Rhesus incompatibility, colloquially known as blood group incompatibility, primarily affects pregnant women and their unborn children in their second pregnancy. In the case of rhesus incompatibility, the rhesus factor in the mother’s blood does not match that of the unborn child, which can lead to significant health complications for the baby. During regular screening examinations during pregnancy, the gynecologist checks the risk of the mother and the baby on the basis of the maternal blood count and with the help of ultrasound examinations. In this way, treatment for any rhesus incompatibility that may be present can be initiated as a precaution.
What is rhesus incompatibility?
Rhesus incompatibility refers to an incompatibility of the blood groups of a pregnant woman and her unborn child, which relates to the rhesus factor. This can be either positive or negative. Rhesus incompatibility, which is dangerous for the unborn child, always occurs only in a woman’s second pregnancy. The prerequisite for Rh incompatibility is that the mother carries the Rh factor negative (Rh negative) in her blood. On the other hand, the unborn baby as well as its father are tested Rh positive. The Rh factor of about 15 to 20 percent of Europeans is negative, while all others are Rh positive. Because of the difference in rhesus factors between the mother and the unborn child, the woman’s defense system shows a reaction to the baby’s red blood cells during the second pregnancy, which is called rhesus incompatibility.
Causes
Rhesus incompatibility in the second pregnancy occurs when there is blood contact between the rhesus-negative mother and rhesus-positive baby during the birth of the first baby. In this constellation, the father must be Rhesus positive. This blood contact causes antibodies to develop in the mother’s blood against the child’s positive rhesus factor, which can lead to significant health problems in the baby. If a pregnant woman has already suffered a miscarriage or received a blood transfusion, caution should also be taken in the first pregnancy to avoid Rhesus incompatibility, as antibodies may already have been formed. In these cases, rhesus-negative women are treated prophylactically for rhesus incompatibility during the first pregnancy.
Symptoms, complaints, and signs
Rhesus incompatibility (haemolytic disease) can occur in two ways: in the first child by contact with the mother’s blood, and in the second by the maternal immune system recognizing certain blood group characteristics or thesus factors in the child’s blood as incompatible during pregnancy. The symptoms are identical in both cases. One of the main features of rhesus incompatibility is anemia. This is indicated by signs such as strikingly pale skin or lack of oxygen in the child’s organism. The cause of this is the insufficient number of red blood cells. Red blood cells are the units that can absorb and transport oxygen. Organs such as the liver or spleen may increase in size due to increased blood production. The latter seeks to compensate for anemia. Increased bilirubin excretion into the newborn’s blood may occur as a result of the increased breakdown of blood cells. This can be seen in the classic symptoms of jaundice in the newborn. Medical treatment must begin at this stage at the latest. This is because the continued increase in bilirubin can lead to bilirubin deposits in the infant’s brain. As a result of severe anemia, permanent symptoms such as infantile developmental blockages or hearing problems may develop. Hydrops fetalis, a rhesus incompatibility that is often fatal, is indicated by water retention in the fetal body. This symptomatology is often fatal before birth.
Diagnosis and course
Rhesus incompatibility is detected by analysis of the blood group and rhesus factor in maternal blood at the beginning of a woman’s pregnancy. This examination is part of the usual prenatal care performed by the gynecologist. In addition, the gynecologist monitors the development of the unborn child with the help of ultrasound examinations. During these, he can detect abnormalities such as edema or hydrops fetalis, which are due to rhesus incompatibility.If a Rhesus negative woman has already formed antibodies in her blood due to a previous pregnancy, a blood transfusion or a miscarriage, early treatment of the Rhesus incompatibility is absolutely necessary. Otherwise, severe damage to the infant, such as anemia, brain damage or water retention may result. With timely treatment, there is little risk for the infant to suffer permanent damage from rhesus incompatibility.
Complications
In modern medicine, complications due to rhesus incompatibility are rare thanks to comprehensive screening and prophylaxis. Rhesus incompatibility must be treated because otherwise the child’s life is in danger. When antibodies enter the child’s bloodstream via the mother, they attach themselves to the child’s red blood cells and destroy them. The number of red blood cells is reduced and causes anemia in the child (hemolytic anemia). The resulting lack of oxygen in the body of the unborn child can promote developmental disorders and damage to organs. As red blood cells are depleted, the bone marrow, liver and spleen try to counteract the loss and swell as a result. This causes the liver to overload, the swelling impairs blood flow, and water leaks from the blood into the child’s body tissues. This accumulation of fluid is visible on ultrasound. If it is not treated, the child may die in the womb. After birth, there is a risk of oxygen deficiency due to anemia. In addition, there may be excessive jaundice, which must be treated without fail to prevent the breakdown products from depositing in the brain and causing severe neurological damage. If this severe jaundice is not treated appropriately by experienced physicians, the child’s life is in acute danger.
