Immunoglobulin during pregnancy with a negative Rh mother: the essence of the action, the rules of administration. Pros and cons of using immunoglobulin during pregnancy

During pregnancy, the immune system of women weakens, so they are more likely to get sick with various diseases. The fetus is a foreign body for the woman's body. With a decrease in general immunity, the likelihood of its rejection decreases. Sometimes the immune system is so weakened that a woman is no longer able to resist infections that pose a threat to the unborn child. Doctors for patients with secondary immunodeficiency prescribe human immunoglobulin during pregnancy.

Immunologists use immunoglobulin for pregnant women when the benefit of the drug to a pregnant woman outweighs the potential risk to the fetus.

What immunoglobulin is administered during pregnancy? For the prevention and treatment of infectious diseases, a simple human immunoglobulin is prescribed. The second immune drug that is used during pregnancy is anti-Rhesus immunoglobulin. It is administered to Rh-negative women who are pregnant with an Rh-positive fetus. The drug prevents the breakdown of the erythrocytes of the unborn baby. After its introduction, the Rh conflict and hemolytic disease of the newborn do not develop.

Prevention of infectious diseases in pregnant women

Infectious diseases adversely affect the course of pregnancy. Many viruses infect fetal tissues and cause birth defects. Rubella is a childhood infection that is easily carried by children. Rubella virus infection during pregnancy leads to severe fetal malformations.

If a woman gets rubella in the first trimester of pregnancy, hereditary rubella syndrome can develop, manifested by three symptoms: clouding of the lens (cataract), deafness, and heart defects. Infection with the rubella virus can lead to the following consequences:

fetal growth retardation syndrome;
encephalitis (inflammation of the brain);
damage to the lymph nodes, liver and spleen;
defects in the development of the skeleton and genital organs;
microcephaly.

Rubella infection can cause a missed pregnancy or miscarriage. In some cases, signs of the disease (hearing loss, autism, psychomotor development disorders, diabetes mellitus) appear at a later age of the child.

The disease in pregnant women is asymptomatic. When a pregnant woman comes into contact with a patient with rubella, doctors conduct a serological examination within 10 days to determine the level of class M and G immunoglobulins. The presence of M immunoglobulins indicates a primary infection, the most dangerous for pregnant women. A high content of class G immunoglobulins indicates the presence of immunity to the rubella virus.

There are no effective drugs to treat rubella in pregnant women. Doctors carry out disease prevention at the stage of pregnancy planning. Upon contact with the patient, human immunoglobulin is administered.

Herpes is one of the most common infections during pregnancy. Infectionists believe that the greatest danger to the fetus is herpes type II (genital). When infected with the causative agent of herpes type I, the virus can be released into the blood of a pregnant woman, which is dangerous for the fetus. When infected with the herpes virus in the first trimester of pregnancy, the risk of developing malformations in the fetus of heart defects, defects in the gastrointestinal tract, and hydrocephalus increases. If a woman gets herpes in the second or third trimester of pregnancy, the fetus may develop pancreatitis, hepatitis, encephalitis, or pneumonia. Pregnant women are prescribed antiviral therapy and simple human immunoglobulin.

Anti-rhesus immunoglobulin during pregnancy

Anti-Rhesus immunoglobulin is a protein immunologically active fraction, which is obtained from the blood of donors. The drug is prescribed in case of getting into the blood of a pregnant Rh-negative woman of erythrocytes of a Rh-positive fetus:

After an abortion or ectopic pregnancy;
With premature detachment of the placenta, which is accompanied by bleeding from the vessels of the placenta;
In the third stage of labor, when the placenta separates from the uterine wall;
If a woman underwent an invasive study (amniocentesis, cordocentesis - puncture of the fetal bladder or umbilical cord).

Anti-Rh immunoglobulin is used in the second and subsequent pregnancies to prevent Rhesus conflict. If you enter anti-Rhesus immunoglobulin within 72 hours after birth, then there will be no further problems. With the threat of miscarriage, the drug is administered at 28 weeks. The mother's body receives ready-made antibodies that destroy the fetal red blood cells if they enter her bloodstream. Antibodies administered with immunoglobulin are stored during pregnancy in the mother's body for 12 weeks, and then they are independently excluded from the general blood circulation system.

