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We talk to Prof. dr hab. n. med. Mirosław Wielgoś.
Professor, by way of introduction, when are we talking about a serological conflict?
Prof. dr hab. n med. Mirosław Wielgoś: A serological conflict is a situation in which a pregnant woman produces immune antibodies directed against antigens of the baby’s red blood cells in the uterine cavity. So, to speak of a serological conflict at all, it is not enough to have serological incompatibility between partners – for example, a partner with an Rh (-) blood group and a partner with an Rh (+) blood group. It is still not enough. As long as there are no antibodies, there is also no conflict, let alone the consequent hemolytic disease of the fetus.
How often is a serological conflict found?
MW: Fortunately, serological conflict is a less and less frequent pathology. Not so long ago, it involved about 0.5% of all pregnancies, now the incidence is much lower. This is due to the effective immunoprophylaxis for many years.
How is it diagnosed?
MW: Every pregnant woman – regardless of the blood group she has – must have a test for the presence of immune antibodies to red blood cell antigens at the beginning of pregnancy. In those women who do not have antibodies, the test should be repeated according to a schedule that depends on what blood type they have. However, if the presence of antibodies is detected, their type should be immediately identified, titered and – preferably – referred to a reference center, for example to the University Center for Women’s and Newborn Health at the Medical University of Warsaw, at 1/3 Starynkiewicza Square. Further diagnostics is based on ultrasound and Doppler examinations, and in the event that the results of these tests are abnormal, intrauterine treatment, consisting of intrauterine transfusions, should be instituted.
What are the consequences of its statement? What is it threatening to do?
MW: The consequence of serological conflict is hemolytic disease of the fetus – in a child developing in the womb, severe anemia, chronic intrauterine hypoxia, damage to tissues and organs of the fetus, generalized edema, and in extreme cases – fetal death occur. This is the case when the disease is not detected early enough, and therefore the diagnosis described above has not been performed. Fortunately, now it is possible not only to detect the threat, but also to treat it very effectively.
Is there a possibility of prophylaxis for pregnant women with identified conflict?
MW: In the case of a serological conflict, and therefore in the presence of immune antibodies, there is no possibility of prophylaxis. Immunoprophylaxis related to the administration of anti-D immunoglobulin is not intended to lead to immunization, and thus to the production of antibodies. Therefore, it must be used when there is only a serological incompatibility, and not an already realized conflict.
How is it done and when is it recommended to give immunoglobulin D to the expectant mother?
MW: Every Rh (-) woman who has no immune antibodies, after a miscarriage, after ectopic pregnancy, after invasive intrauterine procedures and after delivery (if she gives birth to a Rh-positive child), must receive prophylactic anti-D immunoglobulin in an appropriate manner. dose. To prevent the so-called late immunizations, which usually occur in the third trimester of pregnancy, are also recommended to use the so-called intra-pregnancy immunoprophylaxis, between 28 and 30 weeks of pregnancy. This management should be considered in Rh (-) women who have not yet developed antibodies. Regardless of this, preventive measures should be repeated after delivery, if the baby turns out to be Rh (+) blood type.
What does intra-pregnancy prophylaxis involve? What are the benefits of this? And also how can women get this prophylaxis? Is it reimbursed?
MW: As I mentioned, intra-pregnancy prophylaxis prevents late immunizations that may occur in the third trimester of pregnancy. In such a situation, it turns out that antibodies are present after delivery and it is – unfortunately – too late for classic post-pregnancy prophylaxis.
Intra-pregnancy prophylaxis is currently not reimbursed, but advanced measures are underway to change this state of affairs. Currently, the doctor in charge of pregnancy should inform his patient about the possibility and legitimacy of such prophylaxis, and if she is interested in this proposal – write out a prescription for one of the commercial preparations available in pharmacies. The price of the injection is about PLN 300-400.
Are women aware of the risk of serological conflict, its consequences and the possibilities of prevention?
MW: The awareness of women in this area is very diverse. It depends on how much information they get from their doctor or midwife. It is very important to inform pregnant women about the possibility of carrying out intra-pregnancy immunoprophylaxis, which is still not used routinely.
Is it possible to eliminate the Rh serological conflict?
MW: It seems that the complete elimination of the serological conflict is not possible, but surely proper care of pregnant women in the discussed scope may significantly contribute to further reduction of the scale of the phenomenon, and even to its marginalization. The condition is, however, compliance with the above-mentioned principles of prophylaxis, and if it is too late for it, appropriate diagnosis and therapy should be carried out when it is necessary.
On June 16, the educational campaign “Pregnancy-Conscious Motherhood” was released with Gazeta Wyborcza as a special thematic supplement. The main partner of the campaign is the Polish Gynecological Society. Media patron of the MedTvoiLokony website. The add-on is available online especially for our readers.