When future mom gets registered in the antenatal clinic, she rents a number of laboratory tests, including the determination of blood group and Rh factor. The same analysis takes place and the future father. Why do it? To have the first weeks of pregnancy to determine whether the fetus of a threat hemolytic disease of the newborn (HDN) due to immunological conflict due to incompatibility of blood and fetal mother.
Incompatible blood group typically arises if a mother blood group 0 (I), and the baby A (II) or In (III). For Rh-negative Rh conflict resulting in the mother, the father and a positive fact, if the pregnancy was preceded by other births, miscarriages, abortions. In other words, during each of the previous pregnancy in a woman's body to form and accumulate the antibody.
Since the conflict of blood group such laws are not observed, HDN can occur already during the first pregnancy. As a rule, the red blood cells of the child inherit certain paternal antigens that are absent in the mother. Thus, the mother's body produces antibodies to these antigens. Fetal red blood cells found in the mother's bloodstream starting from 16-18 weeks of pregnancy. The earlier start to produce antibodies, the harder the course of the disease, as they penetrate to the fetus through the placenta. With an increase in antibody titer, is the destruction of erythrocytes (hemolysis) either in utero fetus in utero or after birth.
As a result, hemolysis is formed bilirubin accumulating in adipose cells, the subcutaneous fat layer and skin stained child becomes yellow. If the blood bilirubin accumulates a lot of baby, it penetrates into the structure of the brain (nucleus) that contain fat inclusions. The most severe complication in this case is called "kernicterus".
Timely to suspect a conflict, should be carefully monitored at the antenatal clinic. All women with Rh-negative blood should be tested for titer determination antirhesus antibodies to red blood cells of the child. The first time when registering, the second at 18-20 weeks, and in the third trimester of every 4 weeks.
The result is dangerous if the antibody titer increases or fluctuates undulating (i.e. increases, then decreases). The need for amniocentesis (amniotic fluid intake) is solved individually. On ultrasound, with severe edematous form, fetal posture characteristic of the Buddha and the "halo" around the cranial vault. This is due to swelling, which are formed in utero when the fetus is reduced hemoglobin to 70-100 g / l. Because placental edema weight significantly increases (normally it is 1 / 6-1 / 7 of the body weight of fetus).
classification of HDN
The most severe manifestation of Rhesus conflict - edematous form of HDN. The most common - bilious. In some children there is jaundice at birth (congenital icteric form), most evident in the first days of life. anemic form is diagnosed in 10-20% of children who tend to look pale, limp, bad eating, and very slowly put on weight. In addition, they have found an increase in size of the liver, spleen and different degrees of severity of anemia.
How to treat?
An integral part of the treatment - the child adequate nutrition. In any case it is impossible to give up breast-feeding. We should not be afraid of that antibody with milk will fall to the child and aggravate the situation. After contact with the milk in the stomach, the antibodies are destroyed under the influence of an aggressive environment. But the possibility and method of feeding (breastfeeding or feeding expressed milk) defines a pediatrician based on the severity and course of the nature of the disease.
The main method of treatment - phototherapy, as with any jaundice. Using this method, bilirubin converted into water-soluble form and excreted through feces and urine. In severe with high levels of bilirubin and / or low hemoglobin holding exchange transfusion operations necessary (GOIC). This procedure is carried out under conditions of intensive care units, because it requires sterility and trained personnel.
To prevent a baby with HDN to all women with
Rh-negative blood, in the first 24-72 hours after birth or abortion should always be enter Rh immunoglobulin, facilitating the rapid removal of the child's red blood cells from the bloodstream mother.