Anti-Rhesus immunoglobulin is administered intravenously in a hospital setting. The drug is well tolerated, but with individual intolerance, allergic reactions may develop. In this regard, the woman is under the supervision of doctors within 2 hours after the administration of immunoglobulin.

In some cases, during the first hour, patients experience an increase in body temperature, chills, weakness, drowsiness, and rapid heartbeat. The introduction of immunoglobulin during pregnancy may be accompanied by pain in the muscles and joints, allergic reactions. Manipulation rooms in the Yusupov hospital are equipped with an anti-shock kit. In the event of signs of anaphylactic shock, adrenaline, antihistamines, glucocorticoid hormones and plasma-substituting solutions are administered to patients.

The introduction of immunoglobulin during pregnancy

Ampoules with immunoglobulin are taken out by nurses from the refrigerator and kept for two hours at an air temperature of 18–22 °C. To prevent the formation of foam, the drug is drawn into the syringe with a needle with a wide lumen. Simple immunoglobulin is administered intramuscularly, and anti-Rhesus - intravenously slowly. Before performing the injection, the needle is changed.

The medical staff of the Yusupov hospital is attentive to all complaints that may arise during the administration of immunoglobulin. Nurses stop the administration of the drug and report the side effect to the doctor. All data is recorded in a special log. It registers the name of the immunoglobulin, the manufacturer, the dose of the drug and the route of administration. Note the body temperature and the presence of unwanted reactions.

The use of a simple immunoglobulin during pregnancy can increase the overall and specific resistance of a woman's body. The purpose of the introduction of anti-Rh immunoglobulin is the prevention of Rhesus conflict and hemolytic disease of the newborn. Book an appointment with an immunologist by calling the clinic. After the examination, the doctor may, if necessary, prescribe human or anti-Rhesus immunoglobulin. These are absolutely safe drugs. After the introduction of immunoglobulins, the doctors of the Yusupov hospital did not subsequently observe infection with the human immunodeficiency virus or pathogens of viral hepatitis.

Bibliography

ICD-10 (International Classification of Diseases)
Yusupov hospital
"Diagnostics". - Brief Medical Encyclopedia. - M.: Soviet Encyclopedia, 1989.
"Clinical evaluation of the results of laboratory studies" / / G. I. Nazarenko, A. A. Kishkun. Moscow, 2005
Clinical laboratory analytics. Fundamentals of clinical laboratory analysis V.V. Menshikov, 2002.

Prices for diagnostic tests

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic. The list of paid services provided is indicated in the price list of the Yusupov hospital.

The incompatibility of the blood of the fetus and mother according to the Rh factor is one of the serious problems in obstetrics. Severe forms of hemolytic disease can even lead to life-threatening problems in a newborn baby. A pathological condition in 90% of cases occurs when the mother has Rh-negative blood, and the child is positive. Less often, such reactions occur with incompatibility for other blood factors.

To prevent the development of such conditions, the introduction of immunoglobulin after childbirth or termination of pregnancies at different times is used. What is this drug, how does it work and how effective is it?

Read in this article

How does immunoglobulin work after childbirth

If a woman has an Rh-negative blood affiliation, then there are no certain proteins on the surface of her red blood cells. According to statistics, about 15% of people on Earth have this, this is an absolute norm.

In the case when a baby developing in utero carries Rh-positive blood, its red blood cells have such proteins. In this they differ from the mother's blood cells.

During pregnancy and childbirth, several milliliters of plasma and the child's uniform elements enter the woman's vessels. As a result, the mother's body begins to actively respond to such foreign cells with the formation of antibodies. The latter later penetrate even intrauterine to the fetus and begin to destroy those very Rh-positive red blood cells with the development of anemia in the child.

The consequences can be so serious that intrauterine death of the baby is not excluded.

Immunoglobulin is a drug containing components that can actively bind the Rh-positive erythrocytes of the child in the mother's blood, if they got here. Thus, if fetal red blood cells are circulating at the time of drug administration, they are destroyed without any consequences for the body.

