RH陰性（熊貓血）媽媽的注意事項

什麼是Rh陰性血？

What is the Rh factor?

Rh陰性血型是Rh血型系統的一種。人們大多知道血型有四種類型，即A型、B型、O型、AB型，它們都屬於ABO血型系統。其實，血型不止這四種，而是有數十種類型或系統，龐大複雜。由於A型、B型、O型、AB型以外的血型抗原性大都不強，所以臨床醫學家認為，除上述四種血型外，再加上Rh血型系統是臨床上應用最廣也最為重要的血型。

Just as there are different major blood groups, such as type A and type B, there also is an Rh factor. The Rh factor is a protein that can be present on the surface of red blood cells. Most people have the Rh factor—they are Rh positive. Others do not have the Rh factor—they are Rh negative.

Rh（-）是隱性基因。當Rh（+）的父母將有Rh（-）基因同時遺傳給子代，其子一代即表現為Rh（-），雙親有一人是Rh（-）時，其子女為Rh（-）的機會增大，反之機會減少。

無論是Rh（-）者還是Rh（+）者其差別僅僅是血型的不同，都屬健康人群。但Rh（-）者遇到特殊時其臨床意義不容忽視，如連續兩胎母嬰Rh血型不合的妊娠，很可能導致胎兒的嚴重傷害；又如有輸血、人流等免疫史的病人再次輸入Rh（+）血時，可能產生強烈的溶血性輸血反應。

The Rh factor is inherited—passed down through parents』 genes to their children. If the mother is Rh negative and the father is Rh positive, the fetus can inherit the Rh gene from the father and could be either Rh positive or Rh negative. If the mother and father are both Rh negative, the baby also will be Rh negative.

The Rh factor can cause problems if you are Rh negative and your fetus is Rh positive. This is called Rh incompatibility. These problems usually do not occur in a first pregnancy, but they can occur in a later pregnancy.

Rh陰性血懷孕的麻煩

「熊貓血」女性可以懷孕，可以懷二胎，但是麻煩會比別人多一些。

如果丈夫的血型是Rh陽性，孩子也是Rh陽性的話，可能會讓媽媽體內產生Rh抗體，如果第二次懷孕孩子依然是Rh陽性的話，就有可能發生胎兒宮內溶血。

為了防止母親Rh抗體的產生，在孕期和分娩以後需要注射Rh免疫球蛋白RhoGAM。

另外，如果在分娩時發生大出血，由於Rh陰性的血型稀少，會對搶救帶來很大的困難。

熊貓血女性懷孕生孩子主要面臨三個問題：

胎兒容易發生宮內溶血

國內沒有合法進口的Rh免疫球蛋白RhoGAM

發生產後出血時比較難拿到血製品

When an Rh-negative mother』s blood comes into contact with blood from her Rh-positive fetus, it causes the Rh-negative mother to make antibodies against the Rh factor. These antibodies attack the Rh factor as if it were a harmful substance. A person with Rh-negative blood who makes Rh antibodies is called "Rh sensitized."

During pregnancy, the woman and fetus do not share blood systems. However, a small amount of blood from the fetus can cross the placenta into the woman』s system. This sometimes may happen during pregnancy, labor, and birth. It also can occur if an Rh-negative woman has had any of the following during pregnancy:

· Amniocentesis

· Chorionic villus sampling （CVS）

· Bleeding during pregnancy

·Manual rotation of a baby in a breech presentation before labor

· Blunt trauma to the abdomen during pregnancy

Do problems usually occur during the pregnancy that causes Rh sensitization?

During an Rh-negative woman』s first pregnancy with an Rh-positive fetus, serious problems usually do not occur because the baby often is born before the woman』s body develops many antibodies. If preventive treatment is not given during the first pregnancy and the woman later becomes pregnant with an Rh-positive fetus, the baby is at risk of Rh disease.

Can I still develop antibodies if my pregnancy is not carried to term?

It also is possible to develop antibodies after a miscarriage, an ectopic pregnancy, or an induced abortion. If an Rh-negative woman becomes pregnant after one of these events, she does not receive treatment, and the fetus is Rh positive, the fetus may be at risk of Rh-related problems.

