Immunoglobulin for the expectant mother: when there is “blood feud” in the womb. This introduction of antibodies does not harm the fetus, the mother, or the newborn.

When pregnancy occurs, serious changes begin in the body, and all its systems begin to work differently. This also applies to the immune system. Many people think that a pregnant woman's immunity should automatically increase to protect the fetus from infectious diseases, but this is not so. Due to increased stress on the body, it weakens, which becomes dangerous for the baby.

If a severe weakening of the immune system can pose a threat to bearing a child, then the woman is given an injection of immunoglobulin during pregnancy. This medicine is of natural origin - it is obtained from human plasma. An active substance is released from it, which is well purified and concentrated in a special way. Immunoglobulin during pregnancy helps the body fight viruses, bacteria and infections. But is it as safe as it seems at first glance?

Human immunoglobulin for pregnant women

There are two types of immunoglobulin:

human;
anti-D immunoglobulin.

These drugs have different effects on the body and are prescribed for certain health conditions of the expectant mother.

Human immunoglobulin during pregnancy is prescribed to protect the fetus from viruses and bacteria. This drug strengthens a woman’s immune system and helps it cope with any infectious agents. An immunoglobulin injection during pregnancy is also prescribed to reduce the likelihood of premature birth or miscarriage.

But immunoglobulin is not safe for pregnant women. Even if there are all indications for the use of the drug, some side effects are observed after the injection:

weakness;
chills;
temperature increase;
cough,
a sore throat,
dizziness,
pain in the back of the head or temples.

An immunoglobulin injection during pregnancy can also cause more serious complications. A woman may experience vomiting and diarrhea, aching joints and lower back pain. After the injection, tachycardia is often observed and the pulse quickens.

But the worst thing is that it has not yet been definitively established how this drug affects the fetus. An immunoglobulin injection during pregnancy can pass without a trace for the unborn baby, or can cause the development of serious diseases.

Indications for the use of anti-Rhesus immunoglobulin during pregnancy

If the father has a positive Rh factor and the mother is negative, then a Rh conflict arises, which poses a serious threat to the fetus. The fact is that the woman’s body begins to produce antibodies in order to get rid of the fetus, which it perceives as a foreign body. When antibodies are produced, the fetus may develop blood diseases, and there is also a high probability of pathology occurring in the newborn.

To reduce the production of antibodies that are dangerous to the child, a woman is prescribed anti-Rhesus immunoglobulin during pregnancy. This therapy allows you to save the child and carry it to term. Anti-Rhesus immunoglobulin is also prescribed for the second pregnancy, if the first one ended in abortion.

Anti-Rhesus immunoglobulin during pregnancy is less dangerous than “human” immunoglobulin. After using it, the temperature may rise and itching of the skin may appear. Nausea, vomiting and stomach upset occur less frequently. This medicine has virtually no contraindications - it is prohibited for people with individual intolerance to the drug.

How to take immunoglobulin for pregnant women

This drug is available in liquid or powder form. It should not be taken without medical prescription. Only a doctor, after studying the tests, can decide whether you should be treated with this drug or not. He also calculates the dosage - it depends on the individual characteristics of each patient’s body. Immunoglobulin can be administered intramuscularly through a syringe and intravenously through a dropper. The method of introducing the medicine into the body is also determined by the doctor.

During pregnancy, doctors recommend avoiding taking any, even the most harmless, medications, not to mention immunoglobulin, which can be beneficial or harm the health of the unborn baby. Taking an anti-Rhesus drug is a necessary measure - it is difficult to maintain a pregnancy without it. But taking human immunoglobulin should be started only after all folk remedies for boosting immunity have been tried. Because the final effect of this drug on the fetus has not been studied, and no one can say for sure what complications its use can cause.

If a pregnant woman has a negative blood type, and the baby inherits the father's positive Rh, there is a risk of Rh conflict. The mother's immune system regards the fetus as a foreign body and tries to reject it. The risk of a conflict between the Rhesus of the mother and baby increases by 10% with each pregnancy. With such initial data, women are often offered an injection of immunoglobulin. For what indications is the drug needed and how many injections are needed?

