HEMOLYTIC DISEASE OF THE FRUIT AND NEWBORN
HEMOLYTIC DISEASE OF THE FETUS AND THE NEWBORN - an immune conflict between the mother and the fetus. The mother's body synthesizes antibodies in response to fetal erythrocyte antigens alien to it. The most common type of immunological incompatibility of organisms of the mother and the fetus is incompatibility for the Rh factor - 97%, incompatibility in blood groups is much less common. The Rh factor in the fetus is found at the 8th – 9th week of intrauterine development, the number of Rh antigens gradually increases. Through the placenta, they penetrate the mother’s bloodstream and anti-Rh antibodies form to them if the mother is Rh-negative. Penetrating through the placenta into the body of the fetus, maternal antibodies cause the breakdown of red blood cells. The second name of this pathology is associated with this - erythroblastosis. Anemia develops, with hemolysis an increased amount of bilirubin is formed; as the compensatory mechanisms in the fight against anemia in the liver and spleen of the fetus hemopoies form, which leads to an increase in these organs and the disruption of their function.
Factors predisposing to hemolytic disease are:
- Rh-positive blood transfusion of Rh-negative woman;
- spontaneous abortion;
- ectopic pregnancy;
- the birth of the Rh-positive baby Rh-negative mother;
- the birth of the Rh-negative baby Rh-positive mother.
Diagnostics. The obstetrician and the immunologist are subject to all women who have had children with hemolytic disease, and all women who have been diagnosed with rhesus sensitization. In the blood of women determine the titer of Rh antibodies 1 time per month until the 32nd week of pregnancy; 2 times a month from week 32 to week 35 and week 36 from week 36.
In the antenatal diagnosis of hemolytic disease, ultrasound (ultrasound) is important, with which signs such as an increase in the size of the liver and spleen, a thickening of the placenta, polyhydramnios, and an edema of the fetus can be detected. According to the testimony and prescription of a physician, amniotic fluid is studied, which is obtained by puncture of the fetal bladder (amniocentesis). Puncture is performed through the abdominal wall. Preliminary with ultrasound, the location of the placenta and the fetus is determined in order to avoid their injury during puncture. In amniotic waters, the content of antibodies, the bilirubin index, the blood type of the fetus - which are essential for assessing its condition and prescribing appropriate therapy are determined. According to the testimony, cordocentesis is also performed - drawing blood from the umbilical cord of the fetus.
For the treatment of hemolytic disease is shown blood transfusion, which is carried out according to indications from the 18th week of pregnancy. Blood transfusion is performed intraperitoneally (into the abdominal cavity of the fetus) or into the umbilical cord vein in close proximity to the placenta. The procedure is carried out under the control of ultrasound. In moderate to severe hemolytic disease, delivery from the 34th week of gestation is indicated.
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.