Rh incompatibility in pregnancy - Symptoms, Diagnosis, Treatment

Rh incompatibility in pregnancy - Symptoms, Causes, Effects, Diagnosis, Treatment and Risk Factors

Rh incompatibility occurs when a pregnant woman and her unborn baby carry different Rhesus (Rh) protein factors. It occurs when a mother with Rh-negative blood type is exposed to Rh-positive blood type from her fetus.

Symptoms and treatment of Rh incompatibility in pregnancy

Rh factor

Rh factor is a protein that is found on the surface of red blood cells (RBCs). Rh factor is indicated by the positive or negative sign after your blood type. People who carry this protein are considered as Rh-positive and people who don't carry this protein are considered as Rh-negative. Rh factor is inherited means it passes from parents to children through genes. Rh factor doesn't affect health but it can create problems during pregnancy.

Rh incompatibility

When the parents-to-be don't have the same Rh factor it is known as Rh incompatibility. Rh incompatibility usually occurs when an Rh-negative mother and an Rh-positive father produce an Rh-positive fetus.

Symptoms of Rh incompatibility

These are the symptoms of Rh incompatibility :

Hemolytic Anemia

When Rh antibodies cross the placenta they attack baby's red blood cells which can lead to Hemolytic disease in the baby. Hemolytic Anemia disease occurs when the antibodies of a pregnant woman attack baby's red blood cells which means that the baby's red blood cells are destroyed. It is a condition where the baby's red blood cells are destroyed faster than the body can replace them. Oxygen is carried by the red blood cells (RBCs) to different parts of the body. Red Blood Cells contain an iron-rich protein called hemoglobin which carries oxygen to the body. 

If hemoglobin carrying red blood cells is not enough to carry the oxygen then the baby won't get enough oxygen which can lead to serious problems. When baby's red blood cells are destroyed they release hemoglobin into the blood. When baby's red blood cells are destroyed then the iron-rich protein hemoglobin broke down into a compound called Bilirubin. Bilirubin chemical build up in baby's bloodstream can cause one or more of the following problems in the baby after birth :

  • Jaundice
  • Buildup of Fluid
  • Low Muscle Tone

In some cases where Rh incompatibility effects aren't prevented then they can lead to severe complications which are given below :

  • Anemia
  • Seizures (Changes in the brain's electrical activity)
  • Kernicterus (Brain damage to the baby)
  • Heart Failure

Rh incompatibility causes

Rh incompatibility generally occurs when a pregnant woman is Rh-negative and her baby is Rh-positive. A pregnant woman creates antibodies against the baby's Rh-positive blood and these antibodies can cross the placenta and attack baby's red blood cells which can lead to Hemolytic Anemia in the baby. 

Rh incompatibility effects during pregnancy

When a pregnant woman is Rh-negative and her unborn baby is Rh-positive and her immune system is exposed to Rh-positive then her body will approach Rh-positive protein as a foreign object. It means if a baby's blood cells cross woman's bloodstream which can happen during her pregnancy, labor or delivery then a woman's immune system will start making antibodies against the baby's red blood cells. Once your immune system has made these antibodies then you're considered to be sensitized to positive blood types. It means that your body might send these antibodies to your placenta (An organ that connects the mother and her baby) to attack the baby's red blood cells.

Rh incompatibility usually doesn't cause problems during the first pregnancy of a woman because the baby's blood doesn't generally enter the mother's circulatory system during the first pregnancy. However, the mother's and baby's blood can mix during birth. If it happens mother's body will approach Rh-positive protein as a foreign substance and might begin making antibodies against the Rh-positive protein. Antibodies stay in blood once they have formed. Thus, Rh incompatibility may cause problems during the second or later pregnancies. 

(Also read: What is NST?)

Rh incompatibility diagnosis during pregnancy

At your first prenatal visit, your doctor will take your blood sample to determine your Rh status. If you're Rh-negative then your partner's blood test will also be taken to determine his Rh status. If you both are Rh-negative then you don't have anything to worry about. But if your partner is Rh-positive and you are Rh-negative then your doctor will look out for the following signs of Rh incompatibility :

Coombs Test

During the Coombs test, a blood sample is taken to see if it contain certain antibodies. A positive Coombs test is one of the signs of Rh incompatibility.

Red Blood Cells destruction

The destruction of red blood cells in the infant's blood is also a sign of Rh incompatibility. It can be easily determined by the shape and structure of red blood cells when examined under a microscope.

Bilirubin levels

If the level of Bilirubin compound is higher than normal levels in baby's blood then it's also a sign of Rh incompatibility.

In some cases the baby can also be treated after birth with the following treatments :

  • Electrolytes
  • A series of blood transfusions
  • Hydrating Fluids
  • Phototherapy

Rh incompatibility treatment during pregnancy

If a pregnant woman has the potential to develop Rh incompatibility then the doctor will give her a series of two Rh immune globulin vaccine during her first pregnancy. Rh incompatibility effects are prevented by giving an Rh immune globulin vaccine (Rhlg) to a pregnant woman during the first trimester (Around 28th week of pregnancy) of her pregnancy. And a second vaccine is also given within 72 hours of giving birth. 

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A woman also might get an Rh immune globulin vaccine if she has an Amniocentesis, a miscarriage, or having any bleeding during her pregnancy. If a pregnant woman has already developing Rh antibodies then her pregnancy will be closely monitored by the doctor to make sure that the levels don't get too high.

Exchange Transfusions

In some of the rare cases if Rh incompatibility is severe and the baby is in danger then the baby can get blood transfusions which are known as Exchange Transfusions. These transfusions can be given to the baby before birth or after birth. These transfusions replace the baby's blood with Rh-negative blood cells which stabilizes the levels of red blood cells and also minimizes the damage caused by Rh antibodies that are present in the baby's bloodstream.

Intrauterine Fetal Transfusions

The blood transfusions which are given to the baby before birth are known as Intrauterine Fetal Transfusions.

Rh immune globulin

Rh immune globulin prevents the mother's body from making Rh antibodies which can cause health problems in the newborn or can affect future pregnancies.

Rh incompatibility risk factors

An Rh-negative woman who carries a child with an Rh-positive partner is at risk of Rh incompatibility.  Rh factor passes from parents to the child through genes. If you're Rh-negative and your partner is Rh-positive then your baby has a 50% chance of having Rh-positive blood. If you're Rh-negative then your chances of having a risk of Rh incompatibility are higher if you were exposed with Rh-positive blood before pregnancy. This may happen during the following situations :

  • An earlier pregnancy or bleeding during pregnancy.
  • A mismatched blood transfusion.

Let your doctors know about your risks of Rh incompatibility early in your pregnancy so that they can monitor it carefully and treat any problem that arises. Don't take too much stress about the problems of Rh incompatibility. Here's wishing you a very happy and healthy pregnancy.  

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Disclaimer: This content is intended for general information only and it should not be used as the basis of patient treatment. The given content is not intended to be a substitute for professional medical advice, treatment, or any diagnosis. Always consult a doctor for more information. Our website doesn't claim responsibility for this information.

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