What is the purpose of immunoglobulin and how does it work?

Immunoglobulin is a drug that is a protein fraction and consists of antibodies extracted from the blood plasma of donors. There are two types of medication:

Human immunoglobulin. Used when a person is faced with an infectious disease (herpes, cytomegalovirus, etc.). The drug is used extremely rarely for pregnant women - it is necessary if the expectant mother’s body does not respond to antibacterial agents or she is at risk of miscarriage. The purpose of using the medication is to stimulate the immune system. A few days after immunization, a woman becomes resistant to infections.
Anti-Rhesus. The drug is injected into pregnant women when a conflict arises between the Rh blood levels of the mother and child.

Anti-Rhesus immunoglobulin (anti-D) differs from normal human immunoglobulin in that it includes antibodies to Rh-positive antigens, rather than to viruses. People without medical training often mistake it for a vaccination, comparing it with vaccines, for example, against the flu or chickenpox. However, the differences are fundamental: the medication contains antibodies synthesized by the immune system, and not inactivated pathogens.

When an anti-Rhesus drug is administered to a mother, the antibodies contained in it replace immune cells, thereby “deceiving” the defenses of her body. Positive red blood cells that enter the bloodstream from the baby are destroyed, which prevents an immune response and termination of pregnancy. Timely use of the drug ensures the normal course of pregnancy and significantly reduces the possibility of hemolytic disease in the second child and subsequent children.

Indications for the use of immunoglobulin during pregnancy

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Before using immunoglobulin, the doctor must weigh the pros and cons, since this is a strong immunostimulating drug, the effect of which on the child developing in the womb has not been fully studied. It is used exclusively for negative Rhesus in women.

Direct indications for the use of serum are:

opposite rhesus indicator in the fetus;
risk of miscarriage;
high risk of Rh conflict;
diabetes;
violation of the placental barrier;
placental abruption;
peritoneal injuries;
late toxicosis in severe form;
ectopic pregnancy;
“positive” blood from the father;
abortion;
infectious diseases.

Contraindications and side effects

The drug is not prescribed in a number of cases:

hypersensitivity to the drug;
severe allergy to any blood products;
Rh negative with sensitization and the presence of antibodies;
Rh positive.

Immunoglobulin should be used with caution during pregnancy if the expectant mother suffers from migraines or kidney disease. The medication cannot be combined with some medications, so a separate syringe or dropper is needed to administer it.

If during injection or infusion into a vein the dosage and rate of delivery of the medicine are observed, there will be no serious side effects. Within an hour the following are observed:

malaise;
headache;
chills;
slight increase in temperature.

Immunoglobulin is normally tolerated by patients, but sometimes a woman may be bothered by:

cough;
nausea and vomiting;
dyspnea;
hyperthermia at the site of needle insertion;
excessive salivation and sweating;
chest and stomach pain;
allergy;
weakness;
aching joints, like flu;
facial hyperemia.

Methods of using immunoglobulin

Immunoglobulin is administered twice: at 28 weeks of pregnancy and immediately after birth. This helps prevent the occurrence of a conflict between the Rhesus of the mother and the baby when the woman becomes pregnant again. The drug is administered intramuscularly and by intravenous infusion. The method of application is determined by the dosage, the state of immunity, as well as how the body of the expectant mother tolerates this substance.

During pregnancy

The drug is administered after the expectant mother has passed a test for antibodies to the D-antigen. If she is at risk of miscarriage, the doctor gives an injection of immunoglobulin in a standard dosage at the 7th month of pregnancy, and a second infusion will be needed after childbirth. The drug remains active in the body for 3 months. Sometimes the timing of the procedure is significantly shifted:

In the 1st trimester, an injection is given if there is a risk of miscarriage or forced abortion.
In case of peritoneal injury at 13–18 weeks or amniocentesis, premature birth, hemorrhage or hematoma formation are possible, therefore the use of the drug is indicated. It is re-prescribed at 26–28 weeks. In case of extensive hematoma, the medicine is administered monthly until delivery.