But there are several conditions that must be observed in order for such prevention to be effective. They are the following:

The introduction of immunoglobulin is carried out in most cases outside the pregnant state. This is the prevention of the development of hemolytic disease. According to some recommendations, the introduction of immunoglobulin during pregnancy is also indicated. But if a woman already has signs of a Rh conflict during gestation, the use of the drug is pointless. The disease can no longer be prevented in this case, including for subsequent pregnancies.
Immunoglobulin must be administered within 72 hours after delivery, and the sooner this is done, the better. The fact is that during childbirth or termination of pregnancy, the maximum reflux of the blood of the child to the woman occurs. The number increases with various additional manipulations - curettage, manual separation of the placenta, etc.

As soon as antibodies to the baby's red blood cells have already formed in the woman's blood, the introduction of immunoglobulin is pointless, since the chain reaction has already been launched.

Who will need the introduction of immunoglobulin after childbirth

Immunoglobulin is administered to women if they are diagnosed with Rh-negative blood. The main indications for administration are as follows:

After the first birth in Rh (-) women. Ideally, if immediately after birth, the baby's blood type, Rhesus are determined, and only in the case of Rh (+), immunoglobulin is administered to the mother.
It is also advisable to administer the drug after the second birth. After the third, it is considered that its use is inappropriate, since immunization has already occurred in any case, or for some reason it has not been and will not be.
After removal of an ectopic pregnancy.
If during childbirth a woman had placental abruption.
If the mother received a transfusion of Rh-positive blood or platelets.
Also, immunoglobulin is administered after miscarriages, non-developing pregnancies, premature births with an unsuccessful outcome.
During gestation, this remedy is used if a chorionic villus biopsy or amniocentesis is performed.

Watch the video about the Rhesus conflict:

Is it necessary to administer anti-Rhesus immunoglobulin

The introduction of immunoglobulin can really insure a woman from the development of a subsequent Rh conflict with her unborn baby. But in order for prevention to be effective, the following conditions must be met:

Administer the drug according to indications, including during pregnancy.
The sooner after childbirth, the more effective. Most manufacturers indicate a permissible time interval of 72 hours, but, for example, similar Russian drugs should be used up to 48.
Be sure to adjust the dose of administered immunoglobulin, depending on the intended exchange of blood between mother and child.

The standard dose is 200 - 300 mcg (this is about 1 - 1.5 ml), but after a cesarean section, manual separation of the placenta and many other manipulations, the amount must be increased by 1.5 - 2 times.

Otherwise, not all red blood cells in the mother's blood will be bound, and an immune response will still develop for the remaining portion. As a result, the effectiveness of prevention is reduced to zero.

Where to get immunoglobulin for injection

Usually, immunoglobulin is available in all gynecological and obstetric departments in hospitals, as well as in antenatal clinics. Its introduction is provided for by treatment protocols and is free of charge.

Also, the drug is available in retail stores in pharmacies, but it is issued only by prescription. Including it is produced under the name "Resonativ".

Reasons why doctors did not administer immunoglobulin after childbirth

Women are not always notified that they have been administered immunoglobulin, as this is a common procedure after childbirth or other similar manipulations.

But sometimes the use of the drug is not provided. This is possible in the following situations:

If a woman has a third and subsequent births. It is believed that such prophylaxis should be carried out for the last time after the second child.
If the newborn baby also has Rh-negative blood. In this case, there is no conflict. But a similar reaction is excluded in subsequent pregnancies if the fetus already has a different blood type.
If a woman has contraindications to the drug, for example, allergic reactions, etc.
If the drug is not available in the hospital or clinic. In this case, the doctor should notify the woman and recommend purchasing, explaining all the possible consequences.

Possible complications from the injection

Immunoglobulin is a blood product administered intramuscularly. After its use, the following complications may occur:

even if such hypersensitivity has never been observed before. It can be urticaria, anaphylactic shock, Quincke's edema. Therefore, if you experience a rash on any part of the body, difficulty breathing, swelling of tissues, and other symptoms, you should immediately inform your doctor.
Soreness, slight swelling, itching and redness may appear directly at the injection site.
Sometimes there are general reactions of the body, such as nausea, vomiting,.
Since immunoglobulin is a blood product, the possibility of HIV transmission cannot be ruled out, despite careful selection of donors and numerous tests of the drug. Therefore, it is recommended to undergo a control examination for these infections in six months.

