Rhesus conflict is a dangerous condition that often ends in the death of the fetus or newborn. It occurs as a result of the immunological incompatibility of a woman and her child. Occurs most often during repeated pregnancy of an Rh-negative patient with an Rh-positive fetus.
Prevalence
Studies in Western countries show that Rh conflict is the second most common cause of stillbirth. Due to this condition, fetal hemolytic disease (HFD) is diagnosed in 1 in 200 infants.
Russian research demonstrates:
- 63% risk of GBP in Rh-sensitized mothers;
- 18% risk of stillbirth as a result of Rh-conflict.
In different countries, the frequency of HDP is different. It is primarily due to the prevalence of carriage of the Rh antigen. Rhesus conflicts are least common in Japan and China. On average, Caucasians are 85% Rh-positive and 15% Rh-negative.
The reasons
Rh-conflict occurs if the child is a carrier of the Rh antigen. 55 such antigens are already known and can be determined in the laboratory. The most common of them: D, C, E. Antigen D is the most immunogenic. With its carriage, the highest frequency of GBP is noted. It causes the formation of many antibodies in maternal blood, even at minimal concentrations. Rh antigens are inherited.
Rhesus conflict occurs when Rh antigens are injected into the blood of a Rh-negative person. This leads to the production of antibodies. The immune system begins to defend itself against antigens. It produces antibodies that destroy red blood cells. These are red blood cells that carry oxygen. It is on their surface that Rh antigens are located.
If the mother is Rh-negative, her immunity is not familiar with these antigens. He perceives them as foreign. Therefore, if the child is Rh-positive (and the probability of this is 85%), the production of antibodies begins, aimed at destroying the erythrocytes of the fetus.
There are different classes of immunoglobulins. The greatest clinical significance is the concentration of immunoglobulins G. They practically do not pass through the placenta until 24 weeks. Therefore, before this period, the Rhesus conflict in a pregnant woman almost never develops (except when the placental barrier is damaged).
What is sensitization?
Sensitization is the process of "acquaintance" of the mother's immunity with the antigens contained on the erythrocytes of the fetus. After this, the production of specific antibodies begins, capable of attaching to antigens and provoking hemolysis of red blood cells. However, this does not happen immediately. The body needs time to produce immunoglobulins in large quantities.
In the vast majority of clinical situations, sensitization does not occur during the 1st pregnancy. Rh antigens are found in fetal erythrocytes. Although they share blood flow with their mother, red blood cells usually do not pass through the hematoplacental barrier. That is, they do not enter the mother's bloodstream from the fetal vessels. And this is a necessary condition for maternal immunity to “get acquainted” with antigens and develop immunoglobulins.
In no more than 5% of women, fetal red blood cells enter the bloodstream in the first trimester, 15% in the 2nd trimester, and 30% in the third trimester. In most cases, contact with red blood cells occurs only during labor. It is this moment that triggers sensitization.
For this reason, in the vast majority of cases, there is no Rh conflict during the 1st pregnancy, even if the mother is negative for the Rh antigen and the fetus is positive. In more than 99% of cases, GBP appears only in the 2nd or more pregnancies. Even during childbirth, immunization does not always occur. The risk is increased with manual separation of the placenta and caesarean section.
Sometimes sensitization occurs even if the pregnancy has not ended in delivery. This is possible if:
- had an abortion;
- a miscarriage has occurred;
- amniocentesis was performed in the 2nd or 3rd trimester;
- fetoplacental bleeding occurred.
Although during the gestation period, single fetal blood cells enter the maternal blood, this is not enough for immunization. It is believed that 50-75 ml of erythrocytes are required for the primary immune response. But for the secondary, only 0.1 ml of red blood cells is enough.
Diagnostics
Diagnosis is based on confirmation of the fact of formation and titer of erythrocyte antibodies in the blood plasma of the future mother. Their formation in large numbers indicates that immunization has taken place.
Titer is a concept that determines the amount of immunoglobulins. When determining most laboratory parameters, the concentration is evaluated - the mass or amount of a substance per unit volume of blood. But instead of concentration in immunology, the titer of immunoglobulins is determined - this is such a dilution of blood serum while maintaining its immunogenicity.
