Rhesus disease is a hemolytic disease that causes a pregnant woman’s blood to destroy her baby’s blood cells. Learn more about rhesus syndrome at Meri Sehat.

Rhesus Factor – An Incompatibility With Foetus

Rh factor is a type of protein found on the surface of your red blood cells.

Introduction

It so happens that sometimes the very body that protects and grows the foetus can actually be the one attacking it. Hence, one of the first tests that you&rsquo;ll have during your pregnancy is the Rh factor test. Let&rsquo;s read on to understand the science behind it. 
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Understanding how the Rhesus factor impacts newborns

Rh factor is a type of protein found on the surface of your red blood cells. Nearly 85% of people are Rh-positive, which means that they have this protein; the remaining people are Rh-negative, which means that they don&rsquo;t have the protein.

The presence or absence of Rh factor is determined genetically. This protein does not affect your health nor cause any inconvenience. However, it can cause hemolytic disease of the newborn (also known as rhesus disease) during pregnancy<a href="#accordion">[1]</a>. 
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If you are Rh-negative and your partner/baby&rsquo;s father is Rh-positive, then there is a 1 in 4 chance that your baby will be Rh-positive, too<a href="#accordion">[2]</a>.

Usually, the mother&rsquo;s and baby&rsquo;s blood do not mix. Even if the baby&rsquo;s Rh-positive, you&rsquo;ll experience little to no complications throughout your pregnancy; the problem ensues at the time of labour and delivery. This is the moment when there&rsquo;s a possibility that your blood will mix with your baby&rsquo;s; even a minute amount of your baby&rsquo;s blood will develop Rh antibodies in your system. This condition is known as Rh sensitization<a href="#accordion">[3]</a>. 
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The first pregnancy isn&rsquo;t usually affected much by it because your body doesn&rsquo;t have any antibodies until after birth. However, following that, these antibodies stay in your bloodstream and, consequently, can be harmful for the next pregnancy. That is, if your&nbsp; second baby is Rh-positive as well, the antibodies will think of your developing baby&rsquo;s red blood cells as foreign objects that need to be eliminated. Hence the antibodies can move through the placenta, reach the foetus and attack its red blood cells. This phenomenon is referred to as Rhesus Disease which can be a life threatening condition for the foetus, owing to the destruction of its red blood cells. 
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Symptoms depend on the severity of the condition. Generally, the following signs indicate that your baby&rsquo;s born with rhesus disease<a href="#accordion">[6]</a>:

<ul>
	<li>Foetus: Your baby will become anaemic, which will make their blood thinner and flow faster. It can be detected by Doppler ultrasound. In severe anaemia, swelling can also be observed during the scans. 
	&nbsp;</li>
	<li>Newborn Baby: Symptoms may not appear until 3 months after birth and even then, they may not be noticeable immediately. <a href="https://merisehat.pk/disease/anemia">Anaemia </a>presents itself as pale skin and increased breathing rate, poor feeding ability, and <a href="https://merisehat.pk/disease/jaundice-65">jaundice</a>. Jaundice is the yellowing of the baby&rsquo;s skin and of the whites of their eyes. The yellow colour is from a buildup of bilirubin; a large amount of bilirubin can also burden the liver. 
	&nbsp;</li>
</ul>

Rh antibodies are also formed when a Rh-negative person receives Rh-positive blood. If you have had a transfusion reaction, you will have the antibodies to attack your first-born&rsquo;s Rh-positive blood<a href="#accordion">[4]</a>.

Other situations in which your baby&rsquo;s blood may come in contact with you include<a href="#accordion">[2]</a>:

<ol>
	<li><a href="https://merisehat.pk/disease/ectopic-pregnancy">Ectopic pregnancy</a>, i.e., the implantation of the fertilised egg outside of the uterus</li>
	<li>Abortion</li>
	<li>Miscarriage</li>
	<li>Molar pregnancy removal, i.e., a benign tumour that forms in the uterus and needs to be removed</li>
	<li>Chorionic villus sampling, i.e., a prenatal test that requires a sample of the placenta villi for testing</li>
	<li>Bleeding during pregnancy</li>
	<li>Injury to abdomen during pregnancy</li>
	<li>External rotation of a breech baby</li>
	<li>Delivery</li>
	<li>Amniocentesis, i.e., a prenatal test that removes a sample of the amniotic fluid</li>
	<li>Cordocentesis, i.e., a prenatal test that requires a sample of baby&rsquo;s blood taken from the umbilical cord 
	&nbsp;</li>
</ol>

Your first trimester blood work will include the Rh factor test until and unless you have vaginal bleeding<a href="#accordion">[3]</a>.No preparation is necessary for this test. It determines your own Rh factor, i.e., whether you&rsquo;re Rh- positive or negative.

