O rh positive blood group pregnancy

Rh Incompatibility

What’s in this article?

If you just found out you’re pregnant, one of the first — and most important — tests you should expect is a blood-type test. This basic test determines your blood type and Rh factor. Your Rh factor may play a role in your baby’s health, so it’s important to know this information early in your pregnancy.

About the Rh Factor

People with different blood types have proteins specific to that blood type on the surfaces of their red blood cells (RBCs). There are four blood types — A, B, AB, and O.

Each of the four blood types is further classified based on the presence of another protein on the surface of RBCs that indicates the Rh factor. If you carry this protein, you are Rh positive. If you don’t carry the protein, you are Rh negative.

Most people — about 85% — are Rh positive. But if a woman who is Rh negative and a man who is Rh positive conceive a baby, there is the potential for a baby to have a health problem. The baby growing inside the Rh-negative mother may have Rh-positive blood, inherited from the father. Approximately half of the children born to an Rh-negative mother and Rh-positive father will be Rh positive.

Rh incompatibility usually isn’t a problem if it’s the mother’s first pregnancy because, unless there’s some sort of abnormality, the fetus’s blood does not normally enter the mother’s circulatory system during the course of the pregnancy.

However, during delivery, the mother’s and baby’s blood can intermingle. If this happens, the mother’s body recognizes the Rh protein as a foreign substance and might begin making antibodies (protein molecules in the immune system that recognize, and later work to destroy, foreign substances) against the Rh proteins.

Other ways Rh-negative pregnant women can be exposed to the Rh protein that might cause antibody production include blood transfusions with Rh-positive blood, miscarriage, and ectopic pregnancy.

Rh antibodies are harmless until the mother’s second or later pregnancies. If she is ever carrying another Rh-positive child, her Rh antibodies will recognize the Rh proteins on the surface of the baby’s blood cells as foreign, and pass into the baby’s bloodstream and attack those cells. This can lead to swelling and rupture of the baby’s RBCs. A baby’s blood count can get dangerously low when this condition, known as hemolytic or Rh disease of the newborn, happens.

Preventing and Treating Rh Disease of the Newborn

In generations past, Rh incompatibility was a very serious problem. But now, significant medical advances can help prevent complications from Rh incompatibility and treat any newborn affected by Rh disease.

Today, when a woman with the potential to develop Rh incompatibility is pregnant, doctors give her a series of two Rh immune-globulin shots during her first pregnancy. The first shot is given around the 28th week of pregnancy and the second within 72 hours after giving birth. Rh immune-globulin acts like a vaccine, preventing the mother’s body from producing any potentially dangerous Rh antibodies that can cause serious complications in the newborn or complicate any future pregnancies.

A dose of Rh immune-globulin also might be given if a woman has a miscarriage, an amniocentesis, or any bleeding during pregnancy.

If a doctor finds that a woman has already developed Rh antibodies, her pregnancy will be closely monitored to make sure that those levels are not too high.

In rare cases, if the incompatibility is severe and the baby is in danger, a series of special blood transfusions called exchange transfusions can be done either before the baby is born (intrauterine fetal transfusions) or after delivery. Exchange transfusions replace the baby’s blood with blood with Rh-negative blood cells . This stabilizes the baby’s level of red blood cells and minimizes further damage caused by Rh antibodies already circulating in the baby’s bloodstream.

Because of the success rate of the Rh immune-globulin shots, exchange transfusions are needed in fewer than 1% of Rh-incompatible pregnancies in the United States today.

If Rh Disease Is Not Prevented

Rh incompatibility rarely causes complications in a first pregnancy and does not affect the health of the mother. But if Rh antibodies develop, they could be dangerous to a fetus during later pregnancies. Rh disease can cause severe anemia, jaundice, brain damage, and heart failure in a newborn. In extreme cases, it can cause the death of the fetus because too many RBCs have been destroyed.

If you’re not sure what your Rh factor is and think you’re pregnant, it’s important to start regular prenatal care as soon as possible — including blood-type testing. With early detection and treatment of Rh incompatibility, you can focus on more important things — like welcoming a new, healthy baby.

Dr Rachel Ryan

Blood Group and Pregnancy

Blood Group and Pregnancy

Important: This is intended as general information only. It may not apply to your specific situation. It is not a substitute for medical advice. If you have a question or concern, please raise it with me at your next appointment or contact me sooner if it’s urgent.

Blood group and pregnancy

Everyone has a ‘blood type’ which is determined by the presence or absence of various proteins on the surface of their red blood cells. These proteins don’t have any effect on how well your red blood cells do their job – which is to carry oxygen around the body. However, they do determine who you can receive a blood transfusion from, and they can cause problems in pregnancy if there is a ‘mismatch’ between the blood group of the mother and the baby. The particular proteins each person has on their red blood cells is genetically determined.