For example, a doctor dilutes serum 2 times. It evaluates whether there is an immune reaction when an antigen is added to it. If there is, it breeds 2 more times and so on. Let's say he has reached a dilution of 1:32, and there is no reaction. This means that the antibody titer is 1:16 (since this is the last dilution at which the immune response was still determined).
All patients with Rh-negative blood donate blood for antibodies. This is done in the first trimester of pregnancy. Then the analysis is repeated once a month. The very fact of the detection of immunoglobulins indicates a high risk of GBP. At the same time, the titer has a certain prognostic value, but is still not used as a criterion influencing the choice of patient management tactics.
Other studies used to diagnose GBP:
- Ultrasound of the fetus and placenta;
- dopplerometry of cerebral blood flow;
- if non-invasive data are obtained in favor of the Rh conflict, amniocentesis or cordocentesis is performed.
Ultrasounds to detect signs of GBP begin to be performed from 18 weeks. Until then, they are not determined. With favorable results of ultrasound and dopplerometry, further studies are carried out at intervals of 2-3 weeks. If signs of incipient hemolytic disease are found, the condition of the fetus is assessed every few days.
The most accurate method for diagnosing GBP is considered to be cordocentesis and assessment of various indicators in the umbilical cord blood. But this is an invasive procedure. It increases the risk of sensitization. Therefore, cordocentesis is performed only if signs of fetal anemia are detected on ultrasound.
Main characteristics:
- hematocrit - the ratio of formed elements to the liquid part of the blood;
- the level of hemoglobin - a protein contained in the composition of red blood cells that carries oxygen;
- bilirubin level - a substance formed during the breakdown of red blood cells.
Be sure to examine the blood for Rh-affiliation.
The fetus always has anemia if Rhesus conflict develops during pregnancy. Table of ideal indicators of hemoglobin (grams per liter) and hematocrit (%) in cord blood, based on gestational age:
In recent years, the method of studying fetal erythrocytes has been increasingly used, which makes it possible to avoid invasive interventions. Maternal blood is taken as a material. The Rh affiliation of the fetus is determined by its DNA.
Treatment
For the treatment of GBP, intravascular blood transfusion (blood transfusion) is used. It is indicated only for moderate or severe anemia. The washed red blood cells are transfused to the fetus. They reduce immunization, reduce the likelihood of edematous hemolytic disease, and allow pregnancy to be prolonged until delivery is safe.
Only washed erythrocytes of Rh-negative donor blood are injected into the fetus. They are administered at a rate of 1-2 ml per minute. To combat edema, a 20% solution of albumin is injected. After the procedure, blood is taken for analysis from the umbilical cord. It re-determines the hematocrit and hemoglobin level.
If necessary, the procedure can be repeated. The decision on whether it is needed or not is made on the basis of measuring the blood flow velocity in the middle cerebral artery (for this, dopplerometry is performed - one of the varieties of ultrasound). Intrauterine transfusions are carried out up to 32-34 weeks. In the future, the issue of early delivery is being resolved.
The following methods were previously used, but are now recognized as ineffective:
- desensitizing therapy;
- extracorporeal blood purification (including plasmapheresis);
- transplantation of a skin flap from a spouse.
Forecast
Not always the Rh-conflict during pregnancy has severe consequences. In a mild form, hemolytic disease occurs with a small titer of anti-Rhesus antibodies. If it is between 1:2 and 1:16, it is highly likely that the baby will be born completely healthy or with slight jaundice that does not have significant clinical significance.
But if the titer is 1:32 and higher (there are titers up to 1:4096), then the disease, as a rule, is more severe. It carries the threat of intrauterine death of the fetus. However, antibody titer is only a prognostic factor indicating the likelihood of severe GBP. Sometimes there is a discrepancy between the level of antibodies and the severity of the Rhesus conflict. This is associated with a violation of the barrier function of the placenta.
Other adverse prognostic factors:
- a sharp increase in the level of antibodies before childbirth;
- early appearance of antibodies during pregnancy;
- alternating rises and falls in titer.
