HEMOLITIC DISEASE OF THE FRUIT AND THE NEWBORN
HEMOLITIC DISEASE OF THE FRUIT AND THE NEWBORN - an immune conflict between the mother and the fetus. The mother's body synthesizes antibodies in response to fetal erythrocyte antigens foreign to it. The most common type of immunological incompatibility between maternal and fetal organisms is Rh factor incompatibility - 97%, and blood group incompatibility is much less common. The Rhesus factor in the fetus is detected at 8–9 weeks of fetal development, the number of Rhesus antigens is gradually increasing. Through the placenta, they penetrate the mother’s blood and anti-Rhesus antibodies are formed to them if the mother is Rh negative. Penetrating through the placenta into the fetus, the mother’s antibodies cause the breakdown of red blood cells. Related to this is the second name of this pathology - erythroblastosis. Anemia develops, with hemolysis an increased amount of bilirubin is formed; as compensatory mechanisms in the fight against anemia in the liver and spleen of the fetus, foci of blood formation are formed, which leads to an increase in these organs and a violation of their function.
Factors predisposing to hemolytic disease are:
- transfusion of Rh-positive blood to a Rh-negative woman;
- spontaneous abortion;
- ectopic pregnancy;
- the birth of a Rh-positive baby by a Rh-negative mother;
- the birth of a Rh-negative child by a Rh-positive mother.
Diagnostics. All women who have had children with hemolytic disease and all women who have Rh sensitization are subject to the supervision of an obstetrician and immunologist. In the blood of women, the titer of Rh antibodies is determined 1 time per month until the 32nd week of pregnancy; 2 times a month from 32 to the 35th week and from the 36th week weekly.
In the antenatal diagnosis of hemolytic disease, ultrasound (ultrasound) is important, in which such signs as: an increase in the size of the liver and spleen, thickening of the placenta, polyhydramnios, and dropsy of the fetus can be detected. According to the indications and the prescription of the doctor, amniotic fluid is examined, which is obtained by puncture of the fetal bladder (amniocentesis). Puncture is performed through the abdominal wall. Previously, with ultrasound, the location of the placenta and the fetus is determined, in order to avoid injury during puncture. In amniotic waters, the content of antibodies, the bilirubin index, the blood type of the fetus are determined - which are essential for assessing its condition and prescribing appropriate therapy. According to indications, cordocentesis is also performed - taking blood from the umbilical cord of the fetus.
For the treatment of hemolytic disease, blood transfusion is indicated, which is performed according to indications from the 18th week of pregnancy. Blood transfusion is performed intraperitoneally (into the abdominal cavity of the fetus) or into an umbilical cord vein in the immediate vicinity of the placenta. The procedure is carried out under the supervision of an ultrasound scan. In case of moderate and severe hemolytic disease, delivery is indicated from the 34th week of pregnancy.
There are three main forms of hemolytic disease in newborns:
- hemolytic anemia without dropsy and jaundice;
- hemolytic anemia with jaundice;
- hemolytic anemia with jaundice and dropsy.