Rhesus conflict between the mother and the fetus is a serious condition that primarily threatens the health of the baby. The arsenal of medicines in the fight against such conditions is small, therefore, a significant role is given to the prevention of the development of such conditions.

One of the means is immunoglobulin, the introduction of which, according to strict recommendations and with careful observance of all conditions, can help prevent the development of such complications.

Women regard such a joyful event as pregnancy differently: someone just tries to take care of themselves, but some try in every possible way to “help” themselves cope with such a heavy load and begin to take a huge amount of vitamins, dietary supplements and other substances, not taking into account that the body during this period purposefully reduces immunity in order to keep the "foreign body" inside and not reject it. Let's try to figure out together how to support immunity, and tell you how immunoglobulin affects both organisms during pregnancy.

What is it - immunoglobulin?

In general, this is a serum produced from the blood of an absolutely healthy person. It is used not only as a general tonic, but also as a very strong drug for raising human immunity. Human immunoglobulin during pregnancy is prescribed only in extreme cases, as it belongs to the category of potent drugs. Each instruction says that its full effect on a pregnant woman and fetus, respectively, has not yet been studied, so this appointment is really an extreme measure that the doctor uses under his own responsibility.

Why is immunoglobulin used during pregnancy?

Despite all the negative consequences that may occur when prescribing immunoglobulin, there are cases when its use is simply vital. Immunoglobulin during pregnancy is the only medicine that can stop the development of a viral infection that does not respond to antibiotics, but rather only progresses. As you know, any disease during this period can be fatal for a developing organism, therefore, if there is a threat of miscarriage, immunoglobulin is also prescribed. Very often this remedy is also used in case of a conflict between the Rh factors of the fetus and the mother. If the child's Rh is negative, and the mother's is positive, or vice versa, then there is a threat of irreparable consequences, up to the rejection of the fetus. Immunoglobulin helps during pregnancy in cases of severe abdominal injuries to the mother, when maternal blood enters the bloodstream of the fetus, a severe stage of maternal immunodeficiency is detected, and in other cases of severe gestation.

Side effects

Like any medicine, immunoglobulin during pregnancy sometimes causes side effects. Naturally, their manifestation directly depends on how the patient's body will be ready to accept a foreign substance. These negative effects include: skin rash, itching, shortness of breath, irritation of the mucous membranes, weakness and drowsiness, as well as increased fatigue; some manifestations of pain in the joints and chest and even tachycardia are possible; increase in blood pressure, temperature. There may be negative manifestations from the gastrointestinal tract: vomiting, nausea, loose stools. As a rule, some of these symptoms can be observed only when the drug is administered for the first time; subsequently, side effects either do not appear at all, or appear in a mild form.

Carefully monitor your health, not forgetting that you are responsible for two! Go through all the inspections as planned, and there will be no problems. Be healthy!

Anti-Rhesus immunoglobulin during pregnancy is prescribed in case of a threatened miscarriage of the fetus. During pregnancy, there is a decrease in the body's defenses in order to preserve the fetus - immunity weakens. However, there are times when the threat of rejection (miscarriage) still becomes a serious problem that requires medical intervention. This situation occurs against the background of a conflict between the Rh factor of the mother and the fetus. Let's consider in detail.

Rh factor

In case of incompatibility of groups according to the Rh factor (negative and positive), the destruction of the red blood particles of the fetus occurs, leading to termination of pregnancy. During the first pregnancy, problems usually do not occur, because the blood of the fetus does not mix with the circulatory system of the mother's body.

However, during subsequent pregnancies, the mother's body begins to perceive the fetus as a foreign dangerous element, and the immune system attacks. The immune system begins to produce antibodies (immunoglobulins) that destroy the embryo's red blood cells.

Women at risk include:

multiparous;
having an abortion;
who gave birth to dead children;
having spontaneous miscarriages;
having an ectopic pregnancy;
undergone obstetric surgery;
undergoing blood transfusion.

How does the conflict of the Rh factor manifest itself? The main symptoms are:

newborn jaundice;
anemia of the newborn/fetus;
dropsy of the newborn / fetus;
neonatal/fetal thrombocytopenia
neonatal/fetal death.

Important! The introduction of the drug before childbirth is mandatory. After childbirth, the drug is administered in the case of the birth of crumbs with a positive Rh factor.

