Dr Suman Bijlani, Gynaecologist, Sonologist, Infertility Specialist, Obstetrician and Laparoscopic Surgeon, Mumbai.

The Rh Negative Pregnancy

My blood group is Rh negative. Will I be able to get pregnant?

Being Rh Negative does not affect your fertility. You can certainly become pregnant.

I am Rh negative. Will there be a problem if I marry a man with Rh positive blood group?

If you marry a man whose blood group is Rh positive, there are certain risks, but those are manageable.

Are there any problems that can happen during pregnancy due to my blood group?

If your husband is Rh positive, then your fetus (baby in womb) may be Rh positive. If your fetus is Rh positive, your body may form antibodies against your own fetus which may harm him/her. The chances of this happening are really small, though.

Why and how do antibodies form?

The Rh positive fetus has Rh antigen in his blood. During pregnancy, sometimes a small amount of fetal blood may ‘leak’ into the mother’s blood stream. This may lead to stimulation of the mother’s immune system which produces antibodies against the baby’s Rh antigen. These antibodies enter the baby’s circulation and destroy his red blood cells and cause anemia.

What precautions should I take so that my baby is safe?

Your obstetrician would test your husband’s blood group. If he is Rh negative, your pregnancy would not be at risk. However, if he is Rh positive, your doctor would test your blood for antibodies against the fetus, every 6-8 weeks. If the test remains negative (meaning no antibodies formed), it means that your baby is safe.

Do I need to take any treatment or injections to protect my baby?

The risk of forming antibodies is highest in the latter half of pregnancy. Your doctor would give you an injection (Inj Anti D) at 28 weeks of pregnancy to prevent formation of antibodies in the last trimester.

If at any time during pregnancy, you get bleeding per vaginum, you would need to take an additional shot of Inj Anti D to prevent antibody formation.

After delivery, the doctor would test your baby’s blood group. If your baby is Rh positive, you would need an additional shot of Inj Anti D to prevent formation of antibodies which may harm your baby in a future pregnancy.

How does Inj Anti D work?

Inj Anti D contains antibodies against the baby’s Rh antigen. When the mother is given this injection, these antibodies destroy the fetal blood, if any, which may have entered into the mother’s blood stream. Thus, the mother’s immune system does not produce antibodies against the fetus.

Do all women need to take that injection?

No. Only if your baby’s blood group is Rh positive, you need to take the injection within 24 hours, preferably as soon as possible.

What if during my pregnancy, at any point of time, my blood test shows positive for antibodies? What effects can that have on my baby?

If you develop antibodies against your baby at any point during pregnancy, your baby is at risk of developing anemia and jaundice inside the womb, which becomes progressively worse with time. Sometimes the anemia becomes so severe that the fetus develops heart enlargement and swelling all over the body.

After delivery, the baby may be born jaundiced or may develop jaundice within 24 hours.

What treatment can be given in such cases?

If antibodies develop during pregnancy, you would then need to get your fetal blood tested (by putting a needle into the baby’s umbilical cord-called cordocentesis) to diagnose how much he/she is affected. If the damage is severe, the doctor may need to deliver the baby urgently or do an ‘exchange transfusion’ within the womb if the fetus is very premature. Herein, the fetal blood is withdrawn and is replaced with fresh blood from a donor of O negative blood. By doing this, the mother’s antibodies are removed. However, this procedure may need to be repeated many times till the baby is safe to be delivered.

What if my baby develops anemia and jaundice after delivery?

If your baby develops jaundice and anemia after delivery, he/she would have to be admitted to intensive care unit and given ‘phototherapy’ to destroy bilirubin in the blood and ‘blood transfusions’ to treat anemia.

What are the chances of having problems in the next pregnancy?

If you have not had any complication in the present pregnancy and have taken Inj Anti D after delivery on time, the chances of developing complications in the next pregnancy are rare (less than 1%). However, all due precautions (as with the first pregnancy) would need to be taken.

I am an Rh positive woman. Can I marry a man who is Rh negative?

If a woman is Rh positive, there is no risk to the pregnancy. You may marry a man who is Rh positive or negative. Just make sure he has enough money J

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