the mother, no conflict is observed, and the baby can be delivered without complications - on this side.

There are no problems when the mother has a positive status and the fetus has a negative status.

If the situation is the opposite, then the mother’s blood may begin to produce antibodies 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 pregnancy 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 carry the pregnancy to term, but the necessary therapeutic measures were not taken, the process triggered by the production of antibodies continues after the birth of the baby.

Hemolytic disease appears, in which the functioning 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.

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 experience any signs of developing a blood group conflict. A blood test will help you 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 may be observed:

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

Prevention of serious complications is to regularly donate blood for analysis and identify 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 fetal condition worsens, then premature delivery or intrauterine blood transfusion to the fetus may be required.

Some gynecologists regularly 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 a 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 during the pregnancy of an Rh-negative woman.

Hemolytic disease of the newborn requires mandatory treatment to avoid the development of severe complications. The more pronounced the symptoms, the more intense the conflict, which is confirmed by a blood test for elevated bilirubin levels. The point of 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 carried out. If this does not help, or the level of bilirubin in the blood increases 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 blood group conflict occurring in practice is very small, and secondly, it most often occurs much easier than Rh conflict, and cases of severe are relatively rare, therefore conflict according to the AB0 system is considered less dangerous for the baby’s health.