Modern methods of therapeutic effects allow you to successfully convey pregnancy. However, they try to carry out delivery as early as possible in order to avoid complications. Pregnancy is prolonged up to 36 weeks. If the cervix is ripe, and the condition of the fetus is compensated, childbirth is carried out through the natural birth canal. In severe GBP, a caesarean section is indicated.
Prevention
Primary prevention is to reduce the chance of sensitization in an Rh-negative woman. The secondary is aimed at preventing a Rh conflict if sensitization has already occurred.
Basic preventive measures:
- blood transfusions are carried out only taking into account the Rh-affiliation of the blood of the donor and recipient;
- if possible - refusal of invasive procedures during the first pregnancy, physiological childbirth;
- preservation of the first pregnancy (abortion increases the risk of sensitization).
For the prevention of Rhesus conflict, pregnant women without sensitization phenomena, but at a high risk of it, are shown the introduction of human human immunoglobulin anti-Rhesus. The risk is considered high if there was a history of pregnancy, no matter how it ended (abortion or childbirth), including ectopic.
Specific antibodies are administered intramuscularly at a dose of 300 mcg for 3 days after childbirth, abortion, surgery to remove the fetal egg in an ectopic pregnancy, or other event that carries the risk of sensitization. If there was a caesarean section or manual detachment of the placenta, the dose of the drug is increased to 600 mcg. The drug used inhibits the immune response.
All women with Rh-negative blood, when the father is Rh-positive, during the gestation period, antenatal prophylaxis of sensitization is carried out if there are no anti-Rhesus antibodies in the blood. As a rule, red blood cells begin to enter the maternal circulation no earlier than 28 weeks. Therefore, it is from this period that prevention is carried out. Patients receive 0.3 mg of immunoglobulin per day. Special antibodies are introduced that are not able to cross the placenta.
Occasionally, prophylaxis is started at an earlier date. Up to 28 weeks, it can be performed with placental pathology, if the hematoplacental barrier can be broken, as well as after performing any invasive procedures that carry an increased risk of sensitization (amniocentesis, cordocentesis, chorionic biopsy). In a newborn baby, blood is checked for Rh antigens. If the analysis is positive, a second injection of immunoglobulin is indicated during the first 3 days after delivery.
Rhesus conflict is a life-threatening condition for the fetus that can be avoided if diagnosed in a timely manner and receive medical prophylaxis. To detect it, a blood test for antibodies to Rh antigens is used. In 99% of cases, the conflict develops only with a second pregnancy. When it occurs, the introduction of washed erythrocytes to the fetus and the prolongation of pregnancy until the time when childbirth or operative delivery becomes possible is possible.
Dear Maxim Stanislavovich! I would like to contact you with my problem. Now I am 30 years old, I have one baby 3 years old. For 10 years I have been observed by a gynecologist due to the presence of multiple fibroids in combination with adenomyosis. Nodes do not stand still, there is growth dynamics. I have been seeing one gynecologist for a long time, but I go additionally for consultations to others. All doctors, doing ultrasound, groan and gasp, what I have with my uterus at such a fairly young age. No one prescribed any treatment. They couldn’t get pregnant for a little over a year, they already wanted to stimulate the ovaries and send them to IVF, but it turned out to get pregnant on their own and carry it out without problems. After going to the doctor, who has been observing me and my body for a long time, she said that everything is bad, everything is growing, she is afraid of degeneration into a sarcoma and said that the uterus needs to be removed, the ovaries remain, everything is fine with them. But she sent me for a verdict consultation to a doctor who performs operations, she looked at the last ultrasound, looked at the chair, said everything is huge, it must be removed, but since I am quite young, it is always possible to remove and this is the last thing that can be done, she said, let's try to pierce 3 injections of luprid depot, there are cases that everything decreases significantly and you can postpone the operation for some period. Now the second child is not in the plans with her husband, if only later, but she said there are no deadlines in stock, either now after the injections, or never. In general, I was offered 2 options - to inject and see what happens next, or to lie down and remove the uterus with the cervix. The last ultrasound was on August 22, 2019, on the 7th day of menstruation, the size of the uterus: length 120mm, front-back. 119, width 120, uneven contours, heterogeneous structure, inter.subser along the front wall. m / y 36 × 30, in