Rh incompatibility during pregnancy occurs when the mother is Rh negative and her body cannot tolerate the presence of Rh positive red blood cells of the fetus, which after a first pregnancy already recognizes.
We have already talked about the danger of Rh incompatibility for pregnancy and that it is now possible to almost completely prevent Rh incompatibility thanks to injections of imunoglobulin given to the mother in the middle of pregnancy and postpartum righ now.
But what happens if, for some reason, the incompatibility between the blood of the pregnant woman and the fetus develops and this disorder is detected?
This disorder is known as hemolytic disease or Rh disease of the newbornor ("fetal erythroblastosis"), and occurs when the woman produces antibodies during pregnancy that attack the red blood cells of her own fetus. The severity of this condition can vary widely, and the treatment will depend on that severity.
If the woman has already developed Rh antibodies
If it is detected that the pregnant woman has already developed Rh antibodies, it will be necessary to monitor and monitor the pregnancy very closely to ensure that Rh levels are not very high. In some cases, the baby has no symptoms of the disease; in other cases it can lead to the death of the baby before or shortly after birth.
The treatment of Rh incompatibility disease can be approached from two points of view: prenatal and neonatal, since it can be treated in the womb, before the baby is born, or once the baby is born.
- Prenatal treatment
The prenatal treatment of hemolytic disease aims to reduce maternal antibodies, improve fetal anemia and thus the fetal condition, avoiding subsequent complications of neonatal hemolytic disease. In fetal anemia mainly the method in use today is intravascular transfusion.
It is an ultrasound transfusion, locating the umbilical vein and directly injecting Rh-negative blood to the fetus, which substantially improves anemia once the procedure has started.
- Treatment in the newborn.
The treatment of the newborn already affected depends on the severity of the condition. Mild Rh incompatibility can be treated with aggressive hydration and phototherapy using bilirubin lights, with a full recovery prognosis.
In exceptional cases, if the incompatibility is serious and the baby is in danger, a series of blood transfusions can be performed while the baby is in the womb or after delivery.
It is not just any transfusion but of an exchange transfusionThe procedure is to slowly draw blood from the patient and replace it with fresh blood or plasma from a donor, something like drawing blood on one side and replacing it on the other.
In short, exchange transfusion replaces the baby's blood with red blood cells whose Rh factor is negative, stabilizing the baby's red blood cell level and minimizing the damage that the circulation of Rh antibodies already present in the baby's blood flow can cause.
However, given the percentage of success achieved by Rh immunoglobulin injections as prevention of Rh incompatibility, exchange transfusions are only necessary in 1% of pregnancies with incompatibility in the United States.
Thus, Rh incompatibility treatment is possible, a problem that has become infrequent in places that provide good prenatal care, given the importance, in this as in so many other aspects, of control during pregnancy. A simple blood test will determine the risk of incompatibility and can be prevented without having to treat it.
