RHESUS-CONFLICT: prevent according to world standards

Abstract

The article is devoted to the prevention of the development of rhesus-conflict. A literature review, clinical guidelines and recommendations for highlighting and discussing of this pathology are presented. The history of the formation of anti-rhesus immunoglobulin, the results of its first use in the pregnant women are described. The factors for predicting the risk of hemolytic disease of the fetus and newborn development, standards for the diagnosis of hemolytic anemia are given. The approaches to the management of this pathology, recommended by foreign professional societies of obstetricians and gynecologists, are presented. In the article there are the stages of rhesus-conflict prevention: antenatal prophylaxis at 28–34 weeks of gestation, postpartum prophylaxis if the newborn is Rh-positive, and the prophylaxis after pregnancy complications associated with prenatal fetal and maternal bleeding. The indications and doses of anti-rhesus immunoglobulin use during antenatal prophylaxis at 28–34 weeks of gestation are given. The management of postpartum prophylaxis is described in detail, which indicates the doses and method of administration of anti- rhesus immunoglobulin to non-immunized Rh-negative women in case of the birth of a Rh-positive child, the indications for increasing the dose of anti-Rh immunoglobulin are presented also. The importance of performing the Kleihauer-Betke test for assessing the volume of fetal maternal transfusion is described. The conditions during which the prevention of Rh-conflict is carried out after complications of pregnancy which are associated with prenatal fetal and maternal bleeding, anti-rhesus immunoglobulin are given. The approaches to the prevention of rhesus-conflict are considered, which are reflected in the clinical protocol for obstetric and gynecological care, which unites all the latest world recommendations.