When should you see a doctor?
The earliest case in which a physician will intervene is when an expectant rhesus-negative mother fails to produce antibodies during her second pregnancy. In this case, rhesus prophylaxis is used to prevent rhesus incompatibility between the 28th and 30th weeks of pregnancy. As part of medical prophylaxis, the expectant mother is injected with anti-D immunoglobins or antibodies during the 28th-30th week of pregnancy and within 72 hours after delivery. This destroys the baby’s Rhesus-positive blood cells that are in the mother’s circulation. With this prophylactic measure, the unborn child suffers no harm, as the antibodies are quickly broken down. The only thing that is ensured is that the maternal organism does not produce antibodies. If a newborn baby has rhesus incompatibility, it depends on the severity of this phenomenon. Medical treatment is inevitable in most cases, because of anemia and jaundice. In a milder case of rhesus incompatibility, phototherapy with blue light may be sufficient. The effect is that the bilirubin molecules can be broken down and excreted. If this did not happen, the newborn could suffer brain damage. In a severe case of rhesus incompatibility, there is no way out without blood transfusions. In such cases, transfusions may be necessary even during pregnancy. Today, thanks to medical advances, something can be done to ensure that both survive.
Treatment and therapy
Treatment of rhesus incompatibility takes place during the first pregnancy. In the 28th week of pregnancy, the expectant mother with negative rhesus factor receives preventive rhesus factor antibodies, which prevent rhesus incompatibility from developing. Also, within three days after the birth of the rhesus-positive baby, another administration of these anti-D immunoglobulins, or antibodies, is given. This repeated administration eliminates the risk of the baby developing rhesus incompatibility in another pregnancy. To rule out the risk of rhesus incompatibility, an antibody screening test is also performed in the mother’s blood during pregnancy. If abnormalities occur, a timely reaction can be taken to rule out rhesus incompatibility and minimize the risks for the unborn child. If complications occur, this can have different consequences for the newborn.If the course of rhesus incompatibility is rather mild, phototherapy or blood transfusion are usually sufficient for the newborn baby. In severe courses, such as hydrops fetalis, the newborn baby must receive intensive medical care to ensure survival despite rhesus incompatibility.
Prevention
To prevent rhesus incompatibility, it is essential for pregnant women to have regular checkups with their gynecologist. Blood tests in the mother and ultrasound checks of the unborn child can virtually eliminate the risk of rhesus incompatibility.
Follow-up
In the case of rhesus incompatibility, no special or direct measures of aftercare are usually possible, and sometimes they are not even necessary. However, affected individuals should call for a diagnosis early on and initiate treatment to prevent complications or other medical conditions from developing as the disease progresses. The sooner rhesus incompatibility is detected, the better the further course of the disease usually is. Therefore, a doctor should be consulted at the first signs and symptoms of the disease. As a rule, treatment is only necessary after the birth of the child. However, before birth and during pregnancy, further examinations and regular check-ups by a doctor are very important. The children are dependent on taking various medications. This significantly alleviates the discomfort and also prevents complications. Sometimes the parents depend on the support and also on the help of friends and family. This can prevent the development of depression and other psychological upsets. The further course of rhesus incompatibility is strongly dependent on the time of diagnosis, although the life expectancy of the affected person is usually not reduced by the disease.
What you can do yourself
In the case of rhesus intolerance, it is essential to seek medical assistance. The options available to doctors are life-saving in the case of the organism’s intolerance. Otherwise, there is a threat of premature death of the mother or child. In severe cases and in case of refusal of treatment, the death of mother and child may occur. The alternative healing methods or even home remedies are not effective in this area. Since it is a problem and incompatibility of blood groups, the administration of medication is mandatory. Therefore, in case of an existing pregnancy, cooperation with a doctor should be sought and maintained. Already at the first irregularities, a feeling of indisposition or a diffuse feeling of illness, consultation with a medical doctor should be sought. Only in this way can it be guaranteed that the necessary measures as well as controls of the health condition are initiated at an early stage. Other approaches, which fall within the scope of self-help, do not exist in the case of rhesus incompatibility. If the pregnant woman adheres to the treatment options, complications or side effects are hardly to be expected nowadays. Thanks to the medical possibilities, mother as well as child survive in the present time.