Rh陰性血妊娠正確的處理流程

●制訂Rh陰性妊娠的臨床指南；

●制訂Rh陰性妊娠的門診和住院診療流程，要包括胎兒醫學、實驗室、輸血科、麻醉科、母體醫學、新生兒科的內容；

●把每一位Rh陰性孕婦作為高危妊娠進行管理，並在門診和住院病例上粘貼明顯的標誌；

●孕期進行Rh抗體的篩查與監測；

●有指證時注射Rh免疫球蛋白RhoGAM；

●孕期早點確認宮內胎兒的Rh血型，可以採用羊膜腔穿刺的方法，但是現在更多的是採用母親外周血無創胎兒DNA（NIPT）檢測來確認胎兒的Rh血型；

●定期進行胎兒大腦中動脈血流的監測，來發現和監測胎兒宮內溶血的程度；

●定期進行超聲檢查，及時發現和監測胎兒水腫的程度；

●必要時胎兒宮內輸血；

●孕期定期採集Rh陰性孕婦自己的血並儲存，分娩時進行回輸；

●產後出血時可以收集血液進行血液的自體回輸；

●在沒有Rh陰性血的情況下，有非同型輸血（Rh陽性血的輸血）Protocol；

●與血庫有密切的聯繫，可以快速響應及時拿到Rh陰性血；

●與當地的外資診所聯繫，必要時可以及時拿到RhoGAM；

●出生后新生兒Rh血型的快速檢測。

How does Rh sensitization affect the fetus during pregnancy?

Problems during pregnancy can occur when Rh antibodies from an Rh-sensitized woman cross the placenta and attack the blood of an Rh-positive fetus. The Rh antibodies destroy some of the fetal red blood cells. This causes hemolytic anemia, where red blood cells are destroyed faster than the body can replace them.

Red blood cells carry oxygen to all parts of the body. Without enough red blood cells, the fetus will not get enough oxygen. Hemolytic anemia can lead to serious illness. Severe hemolytic anemia may even be fatal to the fetus.

How can I find out if I have become Rh sensitized?

A blood test, called an antibody screen, can show if you have developed antibodies to Rh-positive blood and how many antibodies have been made. If you are Rh negative and there is a possibility that your baby is Rh positive, your health care provider may request this test during your first trimester and again during week 28 of pregnancy.

Can Rh sensitization be prevented?

Yes. If you are Rh negative, you will be given a shot of Rh immunoglobulin （RhIg）。 RhIg is made from donated blood. When given to a nonsensitized Rh-negative person, it targets any Rh-positive cells in the bloodstream and prevents the production of Rh antibodies. When given to an Rh-negative woman who has not yet made antibodies against the Rh factor, RhIg can prevent fetal hemolytic anemia in a later pregnancy.

Can RhIg help me if I am already Rh sensitized?

RhIg is not helpful if you are already Rh sensitized.

When is RhIg given?

RhIg is given to Rh-negative women in the following situations:

· At around the 28th week of pregnancy to prevent Rh sensitization for the rest of the pregnancy

· Within 72 hours after the delivery of an Rh-positive infant

· After a miscarriage, abortion, or ectopic pregnancy

· After amniocentesis or chorionic villus sampling

What if I am Rh sensitized and my fetus is Rh positive?

If you are Rh sensitized, you will be monitored during pregnancy to check the condition of your fetus. If tests show that your baby has severe anemia, it may be necessary to deliver your baby early （before 37 weeks of pregnancy） or give a blood transfusion while your baby is still in your uterus （through the umbilical cord）。 If the anemia is mild, your baby may be delivered at the normal time. After delivery, your baby may need a transfusion to replace the blood cells.

紅楓的產科擁有眾多經驗豐富、技術高超的國際、國內權威專家。我們的服務包括孕前諮詢與保健、產檢、分娩及產後檢查。產檢項目涵蓋常規產檢、胎兒畸形篩查、胎心監護和子宮內胎兒彩超等各方面的檢查。我們為您提供多種分娩方式的選擇，包括家庭式分娩、水中分娩、無痛分娩和剖宮產等。產科醫生可為您提供從懷孕到分娩全程跟蹤式服務。

Our Obstetrics Department offers a broad array of services including preconception checks for couples planning pregnancy, prenatal care for those already pregnant, labor and delivery care,and postpartum checkups. We provide the option for family-accompanied delivery,water birth, epidural anesthesia and Cesarean delivery. The birth is supervised by your Redleaf Obstetrician, midwife, anesthetist, neonatologist, and nurses who will give personal, attentive, and continuous service to each mother.