Indications for use

The achievements of modern medicine have made it possible to find protection against the conflict of Rh factors. The introduction of immunoglobulin changed the clinical picture for the better. When a Rh conflict is detected, a woman is injected with a drug ("Resonativ"), which prevents a dangerous case of rejection of the fetus by the mother's immune system. The scheme of drug administration looks like this:

the first vaccination / dropper - at the age of the fetus 28-32 weeks;
the second vaccination - after childbirth (after 72 hours).

Vaccination is also administered in the following cases:

after a miscarriage;
after an abortion;
with an ectopic pregnancy;
during gynecological operations.

The vaccine does not pose a threat to the fetus, it is administered intramuscularly or intravenously. The dosage is selected in accordance with the condition of the pregnant woman and the presence of intrauterine bleeding.

After the introduction of immunoglobulin, there may be consequences in the form of:

short-term hyperthermia;
dizziness and nausea;
allergic manifestations;
shock (in rare cases).

Important! Self-treatment with immunoglobulin is not safe!

pharmachologic effect

The preparation of anti-Rhesus immunoglobulin for a dropper is a colorless (or yellowish) liquid in ampoules. The active substance for vaccination is produced from the blood of donors who have successfully passed the test for the presence of antibodies.

The drug is indicated for women with a negative Rh who are at risk after:

giving birth to a child with a positive blood group;
abortion from a husband with a positive group.

The introduction of immunoglobulin prevents the production and development of antibodies in the mother's body. As a result of the following births in the mother:

antibodies to the child's blood will not appear;
the fetus will fully develop;
there will be no stressful situation of fear of childbirth.

Prevention

Women with a negative group must be careful before and after childbirth:

avoid invasive procedures;
do not perform artificial termination of pregnancy;
check the compatibility of the group during blood transfusion;
conduct sensitization to fetal erythrocytes.

Women with a negative group should regularly check the presence of anti-Rhesus immunoglobulins before delivery.

Important! Anti-Rhesus vaccination is widely practiced in our country, however, the effect of the vaccine on the body has not been fully studied. The question "to do or not?" remains unanswered. Each expectant mother must decide on her own - for or against. When choosing an answer, trust in a personal obstetrician-gynecologist is of great importance.

Baby feeding

How to feed a newborn if the mother is Rh negative and her husband is Rh positive? Breastfeeding is allowed in the following cases:

if the child is the firstborn;
if the mother was injected with immunoglobulin after the first birth.

In mother's milk, antibodies are detected about three days after birth. If an anti-Rh injection was not given to a woman with a negative blood type, then a newborn with a positive Rh factor may suffer from feeding.

A mother's negative blood type is not a sentence for having children from an Rh-positive man. Many women have been able to bear and give birth to healthy newborns, so there is no need to panic prematurely. For more information about the negative Rh factor during pregnancy, watch the video:

Serum anti-rhesus immunoglobulin Do pregnant women need vaccinations or can they wait? Rubella vaccine before pregnancy - an opportunity to avoid complications

Pregnancy entails a variety of metamorphoses in the body and not always these changes are in a positive direction. During this period, immunity is significantly reduced. The body itself provokes this process, consciously and purposefully.

Such an event is necessary for the successful bearing of the baby, so that the body itself does not perceive it as a foreign body, otherwise the fetus may be rejected.

Sometimes doctors use, for example, for those who have problems with bearing. The agent can be administered in the form of droppers or injections. This drug is based on the active substance isolated from plasma, then purified and concentrated. Its action is aimed at immunomodulation and immunostimulation.

The tool helps the body to resist a variety of viruses and other microorganisms that are pathogens. Another feature of the drug is the replenishment of the level of IgG antibodies, which reduces the possibility of developing infections in women with primary and secondary immunodeficiency.

It is produced in two forms: ready-made solution and powder. Released by prescription only.

When is the administration of immunoglobulin necessary?

There are two types of this drug: anti-D-immunoglobulin and "normal". These are completely different substances and each of them has its own indications for use. At the same time, they are prescribed only in extreme cases, when there is a serious danger to the health of the patient.

Pregnant women are prescribed immunoglobulin only if there is a real threat of premature birth or miscarriage. In addition, it is used in the event of pathologies (infections) that can affect the health of the fetus and the expectant mother. In addition, this tool is used for a fairly well-known Rhesus conflict.