Before using the drug, warm it for 2 hours at a temperature of 18–20°C. For injection, select a large muscle (buttock, shoulder), where the serum is slowly injected with a special syringe tube. After the procedure, the patient should be under the supervision of doctors for about an hour so that they can assess her body’s reaction to the medication.

After childbirth

Before giving birth, the woman is warned that repeated use of the drug may be necessary. The indication for the procedure is positive Rh in the born child. Otherwise, there is no need for the medicine.

It is recommended to administer the medication within 72 hours after birth, preferably as early as possible. If a test was carried out in the delivery room and antigens were detected in the child, the injection is given immediately. During the first gestation, the risk of Rh conflict is lower, and during the second and all subsequent gestations, it is higher, so the use of the medication makes it possible to avoid complications in the future. Immunoglobulin is also administered after an ectopic pregnancy, its artificial termination, miscarriage, death of a child during childbirth, and placental abruption during a difficult delivery.

The dosage is adjusted depending on how many “foreign” red blood cells (baby’s blood cells) enter the mother’s bloodstream. The standard dose (200–300 mcg) is increased by 1.5–2 times during cesarean section or manual placental abruption.

If the medicine was not administered, then three days later the woman must be tested for antibodies. Their presence can negatively affect the baby, as a result of which doctors will recommend switching him from breast milk to formula.

Consequences for the expectant mother

Immunoglobulin has been used to support the condition of women with complicated pregnancies since 1968, and so far there have been no cases of severe reactions to the drug. However, its use still has possible negative consequences:

Side effects such as skin redness and hyperemia appear infrequently and disappear within 24 hours. A serious consequence of the administration of the drug is anaphylactic shock, but such cases are recorded extremely rarely. If an acute allergic reaction occurs, doctors will immediately provide first aid.
Infection with difficult to treat or incurable infections. The use of extracts from donor blood carries the risk of hepatitis or HIV viruses entering a woman’s body. However, the manufacturers of the drug claim that before its creation, donors are carefully checked, and the serum undergoes multi-stage purification, which practically eliminates all risks. The possibility of infection is 1:10000.
Possibility of overdose. If you follow the manufacturer's instructions regarding calculating the amount of the drug, there are no risks for a pregnant woman. When 15 ml of “foreign” red blood cells enter a woman’s blood, 300 mcg of medication is injected. Experts determine the dosage using the Kleihauer and Bethke method of counting the number of red blood cells.

Prevention of Rhesus conflict

If a woman with negative Rh is planning a pregnancy in advance, she needs to ask the father of the unborn baby to undergo an examination to prevent complications during pregnancy. If she becomes pregnant, you must:

register with a gynecologist before 12 weeks;
administer immunoglobulin at the time prescribed by the specialist if the father’s blood is “positive”;
in the absence of sensitization, use the drug during all pregnancies.

Women with a negative blood type should be careful: if possible, avoid invasive procedures and not have abortions. Immunoglobulin will have to be administered both during natural termination of pregnancy and during abortion. Even if a pregnant woman is given immunoglobulin, the doctor will give her a monthly referral to test for antibodies in the blood.

Each person is unique: we have different eye color, nose shape, height, weight. We also differ from each other in blood types.

There are four blood groups, discovered back in 1900 by Karl Landsteiner. Forty years later, another specific protein was discovered - the Rh factor, which will be discussed in this article.

Information Rh factor (Rh) is an antigen (protein) that is found on the surface of red blood cells (erythrocytes). People whose red blood cells contain this protein are considered Rh positive (80-85%), the rest are Rh negative.

The importance of the Rh factor during pregnancy

They say: "Love is blind." It happens that families appear where, and her husband is a carrier of the Rh factor. According to statistics, every tenth pregnant woman is Rh negative, and the fetus is positive. It is these women who may experience an unpleasant phenomenon during pregnancy – Rh conflict.