the bottom 52 × 30 mm, this is what can be measured by the device, so the entire uterus is dotted with small nodes, like grapes, endometrium 7 mm-1 phase, left ovary 34 × 15, no change, right 35 ×18, no change. Conclusion: multiple uterine fibroids in combination with adenomyosis. Prior to this, the previous ultrasound was done on April 6, 2019, the size of the uterus: length 98, front-back. 110, width 115, uneven contours, heterogeneous structure, dif., on the front wall inter. subser. m/y 38×32, side by side 35×31 mm, endometrium 12 mm, ovaries unchanged. Since April to August, the uterus has increased and now corresponds to 14 weeks of pregnancy, my doctor considers the only way out is removal. She also considers the injection of injections to be the only way out, but then to cancel the Mirena coil for 5 years and not touch the uterus. Other ninecologists don’t know what to do with me at all and speak directly, we are not able to help, you need specialists of a completely different level, I can hardly find such specialists in Gomel. An aspirate was taken from the uterine cavity on June 6, 2019, according to the results everything is fine, the diagnosis is fibroids in combination with adenomyosis, endometrial pathology. Closure: endometrium in the secretion phase, middle stage. Donated blood for tumor markers CA 125 -33, 11, HE 4 -81.53, ROMA premenopausal -21.31, ROMA postmenopausal - 27.87, PEA / CEA - 0.919. Hemoglobin 147, serum iron 21.7, ferritin 38.2. In addition to this, my gynecologist sent me to treat a cyst on the cervix, there was always an inflammatory type of smear, the cytology is normal, she said go treat, suppositories will not help, nothing will help, go to treat, you will come like a new penny with a good neck. I went for an additional charge and did a colposcopy, the doctor said a purulent cyst, it needs to be treated, it is like a pimple on the face with contents and it will not disappear anywhere. On April 8, for a fee, the professor performed a radio wave ablation of the cervix for me, two months later she came to this professor for an appointment, did a colposcopy, said everything was healed, live as you used to, and sent me home. I went again to another specialist for a colposcopy, she looked, said the wound had not yet healed at all, let it heal for another 2 months and not climb there. And the last doctor I visited, who operates and said to try injections for now, when examined on the chair, said that the cervix is in poor condition, that there are foci of endometriosis on it and this is most likely after ablation. She even took a picture and showed how inflamed, red-burgundy she was, that's why she said that if you remove the uterus, I won’t leave you such a neck, it is in poor condition. And if you inject injections, then in 3 months, while I am pierced, I will treat the neck again, but not with the professor who did the ablation. They took an aspirate, because after this ablation I had bleeding on the 16th day of my period and before the next one, and so from month to month, although this had never happened before with all my problems. My gynecologist said that this was not related to ablation, it just happened, that your endometriosis is making itself felt, so in order to rule out something terrible, they took me an aspirate. And this doctor who does the operation said that it was the cervix with endometriosis foci that was bleeding. They say about EMA that I can’t do it, since my whole uterus is strewn with grapes, this is not my option. In such a situation. Sorry for such a long text. What is possible in my situation, tell me, please. Or there are no options, only the removal of the uterus with the cervix. But 30 years, somehow cruelly at all ... Our doctors have such an opinion, it bleeds, the cervix is bad, the uterus is all dotted with knots, everything is growing, endometriosis, only to be removed with the help of abdominal surgery. To be honest, I don’t see the point in injections of luprid depot. What will happen to me after they are cancelled... I think about it. And is there a need to remove the uterus with the cervix in my situation? Thanks in advance!
Sunday, September 7, 2014
Everyone is aware that the Rhesus conflict is bad, but few people know how it manifests itself and what it threatens. Unfortunately, the concept of this problem appears only when we are faced with its negative consequences, although they could have been avoided. That is why it is necessary to understand this issue.
What is the Rh factor?
The Rh factor is a system of human antigens that is located on the surface of the red blood cell. If the Rh factor is present in the blood, then “Rh positive” is determined, if it is not, then “Rh negative”.
Many women find out about their blood type and Rh factor when they are already pregnant, when they register at the antenatal clinic. Remember that the blood type and Rh factor do not change throughout life, and you need to know them as early as possible, for this it is enough to donate blood from a vein once.
