Hemolytic Disease of Fruit and Newborn
Hemolytic disease of the fetus and the newborn is an immune conflict between the mother and the fetus. The mother's body synthesizes antibodies in response to alien to it erythrocyte antigens of the fetus. The most frequent type of immunological incompatibility of the mother and fetus organisms is the Rh incompatibility - 97%, incompatibility by blood groups is much less common. Rh factor in the fetus is found at the 8th-9th week of intrauterine development, the amount of rhesus antigens is gradually increasing. Through the placenta, they penetrate the mother's blood and antiresus antibodies are formed to them, if the mother is Rh-negative. Penetrating the placenta into the fetus, the antibodies of the mother cause the decay of red blood cells. This is associated with 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 are formed foci of hemorrhage, 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 the Rh-negative woman;
- Spontaneous abortion;
- ectopic pregnancy;
- Birth of Rh-positive child by Rh-negative mother;
- Birth of Rh-negative child with Rh-positive mother.
Diagnostics. All women who have children with hemolytic disease and all women who have rhesus sensitization are subject to supervision of the obstetrician and immunologist. In the blood of women, the titre of Rh antibodies is determined once a month until the 32nd week of pregnancy; 2 times a month from 32 to 35 weeks and from the 36th week on a weekly basis.
In antenatal diagnosis of hemolytic disease, ultrasound (ultrasound) is important, in which such signs as: enlargement of liver and spleen, thickening of the placenta, polyhydramnios, and dropsy of the fetus may be identified. According to the indications and prescription of the doctor, the amniotic fluid that is obtained by puncture of the bladder (amniocentesis) is examined. Puncture is carried out through the abdominal wall. Previously, with ultrasound, the location of the placenta and fetus is determined, in order to avoid their injury during puncture. In the amniotic waters, the content of antibodies, the bilirubin index, the blood group of the fetus are determined - which are essential for assessing its condition and the appointment of appropriate therapy. According to the indications, a cordocentesis is also taking - 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 made intraperitoneally (into the abdominal cavity of the fetus) or into the vein of the umbilical cord in the immediate vicinity of the placenta. The procedure is carried out under the supervision of ultrasound. With moderate and severe hemolytic disease, delivery was shown 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.