Additionally- incompatibility of blood groups according to the Rh factor between a Rh-negative mother and a Rh-positive child, leading to the breakdown of red blood cells in the fetus.

Normally, during pregnancy, the blood of the mother and fetus do not mix, so most often in the first pregnancy there is no Rh conflict. However, during childbirth, abortion, miscarriage or intrauterine manipulation, the child’s red blood cells come into contact with the woman’s blood, and the mother’s body perceives them as foreign and dangerous. The mother’s immune system gives the command: “Destroy!” and begins to produce specific antibody proteins (immunoglobulins). There are certain groups of women at risk for developing Rh conflict:

Multiparous women (subject to the birth of Rh-positive children);
Women with a history of abortion, spontaneous miscarriage, stillbirth, hydatidiform mole;
Women with a history of;
Women after and other invasive obstetric surgeries;
Women who received transfusions of blood and its components.

Anti-Rhesus antibodies (immunoglobulins) attack the fetal red blood cells, leading to their hemolysis (disintegration). The main manifestations of Rh conflict are:

Hemolytic jaundice of the newborn;
Anemia of the fetus and newborn;
Thrombocytopenia of the fetus and newborn;
Hydrops of the fetus and newborn;
Death of a newborn.

Diagnostics

As always in medicine, the best treatment is prevention. That is why a woman planning a pregnancy should know the blood type - both her own and the father of the child. A Rh-negative woman who has already had a pregnancy or blood transfusion must be tested for anti-Rhesus immunoglobulins. This analysis is given:

From a vein;
On an empty stomach;
By abstaining from and taking medications before taking the test.

In addition to preconception preparation, an Rh-negative woman will undergo such testing regularly throughout her pregnancy as directed by her attending physician. If no antibodies are detected in the analysis, the probability is extremely low. If there are immunoglobulins, then their quantity (titer) is also important. You should not try to interpret your tests yourself, because even doctors have not come to a consensus and many questions regarding Rh conflict remain open.

Prevention of Rhesus conflict

Fortunately, medicine has made great strides forward and modern women do not have to repeat the fate of their great-grandmothers, when a huge number of miscarriages and stillbirths were considered “a bitter woman’s lot.” The introduction of anti-Rhesus immunoglobulin into practice has been one of the greatest achievements of recent decades. The CIS market is mainly represented by the Swiss drug “Rezonativ”; in North America the drug “RhoGAM” is used.

Use of immunoglobulin during pregnancy

Method of administration

The recommended administration regimen involves administering the first dose of the drug at 28-32 weeks of pregnancy, with the second dose administered within 72 hours after birth. If prenatal prophylaxis was not given, a specific dose of the drug should be administered within 72 hours after childbirth, miscarriage, abortion, ectopic pregnancy, or any intrauterine obstetric surgery.

Dosage

The dose is selected individually depending on the outcome of pregnancy and the severity of fetal bleeding.

Safety

Anti-Rhesus immunoglobulin is absolutely safe for the fetus. The drug is administered into the muscle with a special syringe.

Side effects

Most often, the injection is easily tolerated, but some side effects are possible:

A short-term increase in temperature up to 40 degrees Celsius;
General weakness, chills;
Headache, nausea, vomiting;
Skin reactions - swelling, itching, burning, redness;
Allergic reactions;
In rare cases, shock and anaphylactic reactions.

Trusting your doctor and following all recommendations is the key to successful motherhood!

Pregnancy entails various metamorphoses in the body and these are not always changes 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 a baby, so that the body itself does not perceive it as a foreign body, otherwise the fetus may be rejected.

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

The product helps the body resist a variety of viruses and other microorganisms that cause diseases. 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 available in two forms: ready-made solution and powder. Available only by prescription.

When is immunoglobulin administration 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. However, they are prescribed only in extreme cases when there is a serious danger to the patient’s health.

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 remedy is used for the fairly well-known Rhesus conflict.

