As you know, blood groups are A B AB AND 0 and they contain a Rh factor. This Rh factor becomes RH+ or Rh-.
If the blood type of a pregnant mother is Rh- and the father's blood type is Rh+, Rh Incompatibility, which we call blood incompatibility. We are faced with the syndrome. Apart from these
situations, Blood Incompatibility Syndrome is never experienced, regardless of the Rh of the blood groups.
Why is this incompatibility important? The blood of the baby of the expectant mother is important, if the baby receives his blood from the father. If it is Rh+ (the mother is already Rh-), then during pregnancy or birth, the blood of the mother and the baby come into contact and the erythrocytes (red blood cells) in the baby's blood pass into the mother's blood. These erythrocytes
have the baby's Rh antigens on them. The mother perceives these Rh antigens as foreign, and since these antigens are +, she produces Rh antibodies against these antigens. The baby is not harmed in this pregnancy. However, in the next pregnancy, these Rh antibodies of the mother pass to the baby and the baby's erythrocytes are destroyed. /> They break down and cause anemia, which we call anemia.
I wrote that during birth and pregnancy, the baby's blood passes to the mother and the mother creates antibodies against them.
These situations: Miscarriage, abortion, ectopic pregnancy, amniocentesis, CVS (Chorion Villus Biopsy). are interventions such as cordocentesis. If one of these situations occurs, Anti-D injection must be given within 72 hours to prevent the mother from being affected. This injection is given once from the hip into the muscle (intramuscular). According to some sources, the injection is 14- It can also be done up to 28 days. In pregnant women with blood incompatibility, the Indirect Cooms test is checked at the first check-up. If the indirect Cooms test is negative, there is a risk of developing Rh Isoimmunization (interaction) in the antenatal period, even though it is unlikely to occur, starting from the 20th week. Indirect Cooms should be re-examined at monthly intervals.
In those with negative Indirect Cooms, prophylaxis should be given with 300 micrograms of Anti-D gamma globulin (blood incompatibility needle) at the 28th week. With prophylaxis
from the baby to the mother in the remaining 12 weeks until birth. To prevent the passing blood from creating Rh isoimmunization. If prophylaxis is not applied, Anti-D
gamma globulin is administered within 72 hours after birth. After birth, Direct Cooms is tested from the baby's cord blood and the baby's blood group is studied. The Direct Cooms
test is negative. If the baby's blood type is Rh+, Anti-D gamma globulin, which we call a blood incompatibility injection, is given to the baby within 72 hours. With this injection, we aim to prevent Rh isoimmunization, as in re-prophylaxis. In other words, the mother has antibodies against the erythrocytes coming from the baby.
We are trying to prevent it from forming.
We talked about the indirect and Direct Cooms test. I would like to explain what these mean.
Indirect Cooms is the test that is tested by the mother at the first control of the pregnancy and at 4-week intervals after the 20th week. Free antibodies in the mother's blood. Indirect
In cases with a positive Cooms test, specific Anti-D antibodies in the IgG structure are checked. The critical titer for these antibodies is 1:16 and above. Since IgM does not pass through the placenta, it does not need to be checked. The level above 1:16 does not need to be checked. It is necessary to proceed with advanced tests such as amniocentesis, cordocentesis and USG to investigate the condition of the affected values. If the disease is advanced, it may be necessary to change the baby's blood in the womb. The amniotic fluid taken by amniocentesis is evaluated by the optical density measurement method (DOD450 - depending on the bilirubin density) and is divided into risk groups on the so-called Liley curve. Those in the 2nd or 3rd zone of the Liley curve are severely affected and blood transfusion is indicated. Hemoglobin measurement and blood transfusion to the baby can be performed by cordocentesis.
The direct Cooms test is performed on the baby after birth and the fetal blood is examined by cordocentesis to determine the antibodies on fetal erythrocytes.
There is also the Kleihauer-Betke test. It is a test that helps calculate the amount of fetal erythrocytes mixed into the mother's blood.
If the baby is affected by Rh Incompatibility, the Rh antibodies passed from the mother to the baby will break down and precipitate the baby's erythrocytes. This situation results in severe anemia, anemia called Hydrops Fetalis, heart failure. and it causes a severe condition with accumulation of fluid in the baby's body cavities. The severity of the condition varies depending on the amount of erythrocytes that are destroyed and precipitated, but in very advanced cases, even situations leading to baby loss
may occur.
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