What is Rhesus conflict?
If during pregnancy Rh-positive erythrocytes of the fetus enter the body of a woman with Rh-negative blood (we will talk about the reasons later), then her body begins to produce antibodies in response to a foreign antigen.
Re-entry of Rh-positive erythrocytes already causes a massive formation of Rh antibodies, which easily overcome the placental barrier and enter the bloodstream of the fetus, causing the development of hemolytic disease of the fetus and newborn. The antibodies are directed against the Rh factor on the surface of the erythrocyte and lead to the destruction of the fetal erythrocytes.
Severe anemia develops in utero, which leads to tissue hypoxia, enlargement of the spleen and liver, and dysfunction of the internal organs of the fetus. When an erythrocyte is destroyed, a large amount of bilirubin enters the bloodstream, which, being deposited in the brain, leads to encephalopathy and kernicterus. Without treatment, anemia and disruption of the internal organs are steadily progressing, the terminal stage of fetal hemolytic disease develops - edematous, in which fluid accumulates in the chest and abdominal cavity. As a rule, at this stage the fetus dies in utero.
It is worth noting that the Rhesus conflict is one of the causes of late pregnancy losses, but never affects conception and early miscarriage.
When should you be afraid?
Mom is Rh-positive - dad is Rh-negative: there is no reason to worry, this situation does not affect either conception, or gestation, or childbirth.
Mom is Rh-negative - dad is Rh-negative: there will be no problems either, the baby will be born with Rh-negative blood.
Rh-negative mom - Rh-positive dad: this situation requires special attention not only from doctors, but also from the woman herself, since your health is in your hands, and all subsequent information is extremely important for you.
Women with Rh-negative blood should take a very responsible approach to the issue of planning. Remember that every unwanted pregnancy increases the risk of not having a baby in the future.
Situations leading to the development of Rhesus conflict
As mentioned above, the starting point for the development of the Rh conflict is the entry of Rh-positive erythrocytes of the fetus into the bloodstream of the Rh-negative mother.
When it's possible:
artificial termination of pregnancy (abortion) at any time;
spontaneous miscarriage at any time;
ectopic pregnancy;
after childbirth, including after caesarean section;
nephropathy (preeclampsia);
bleeding during pregnancy;
invasive procedures during pregnancy: cordocentesis, amniocentesis, chorionic villus sampling;
abdominal trauma during pregnancy;
a history of blood transfusion without taking into account the Rh factor (currently this is extremely rare).
All the situations described require specific prophylaxis, the introduction of anti-Rhesus gamma globulin.
Prevention of Rhesus conflict
The only proven method of preventing Rhesus conflict at present is the introduction of anti-Rhesus gamma globulin - and patients should remember this first of all! All situations described above require the administration of anti-Rhesus gamma globulin in the first 72 hours, but the sooner the better. For high efficiency of the preventive action, it is necessary to strictly observe the timing of the drug administration.
Pregnancy in a woman with Rh negative blood
After registration in a patient with Rh-negative blood, it is recommended to take blood samples to determine the titer of anti-Rh antibodies in the blood every month, starting from early pregnancy.
The first signs of a possible hemolytic disease of the fetus are determined by the results of ultrasound at 18-20 weeks of gestation.
Further, the following periods for the study are recommended: 24-26 weeks, 30-32 weeks, 34-36 weeks and immediately before childbirth. However, it is worth noting that the interval between studies is determined by the doctor individually.
In order to specifically prevent the Rh conflict at the 28th week of pregnancy, in the absence of antibodies in the blood, it is necessary to introduce anti-Rhesus gamma globulin. After the introduction of anti-Rh gammaglobulin, blood is no longer given for the titer of anti-Rh antibodies.
After childbirth, the neonatologist (pediatrician) determines the Rh status of the newborn child;
Thus, during a normal pregnancy, anti-Rhesus gamma globulin is administered twice: at 28 weeks and after childbirth.
We have not touched upon the methods of treatment of hemolytic disease of the newborn in the article, since this is the task of other doctors. It is only worth noting that modern technologies, in most cases, help save children with such a diagnosis. But you need to remember that preventing a problem is much easier than solving it, so every pregnancy should be desirable!