Once it&rsquo;s determined that you are Rh-negative, your doctor will get another test done called antibody screening that finds out if you have already developed Rh antibodies in which case, you will be at a high risk for Rh incompatibility<a href="#accordion">[1]</a>. 
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<h5>During Pregnancy</h5>

If you are RhD negative, your doctor will give you Rh immune globulin (Rhlg) during the third trimester of your pregnancy. These anti-D immunoglobulin injections prevent antibody formation.

The 2 ways you can receive these injections are :

<ul>
	<li>In 2 doses- 1 dose is administered during the 28th week of the pregnancy and the second one during the 34th week</li>
	<li>As a single dose wherein 1 dose is given between weeks 28 to 30 of pregnancy 
	&nbsp;</li>
</ul>

<h5>Post Delivery</h5>

Post birth, a sample of the baby&#39;s blood is used to determine the Rh status of the newborn. If the baby is Rh positive, while the mother is RhD negative and hasn&rsquo;t been sensitised then healthcare practitioners will administer&nbsp; an injection of anti-D immunoglobulin within 72 hours of delivery.

This helps to&nbsp; destroy any RhD positive blood cells that may have crossed over into the mother&rsquo;s bloodstream during delivery. To summarise, administration of anti-D immunoglobulin within 72 hours of delivery, doesn&rsquo;t allow the production of antibodies and hence also significantly decreases the risk of the next baby having rhesus disease. 
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Please Note:

<ul>
	<li>Anti-D immunoglobulin is recommended for all pregnant RhD negative women who haven&#39;t been sensitised to the RhD antigen.</li>
	<li>Since the immunoglobulin doesn&#39;t offer lifelong protection against rhesus disease, it needs to be administered at every pregnancy, as long as the mother has not been sensitised</li>
	<li>In case of sensitisation, the anti-D immunoglobulin will not be administered, instead close monitoring will be done to prevent any possible problems. 
	&nbsp;</li>
</ul>

Once you produce antibodies, RhIg therapy will have no effect on you.5&nbsp;If you have Rh sensitization, the only way forward will be for your doctor to monitor your pregnancy closely to see if the foetus has developed the condition. If the baby is delivered on time, blood transfusions will be recommended to replace the sick blood cells with healthy ones. In severe cases, the baby may be delivered early ( through induction or C section - generally done after 34 weeks of gestation) or they may receive transfusions while still inside the mother&#39;s womb.

Hemolytic anaemia can have minor to severe side effects, such as jaundice, liver failure, and heart failure depending on how quickly the condition destroys the baby&rsquo;s red blood cells. 
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Treatment is based on the severity of the disease in the newborn.

<ol>
	<li>In Mild Cases, there may be no need for treatment. However it is important to note that the baby will be monitored closely.</li>
	<li>Infants With Jaundice or high blood bilirubin levels may be treated by phototherapy to lower bilirubin levels<a href="#accordion">[1]</a>.&nbsp;Dehydration is a possibility during phototherapy, hence IV fluids will usually be given into a vein. Phototherapy can reduce the need for a blood transfusion as it aids in the expulsion of bilirubin through urine.</li>
	<li>In Severe Cases, due to the high levels of bilirubin, an infant may require one or more blood transfusions 
	&nbsp;</li>
</ol>

Conclusion

Rhesus factor is genetic and cannot be altered to prevent incompatibility. However, mortality can be reduced by timely intervention. 
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Key Takeaways

<ul>
	<li>Rh factor is a type of protein found outside of the red blood cells. If the protein is present, you are Rh-positive; if it is absent, then you are Rh-negative.</li>
	<li>If a woman (who is Rh-negative) has a baby with a Rh-positive man, there is a 1 in 4 chance that the baby will be Rh-positive, too.</li>
	<li>If the woman has not developed antibodies, the doctor will give them Rh immune globulin (Rhlg) which prevents antibody formation.</li>
	<li>Once a woman produces antibodies, RhIg therapy is ineffective</li>
	<li>In less severe cases, treatment is not required, but in severe cases the foetus may require one or more blood transfusions. 
	&nbsp;</li>
</ul>
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