Anti-Rh immunoglobulin: what to do during pregnancy?

According to the results of medical statistics, it turns out that about 85% of people are Rh-positive, the rest are Rh-negative. Rhesus conflict occurs in two situations: when transfusing Rh-incompatible blood; during pregnancy, a woman with a negative Rh child with a positive. The last option involves the introduction of anti-D-immunoglobulin.

The immune system can divide any cells into “self” and “foreign”, but this protective function becomes a problem during pregnancy, when the mother’s body sees the embryo as a foreign body. After this has happened, the female body begins to produce antibodies, immunoglobulins.

When a meeting with a foreign protein (antigen) occurs for the first time, immunoglobulin M begins to be produced. It, in turn, transmits information about the meeting of the antigen to the B-lymphocyte, and it synthesizes immunoglobulin G - specific antibodies that are designed to interact with the antigen.

If there are antibodies to a particular antigen, then there is a sensitization of the body. The most significant for physicians is the sensitization of a woman to fetal erythrocytes, that is, the incompatibility of the Rh blood factors.

Rhesus conflict can provoke anemia and, in some cases, more severe consequences - damage to the brain and heart of the fetus.

When does Rhesus conflict occur?

With an infection;
Gestose;
gestational diabetes;
Medical manipulations;
During childbirth;
With placental abruption;
Ectopic pregnancy.

It follows from this that anti-Rhesus immunoglobulin during the first pregnancy, which proceeds without complications, may not be synthesized. After the birth of a baby or termination of pregnancy, the likelihood of sensitization increases.

Prevention of the occurrence of Rhesus conflict

For a Rh negative woman, invasive procedures should be kept to a minimum and abortion should be avoided. When transfusing blood, carefully check compatibility. Now widely practiced is the prevention of maternal sensitization to fetal erythrocytes.

There is a method that allows you to determine the level of anti-Rhesus immunoglobulins in the blood. During pregnancy, this analysis is carried out every month until 32 weeks, twice a month until 36, and then every week.

In the case when, before the 28th week, antibodies to the baby's erythrocytes are not detected or their titer does not exceed 1 to 4, then at the same time a kind of vaccination is given - an injection of anti-Rhesus immunoglobulin during pregnancy intramuscularly (Resonativ, HyperRow). This tool is a ready-made antibodies to erythrocytes.

They will stay in the body for about 3 months and then are eliminated. If the fetal blood enters the mother's bloodstream, the injected immunoglobulins will destroy it, so the immune response will not develop, and sensitization will not happen.

Re-introduction occurs within 72 hours from the moment the baby is born. This measure will reduce the risk of Rh conflicts in subsequent pregnancies. But the second anti-Rhesus injection is necessary only if, after the birth of the child, his Rh-positive blood was confirmed.

For the same purposes, anti-Rhesus immunoglobulin is used after abortions that took place after 8 weeks from the moment of conception, as well as for miscarriages, ectopic pregnancies or after premature births, with abdominal injuries and at the end of invasive procedures (for example, cordacentesis and amniocentesis).

If for a period of 20 weeks the titer of anti-Rhesus immunoglobulins exceeds 1 to 16, then it is necessary to control the level of antibodies every 2 weeks. At the same time, the doctor prescribes ultrasound, Doppler, CTG to monitor the condition of the child in the womb.

Sometimes in such a situation, with the appearance of signs of hemolysis, there is a need for intrauterine blood transfusion to the fetus, and the question of premature birth also arises. The current circumstances strictly prohibit the introduction of immunoglobulin.

Method of using immunoglobulin

The medicine is administered intramuscularly by injection or intravenously by drip (dropper). In each individual case, the doctor, see, determines the required dosage, guided by the individual tolerance of the woman and the state of her immunity.

Consequences of intramuscular injection of immunoglobulin during pregnancy

It should be noted that negative reactions from the body are very rare. When administering the drug, it is necessary to observe the dosage and rate of administration, and other recommendations must be observed.

Perhaps the appearance of minor effects during the first hour after the administration of the drug. Usually these are such phenomena as: general malaise, headache, weakness, chills. In some women, the injection provokes an increase in temperature.