Rhesus Disease is a condition in which the mother and baby have different blood types (Rhesus). If the mother’s blood type is Rh- (Rh-negative or Rh negative blood type) but the baby’s blood type is Rh+ (Rh-positive or Rh positive blood type), it will result in blood type incompatibility (Rh Incompatibility).
Rh (Rh) is a protein found on the surface of red blood cells, used in another form of blood grouping , passed down through genetics. It is divided into two forms: Rh+, the most common blood group, and Rh-, the less common blood group.
Blood group incompatibility in general people may not affect the body compared to pregnant women. This is because if the mother has Rh- blood group while the fetus has Rh+ blood group, the mother’s body will react to Rh+ blood group as a foreign object to the body by creating antibodies or antibodies in the blood to oppose, which will destroy the baby’s red blood cells and may cause the baby to have anemia or jaundice.
In the first pregnancy, there may be only minor danger to the mother because the baby with Rh+ blood group is usually born before the mother’s body has created antibodies. But after that, the mother’s body will continue to create antibodies throughout her life. Therefore, in the second pregnancy, the antibodies in the mother’s body are passed through the placenta and can be harmful to the baby.
Symptoms of Rhesus Disease
Rh incompatibility can cause symptoms ranging from moderate to life-threatening in infants, but these symptoms usually subside with treatment for the incompatibility.
When antibodies in the mother’s body destroy the baby’s red blood cells, bilirubin is created. If it is created in excess, it can indicate a problem with the liver. Babies with high levels of bilirubin may have the following symptoms after birth:
- Jaundicecauses the baby to have yellow skin .
- Lethargy
- Hypotonia
Causes of Rhesus Disease
The cause of this condition is that the mother has Rh- blood type, but the fetus has Rh+ blood type. When the mother is sensitive to Rh+ blood, the mother’s body will create antibodies to act as immunity against foreign substances and infections in the body. They are created when the mother is pregnant for the first time. The body will remember and destroy foreign blood cells that enter the body after that.
Maternal Rh+ sensitization is a condition that may occur during pregnancy due to the following factors:
- The baby’s blood cells are transferred to the mother’s blood.
- The mother’s body becomes sensitive to the baby’s blood during birth.
- Bleeding during pregnancy
- Use of medical procedures such as amniocentesis or chromosomal viability testing (CVS)
- The mother suffered injuries to her abdomen.
- It may occur after a miscarriage or ectopic pregnancy.
- A mother with Rh- blood type receives Rh+ blood through a failed blood transfusion, which is a very rare occurrence.
When a pregnant woman is sensitized to Rh+ blood and receives Rh+ blood, the mother’s body immediately creates antibodies. Therefore, if a baby with Rh+ blood is born, the antibodies will be passed to the mother’s placenta and cause Rhesus Disease in the fetus, in which the antibodies will destroy the baby’s red blood cells within the first 2-3 months after birth.
Blood group incompatibility usually does not affect the baby much in the first pregnancy, because the baby is born before enough antibodies have been created in the mother’s body, but it can be more dangerous in subsequent pregnancies.
Diagnosis of Rhesus Disease
Diagnosis of Rhesus Disease can be done mainly by blood test, which are as follows:
Maternal blood test
Normally, pregnant women will have a health check and blood test during pregnancy. Diagnosis of Rhesus Disease is usually based on the results of a blood test, screening for abnormalities that may occur during pregnancy, such as anemia, rubella , HIV infection, hepatitis B virus, including identifying the mother’s Rh blood group. If it is found that the blood group is Rh-, the doctor may perform additional screening and antibody screening in the blood.
If antibodies are detected in the blood, there is a high risk that the fetus will be affected by Rhesus Disease. Therefore, both the mother and the baby will need to be closely monitored and may be tested for additional complications such as anemia or jaundice. However, if the results of the antibodies are not detected in the blood, the doctor will schedule another blood test in the 28th week of pregnancy and may inject an antibody (Anti-D Immunoglobulin) to help reduce the mother’s immunity to the fetus’s blood.
Father’s blood test
If the blood test results indicate that the mother has Rh- blood type, the doctor may also have the father have a blood test. If the results are both Rh-, there is no chance that the baby will have Rh+ blood type, so there is no risk of blood type incompatibility. However, if the father’s blood test results indicate that he is Rh+ or his Rh blood type status cannot be determined, the doctor may use the method of amniocentesis on the mother. By using a needle to insert into the skin and draw a small amount of amniotic fluid from the amniotic sac to check the baby’s Rh blood type. It may also be used to check the bilirubin level in the blood. If the bilirubin level is high, the baby is at risk of developing hemolytic anemia.