The following information is quite complicated – don’t worry if it doesn’t completely make sense to you. I’ll discuss your blood group with you at your first antenatal visit and I’ll make sure that you understand anything that is relevant to your situation.

There are lots of different ways to classify red blood cells but the two most important systems are the ABO and rhesus systems. We’ll deal with ABO system first.

ABO blood group system

People are classified as blood group A, B, AB or O depending on whether they have two proteins (known as the A antigen and B antigen) on the surface of their red blood cells. People with blood group A have the A antigen and people with blood group B have the B antigen. People with blood group AB have both and people with blood group O have neither. Generally speaking, your immune system will react against anything that is not part of your body. In simple terms, this means that the immune system will produce antibodies to attack any ‘foreign’ proteins it detects. This is why some blood types are incompatible. If you have blood group A, your immune system will mount a reaction if it encounters blood group B. If you have blood group B, your immune system will mount a reaction if it encounters blood group A. People with blood group O will react to both A and B blood types and people with AB don’t react to either. Choosing an appropriate ABO type is the first step in preparing a transfusion. Of course, in real life, the actual cross-matching process is much more complicated than this.

It’s possible for a baby to have a ABO type that is incompatible with his or her mother’s. Even when the blood types are technically incompatible, most of the time this doesn’t cause any problems. When it does, the problems are usually mild and happen after the baby is born, which makes them much easier to deal with.

Rhesus blood group system

Our main concern in pregnancy is with the Rhesus (or Rh) system. People are classified as Rh positive or negative, depending on whether they have the Rh protein on the outside of their red blood cells. As you might imagine, people who have the protein are Rh positive and people who don’t have the protein are Rh negative. If someone with Rh negative blood encounters red blood cells from someone who is Rh positive, their immune system will recognize the Rh protein as ‘foreign’ and mount a response against the red blood cells carrying this protein. Once a person has developed antibodies, they are present for life.

This can be a problem in pregnancy for Rh negative women who are pregnant with a baby that is Rh positive. In contrast to antibodies against the A and B antigens, antibodies against the Rh protein do cross the placenta and can cause a severe immune response leading to breakdown of the baby’s red blood cells.

How these antibodies develop

Anti-Rh antibodies can develop if at any stage if a person with Rh negative blood is exposed to Rh positive blood. This might occur in an incompatible transfusion, during childbirth, a miscarriage, a termination of pregnancy, some pregnancy procedures (for example amniocentesis) or trauma during pregnancy. Even without any of these events, a small number of women can develop antibodies due to the fact that a small amount of the baby’s blood always manages to sneak across the placenta and into the mother’s circulation. Fortunately, providing we know that a woman is Rh negative, we can take steps to reduce the risk that she will develop antibodies in all of these situations.

How to prevent the development of antibodies

If we think that a Rh negative woman is at risk of developing antibodies we can give her an injection of Rh antibodies that have been extracted from the blood of blood donors – known as prophylactic anti-D. Unlike a person’s own antibodies, these antibodies don’t last for ever. They remain in the woman’s circulation for about 6 weeks, during which time they go around and ‘mop up’ any Rh proteins so that the woman’s own immune system doesn’t see them and form it’s own antibodies. We vary the dose depending on the gestation and the ‘event’ that has occurred. Therefore, if a Rh negative women has a miscarriage, a termination, a procedure during pregnancy, trauma during pregnancy, or any bleeding during pregnancy we would give her an injection of anti-D.

A small number of women will develop antibodies during their pregnancy even if none of the events above happen. To try to prevent this, we give two doses of prophylactic anti-D to all Rh negative women during the pregnancy – at about 28 weeks gestation and again at about 34 weeks gestation.

During the pregnancy, we’re operating on the assumption that the baby is Rh positive – a reasonable assumption since most people are Rh positive. Once the baby is born, we can test his or her blood group by taking some blood from the cord. If the baby is, in fact, Rh positive, we give the mother a further dose of anti-D in the first couple of days after the birth. However, if the baby is found to be Rh negative, this postnatal dose is not required.

Giving prophylactic anti-D works really well and significantly decreases the likelihood that Rh negative women will develop antibodies. However, like all treatments, is does not work in 100% of cases. A very small number of women will develop antibodies even if anti-D is given appropriately.

What happens if Rh antibodies develop

In most cases, if Rh antibodies develop during pregnancy, they aren’t a major problem in that pregnancy. The problems usually arise in subsequent pregnancies. The antibodies can cross the placenta and attack the baby’s red blood cells. As the baby’s number of red blood cells falls, it becomes progressively harder for oxygen to move around the baby’s body. Initially, the baby can compensate for this by increasing it’s heart rate and directing blood to the most important parts of the body. In severe cases, the baby can become seriously unwell and this condition can be fatal.

