Rh incompatibility is mentioned if the mother's blood type is Rh(-) and the father's blood type is Rh(+). In these couples, the baby can be Rh(+) or Rh(-), if the baby is Rh(-), there is no problem, but if the baby is Rh(+), blood incompatibility may cause Rh immunization and some problems.
The mother's blood type Blood incompatibility cannot occur in any case other than Rh negative and the father is Rh positive.
If the baby is positive in the presence of Rh incompatibility, the mother's blood comes into contact with the baby's blood during pregnancy or birth, and the erythrocytes (red blood) in the baby's blood are added to the mother's blood. cells) passes. There are Rh antigens of the baby on these erythrocytes. The mother responds by producing anti-Rh antibodies. If the next baby is Rh (+), the anti-Rh antibodies formed in the mother's blood during this first pregnancy pass to the baby and cause the breakdown of erythrocytes in the baby's blood and anemia in the baby.
The following situations that may occur during birth and pregnancy: It may cause them to pass to the mother and cause the mother to develop antibodies against them. These situations are:
Interventions such as miscarriage, abortion, ectopic pregnancy, amniocentesis, CVS, cordocentesis.
In these cases, Anti-D injection should be administered within 72 hours to prevent the mother from being affected.
In patients with blood incompatibility (Rh/Rh incompatibility), if the indirect Coombs test (ICT) is negative at the first check-up, ICT should be repeated at four-week intervals starting from the 20th week, due to the possibility of Rh isoimmunization developing in the antenatal period, although it is unlikely. Pregnant women with negative ICT should first be given prophylaxis with 300 micrograms of anti-D gamma globulin (popularly called incompatibility injection) at the 28th week. The purpose of prophylaxis during this period is to cover bleeding from the fetus to the mother that may occur during the 12 weeks until birth. The most important period for prophylaxis in a pregnant woman who is not immunized is birth. Following birth, direct Coombs test (DCT) and baby blood group should be measured from the baby's cord blood. If DCT is negative and the baby's blood type is Rh(+), anti-D immunoglobulin should be repeated. If the baby's blood type is positive after birth, another anti-D gamma globulin injection should be given within the first 72 hours. By preventing the formation of antibodies in this mother, the next pregnancy will be screened for these antibodies. It prevents it from being affected by f. Rh incompatibility does not cause any problems in the first pregnancy.
In blood incompatibility, if the baby is affected, the anti-Rhs passed from the mother cause the baby's blood cells to break down and precipitate. In this case, anemia occurs in the baby. Accordingly, a condition called hydrops is detected in the baby during ultrasound. Heart failure as a result of anemia in the baby and fluid accumulation in the body cavities are the cause of hydrops. Depending on the severity of the disease and the amount of blood cells destroyed, the baby may even die in the womb.
In case the ICT test is positive, titration should be performed. There is no risk for the fetus in the intrauterine period at titrations of 1/16 and below. In this case, repeating ICT at two-week intervals will be sufficient. Pregnancy is not intervened unless ICT positivity is above 1/16. However, since isoimmunization will now have developed, prophylaxis will not be required. If the titration is above 1/16, further examinations such as amniocentesis, cordocentesis and USG should be performed to investigate the severity of the effect. If the disease is severe, it may be necessary to change the baby's blood in the womb.
Situations that may cause Rh alloimmunization in the mother:
These are the conditions of the Rh(-) mother. These are situations that may cause the formation of Rh antibodies.
- Blood transfusion
- Transfer of blood cells from the Rh (+) baby to the mother during pregnancy or birth
- Spontaneous or voluntary abortion
- Curettage
- Ectopic pregnancy
- Early separation of the placenta (the baby's partner)
- Impacts and traumas to the mother's womb
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- Amniocentesis (Taking the baby's water from the mother's womb)
- CVS (Chorion villus biopsy)
- Cordocentesis (Taking blood from the baby's cord)
- External cephalic version (Turning the baby upside down is not done today.)
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