Blood test of the fetus
A maternal blood test during pregnancy can also reveal the Rh blood group of the fetus, as the baby’s DNA can be identified. The test can be performed after the 11th-12th week of pregnancy to provide a definitive result, and is sufficiently early in the pregnancy before the fetus is exposed to antibodies.
If the baby is found to have Rh+ blood type, the pregnant woman may need to be monitored closely so that timely treatment can be given in case complications arise. The doctor may repeat the test in the 6th or 7th month of pregnancy. However, if no increase in antibodies is found in the body, the pregnant woman may need to undergo regular tests to see if the baby is Rh+ or Rh- blood type.
If the fetus is at risk of Rhesus Disease, the doctor may perform additional diagnostics to look for complications such as anemia that may occur in the baby in the following ways:
- Doppler ultrasound can be used instead of amniocentesis tocheck the flow of blood in the arteries of the brain. It uses sound waves to detect the speed of blood flow. If the blood flow is found to be high, the baby is at risk of premature red blood cell destruction because it causes the baby’s heart to pump blood more than normal.
- Fetal Blood Sampling: A blood sample is taken from the fetus through the umbilical cord. If the fetus is found to have anemia, it may require an intrauterine transfusion.
Newborn blood test
Diagnosing Rhesus Disease in newborns involves a blood test through the umbilical cord to look for the transmission of antibodies in the blood. Your doctor may also do a blood test called a Coombs test to look for antibodies that destroy red blood cells in the blood. A positive result could be a sign of blood group incompatibility.
Treatment of Rhesus Disease
Treatment of Rhesus Disease before birth When doctors know the level of antibodies in the mother’s body from the results of the mother’s physical examination and the results of various fetal examinations, it is often found that more than half of the babies have mild symptoms and do not require much treatment. However, the baby’s symptoms must still be monitored regularly to watch for symptoms that may become more severe later. However, if the mother’s antibody levels are found to be high, the doctor may recommend induction of labor before the mother’s antibodies destroy the baby’s red blood cells and cause danger to life.
Treatment for Rhesus Disease after birth depends on the severity of the symptoms. If the symptoms are severe, treatment may need to be started before birth. In cases where the baby has complications after birth, such as jaundice or anemia, the doctor may use the following treatment methods:
- Phototherapy
It is a special type of light that emits blue light through halogen or fluorescent bulbs and shines it on the baby. The doctor will cover the baby’s eyes before exposing the light. This method allows the skin to absorb the light, allowing the baby’s liver to excrete bilirubin more easily. During the exposure, the doctor will give fluids through the veins to prevent dehydration that may occur in the baby. In some cases, the exposure method may reduce the need for blood transfusions.
- Blood Transfusion
In cases where the bilirubin level in the blood is high, the baby will receive a partial blood transfusion with a blood donor of the same blood type through a catheter inserted into the blood vessel. Sometimes only red blood cells are transfused to increase the amount that is already there. This method helps to remove the high bilirubin in the baby’s blood and also removes the antibodies that cause Rhesus Disease. However, the disease can occur while the baby is still in the womb. Therefore, an intrauterine foetal blood transfusion (IFT) can occur before birth and must be performed by a specialist.
- Intravenous Immunoglobulin
The doctor will inject immunoglobulin into the baby’s veins if the baby’s blood bilirubin level is increasing steadily every hour. This method may be used in conjunction with phototherapy. Injecting immunoglobulin into the baby’s veins prevents the destruction of red blood cells, so the baby’s blood bilirubin level does not increase and reduces the need for blood transfusions.
Complications of Rhesus Disease
Rhesus Disease can cause complications for both the fetus and newborn, including:
fetus
If symptoms of Rhesus Disease anemia occur, the fetus may experience heart failure, foetal hydrops, or stillbirth.
Newborn
If a child’s body makes too much bilirubin and it isn’t treated properly, the buildup of bilirubin in the brain can lead to a brain condition called Kernicterus, which can result in learning problems, hearing or vision loss, brain damage, and even death.
Rhesus Disease Prevention
A blood test before pregnancy or in the early stages of pregnancy may help prevent Rhesus Disease. If the mother is found to have Rh- blood type, the doctor may use an injection of Anti -D Immunoglobulin , which reduces the risk of sensitization to Rh+ blood. The drug binds to Rh+ antigens that may enter the mother’s blood during pregnancy, inhibiting the stimulation process and preventing the mother’s blood from producing antibodies.
If the mother has Rh- blood type and is not sensitive to D antigen, the doctor will inject anti-D drugs during the third trimester of pregnancy or in some cases, anti-D drugs may be given within 72 hours after delivery. This method is called Routine Antenatal Anti-D Prophylaxis (RAADP). The drug destroys Rh+ blood cells from the baby that may be transferred to the mother’s blood system during delivery and reduces the chance of antibodies being created in the body, including the risk of Rhesus Disease in the next pregnancy.