Every woman planning a pregnancy should know her Rh factor. This simple analysis is needed to know about a possible serious disease - erythroblastosis, or hemolytic disease of the newborn.
Rh factor (Rh) is one of the two most important (along with the group) blood properties. In the blood of people with a positive Rh factor (Rh +), on the surface of red blood cells - blood cells that carry oxygen - there is an antigen D. If the Rh factor is negative (Rh-) - this antigen is not present.
Even before birth, the fetus develops its own Rh factor. It is inherited from one of the parents. If the baby of an Rh- mother develops Rh+, there is a risk of hemolytic disease of the newborn.
Why is there a risk?
If an Rh-negative mother develops an Rh-positive fetus, her body may react to the D antigen in the baby's blood as foreign. In this case, the mother's immune system will "attack" the blood components of the fetus. The red blood cells will begin to stick together and then die (break down) in the baby's liver. This can lead to hemolytic disease - jaundice of varying severity. Possible enlargement of the liver and spleen, anemia, in severe cases, the child may die.
During the first pregnancy, the risk of Rh conflict is lower, since antibodies have not yet formed in the mother's blood. If the pregnancy is not the first (it doesn’t matter if there were childbirth, miscarriages or abortions in the past), the risk increases: since in the past the mother may have had time to form antibodies, the immune system begins an “attack” on the fetus almost immediately.
How is the Rh factor inherited?
Any trait can be either homozygous or heterozygous. Homozygous Rh-negative carriage is a condition in which a person receives a gene responsible for Rh- from both mother and father. In this case, his own Rh will always be negative. With heterozygous carriage from one of the parents, a person received the Rh + gene, and from the other Rh-. His own Rh will be positive, but children can inherit both Rh+ and Rh-. If a person has both Rh + genes, then his blood will be Rh +, and his children will inherit a positive Rh factor.
In what case does this matter when planning a pregnancy?
|
If a woman has Rh+ |
In this case, there is no risk of hemolytic disease of the newborn. It doesn’t matter what Rh the child’s father has and what the child himself will form, since in any case, the mother’s blood already has the D antigen. |
|
If both the woman and the father of the child have Rh- |
There is also no risk of hemolytic disease of the newborn. Since Rh- can be in a person only with homozygous carriage, only Rh- can form in a child of such parents. Both mother and child are Rh-negative - there will be no conflict. |
|
If a woman has Rh-, and the father of the child has Rh + |
In this situation, a child can inherit Rh from both mother (-) and father (+). The probability of inheriting Rh (-) is from 50% to 100%. In the first case, the mother and child are Rh-negative, there is no danger. In the second case, if the mother is Rh-, the child is Rh+, there is a risk of hemolytic disease of the newborn. The disease can manifest itself both in mild form (jaundice) and in severe form (anemia, damage to the brain and nervous system, or death). |
It is in the latter case that it is very important for future parents to know about this feature during pregnancy planning.
If a woman with a negative Rh factor has already been pregnant in the past (no matter how the pregnancy ended: childbirth, miscarriage or medical abortion), the likelihood of an Rh conflict increases.
How to prevent the disease?
If pregnancy has already occurred, the only option is to monitor the health of the mother and regularly monitor blood counts (antibody titer). Depending on the result of the tests, the doctor may prescribe a conservative (therapeutic) treatment - the introduction of immunoglobulin at the 28th and in some cases again at the 34th week of pregnancy.
If the couple has IVF plans, the risk of Rhesus conflict can be eliminated with the help of preimplantation diagnostics of the embryo. But for this, first of all, it is necessary to determine the genotype of the father of the child (to conduct a genetic analysis).
If a man has a homozygous type of Rh inheritance (that is, he inherited Rh + from both his mother and father), his children cannot inherit Rh-. That is, all children will be with a positive Rh factor. In this case, it remains only to resort to conservative treatment already during pregnancy.
If the carrier type is heterozygous, that is, there are Rh + and Rh- in the genes, children will inherit a negative Rh factor in 50% of cases. It is in this case that it makes sense to diagnose the Rh factor of the embryo before transfer to the uterus. The embryologist will select Rh-negative embryos, and the baby will not be threatened by the mother's immune system.