If you are found to have antibodies before or during your pregnancy, I will arrange for very close monitoring of you and your baby. This is done mostly through blood tests to measure the antibody levels and ultrasound monitoring looking for signs of fetal anaemia. There is treatment available both during the pregnancy and for the baby after birth. The most important thing is that we know that the antibodies are present so we can monitor the baby closely. For this reason, all women who are Rh negative will have blood tests during the pregnancy to monitor their antibody status.

Other red blood cell antibodies

There are many other proteins that can be present on the surface of red blood cells. It’s possible to develop antibodies against these other proteins although this happens much less commonly than antibodies against the A, B or Rh proteins. Therefore, all pregnant women should have their blood tested for antibodies at the beginning of and during the pregnancy. I will arrange this as part of your routine pregnancy testing.

What Is Your Blood Group? Doctors Find It Can Affect Your Pregnancy & Your Baby


Recent research has established some strong relationships between your blood group, pregnancy and baby’s health. If you do not know your blood group, it is recommended to get a blood test and find out your blood type. Once you’re ready, understand what a certain blood type can mean for you and your unborn baby.

1. Your Blood Group Can Affect Your Fertility

Every woman has a certain “ovarian reserve” – which is basically the capacity of the ovary to provide eggs. Your fertility levels directly depend on this, and this in turn depends on your body’s production of FSH (follicle-stimulating hormone). A follicle is a small cavity inside which the egg grows. It has been found that a woman’s blood group influences the production of FSH. If FSH levels are higher than 10, your fertility goes down.

  • If your Blood Group is O: Women with O blood group are likelier to have FSH higher than 10. There is thus a risk that they might have a lower egg count and poorer egg quality. This makes such women more vulnerable to suffering from fertility problems or difficulty in conceiving.


2. Your Blood Group Can Determine Success/Failure of IVF

Some experts believe that your blood group affects your chances of success or failure in an IVF (in vitro fertilization) procedure. Many couples who face problems in conceiving now undergo IVF, which involves fertilising the egg with the sperm in the lab and implanting it in the woman’s uterus. The woman’s immune system needs to recognise this object and not reject/destroy it as a ‘foreign’ body.

  • If your Blood Group is O: you are less likely to have successful IVF treatment. Many women with O blood group experience a strong, negative immune response to the ‘foreign material’, and their bodies reject it, leading to failure to conceive.

3. Do You & Your Baby Have ‘Compatible’ Blood Groups?

The blood group of your baby gets decided on the basis of your and your partner’s blood groups. If you and your baby don’t have compatible blood groups, it will affect the antibodies produced in your body when the two types of blood mix. This can create problems for your baby for as long as he is in your womb.

  • Mother is Rh Negative & Father is Rh Positive: In this case, if your baby has Rh negative blood group too, there will be no complications. However, if your baby’s blood group is Rh Positive, this is called Rh incompatibility. In this case, the mother’s body might treat the Rh proteins in the baby’s blood as ‘foreign’ and attack them. When the two blood groups mix in any way, it leads to a condition called Rhesus disease. This is a disease that destroys the baby’s blood cells, and could tragically lead to jaundice, brain damage, heart failure, or even death.

  • Mother’s Blood Group is O & Father’s Blood Group is A or AB: The baby might have blood group A, B or AB. This is is called ABO incompatibility. In this case, sometimes, the mother’s body attacks the baby’s red blood cells by producing antibodies against it.
  • 4. Your Blood Group Can Determine Your Baby’s Risk of Anaemia and Jaundice

    When you are pregnant for the first time, your baby is usually protected until birth because your blood cannot cross the placenta. However, if you are exposed to any of these conditions, your and your baby’s blood may mix sooner than delivery:

    • miscarriage
    • injury that causes bleeding
    • an ectopic pregnancy
    • after an amniocentesis (blood is taken from the umbilical cord for testing)
    • any other testing that involves blood being taken from the placenta

    In these situations, it is a severe risk if you also have Rh incompatibility (as discussed in point 3). Your body will produce antibodies as an immune response. This can lead to the baby having anaemia and/or jaundice.

    How to Protect Your Baby from Blood Group-Related Problems

    So, in case any of the above pointers hold true for you, what is the solution? A baby’s blood group is usually not known during pregnancy. This is why it is recommended to strictly follow these preventive measures to give birth to a healthy baby:

    Blood Type Origins – Rh Negative

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    Endomorphs are most likely to be O negative.

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    Rh Status & Pregnancy

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