In what cases will IVF help?
One of the advantages of IVF is the ability to diagnose embryos before transfer. That is why sometimes IVF is indicated for couples who do not experience problems with conception. Embryo diagnostics makes it possible to detect severe genetic diseases (usually, diagnostics are carried out for the most common or those that have already occurred in the families of patients). IVF is also possible if a high risk of Rh conflict is reliably known, or if the couple has already had a child with hemolytic disease.
Having a healthy baby is a blessing. Even in the most difficult cases, modern medicine and the experience of doctors help to ensure that the baby is born healthy.
Hello again, dear readers! Those who, for one reason or another, faced in vitro fertilization in their lives are concerned about the question: is IVF possible with a negative Rh factor? Why is he dangerous? What are the risks?
Today, I want to help you find answers to these and many other related questions that you will probably have (or have already).
How to prevent danger?
Planning an IVF program involves passing a huge number of tests to both parents. All this is done in order to identify any deviations from the norm and prevent possible risks. One of these tests is the determination of the blood group and the Rh factor. Why are these procedures needed?
"In nature" is only "positive" or "negative" (the first case is more common). In the second case, this is a fundamental factor for the possible appearance of certain difficulties.
If the expectant mother and father are negative, then their future baby is one hundred percent likely to be born negative. If the Rh, on the contrary, is positive for both, then this probability decreases to 25%. A baby born in a family where one of the parents is “plus” and the other is “minus” has equal chances.
However, there is one important detail. In the event that the mother is Rh-negative and the father is positive, there is a chance of occurrence. What is it and what are its consequences?
In the worst cases, rejection of the fetus by the mother's body is possible, and even the threat of miscarriage, however, thanks to timely diagnosis and adequate treatment, any, even the most minor problems, can be completely avoided. 
But do not forget about one nuance: the so-called immunization process. Such a problem can arise only after the first (!) birth of a negative mother, provided that her fetus has the opposite. What's the catch?
During the first pregnancy, antibodies to another Rh in the mother can be formed only during the birth itself (that is, when there is a possibility of blood mixing). Until then, the pregnancy may well proceed without complications.
What can be affected by immunization? On the difficulty in planning subsequent children. Of course, thanks to drug treatment and prevention, you can easily conceive and give birth. However, the risk, although not great, still remains.
Necessary tests for IVF
What we haven't figured out yet is the blood types - there are only four of them. Depending on the Rh and the group number, it can be either rare or more common.
Why do you need to know your group exactly? Why, when planning, such analyzes are carried out?
It must be borne in mind that the first negative is quite suitable for any person, as it is “universal”. Any type of blood interacts well with the fourth positive, but it itself is not suitable for everyone. The first, second and fourth negative groups, as well as the fourth positive group, are quite rare, by their nature, and do not occur often. 
As you may have guessed, depending on the type of group, there are certain restrictions in case a blood transfusion is needed.
This is interesting: for those who are worried about his negative Rh factor, I want to talk about one of its benefits. It has been scientifically proven that such people are taller, have a fast metabolism, are resistant to stress and have an extraordinary eye or hair color (for example, bright red hair or blue eyes).
Example from personal experience
What does planning look like in practice in such a situation? If you scour the internet, you will find a lot of feedback on this and almost all of them will be positive.
I will not go far, I will give an example from life. My friend, after many years of unsuccessful attempts, decided - after all, on IVF. During the examination, it turned out that she has a high probability of a Rh-conflict. However, the doctor assured that this is not a problem at all and there is no danger here. (By the way, she has already given birth, pregnancy and childbirth were wonderful; mother and daughter are alive, healthy and happy). 
By the way, there are no changes in the IVF procedure itself in such cases either! That is, it remains the same, standard.
Now let's draw a line:
- under any conditions, the in vitro fertilization procedure is unchanged;
- the likelihood of a Rh-conflict is not at all terrible, and any possible complications are easily eliminated thanks to medications;
- blood type and Rh factor will in no case become an obstacle on the way to happy motherhood.
OK it's all over Now. I hope all your fears and doubts have disappeared. All good health and successful conception. Until new articles.
Always yours, Anna Tikhomirova