Anti-Rhesus 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. Rh conflict occurs in two situations: when transfusion of Rh-incompatible blood; when a woman with Rh negative is pregnant with a child who is Rh positive. The last option involves the administration 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 happens, the female body begins to produce immunoglobulin antibodies.

When a foreign protein (antigen) is encountered for the first time, immunoglobulin M begins to be produced. It, in turn, transmits information about the encounter with the antigen to the B-lymphocyte, which synthesizes immunoglobulin G - specific antibodies that are created to interact with the antigen.

If there are antibodies to a specific antigen, then sensitization of the body occurs. The most significant thing for doctors is a woman’s sensitization to fetal red blood cells, that is, the incompatibility of Rh blood factors.

Rh conflict can cause anemia and, in some cases, even more serious consequences - damage to the brain and heart of the fetus.

When does Rh conflict occur?

For infection;
Gestose;
Diabetes in pregnant women;
Medical manipulations;
During childbirth;
With placental abruption;
Ectopic pregnancy.

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

Prevention of Rh conflict

For a woman with negative Rh, it is necessary to minimize invasive procedures and avoid abortions. When transfusing blood, carefully check compatibility. Prevention of maternal sensitization to fetal red blood cells is now widely practiced.

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.

If, before the 28th week, antibodies to the baby’s red blood cells are not determined or their titer does not exceed 1 to 4, then at the same time they give a kind of vaccination - an injection of anti-Rhesus immunoglobulin during pregnancy intramuscularly (Rezonativ, HyperRow). This product is a ready-made antibody to red blood cells.

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

Re-entry occurs within 72 hours from the moment the baby is born. This measure will reduce the risk of Rh conflicts in subsequent pregnancies. But a second anti-Rh 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 pregnancy or after premature birth, for abdominal injuries and at the end of invasive procedures (for example, cordacentesis and amniocentesis).

If at 20 weeks the titer of anti-Rhesus immunoglobulins exceeds 1 to 16, then the level of antibodies must be monitored 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, when signs of hemolysis appear, the need for intrauterine blood transfusion to the fetus arises, and the question of premature birth also arises. The current circumstances strictly prohibit the administration of immunoglobulin.

Method of using immunoglobulin

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

Consequences of an intramuscular injection of immunoglobulin during pregnancy

It is worth noting that negative reactions from the body are very rare. When administering the drug, it is necessary to observe the dosage and speed of administration, and other recommendations must be followed.

Minor effects may appear during the first hour after administration of the drug. Usually these are phenomena such as: general malaise, headache, weakness, chills. In some women, the injection provokes a fever.

Pregnancy is a natural condition for the female body. Under the influence of hormonal changes, protective properties are reduced. The likelihood of various infectious diseases that are dangerous to the development of the fetus increases.

In special cases, when the patient is diagnosed with primary or secondary immunodeficiency, or there is a risk of miscarriage, she is prescribed immunoglobulin therapy. This is a drug based on antibodies obtained from donor plasma.

Types of immunoglobulins

There are several types of immunoglobulin during pregnancy; they are not interchangeable, since their mechanism of action on the body is different.

The main drugs used during pregnancy:

human - concentrated purified bodies isolated from donor plasma, the main task is to adjust a woman’s immune parameters to fight various viruses and infections, IgG levels are normalized, can be part of multicomponent preparations, separately available in the form of a powder for diluting injections;
anti-Rhesus - the possibility of developing a conflict in a woman with a negative Rh factor increases with each subsequent pregnancy, this leads to hemolytic disease of the fetus, anti-Rhesus immunoglobulin is used to prevent the condition, it is important for a woman to register before 12 weeks, the drug can be administered at the planning stage.

Administration of the drug is practiced after childbirth to reduce the formation of antibodies during subsequent pregnancies. If the father, like the mother, has a negative Rh factor, prescribing the drug does not make sense, due to the lack of conflict.

Indications for the use of immunoglobulin

Each expectant mother undergoes tests to determine antibodies to identify the presence of types A, E, G, M to various allergens. It is carried out 2 times to confirm the results, the accuracy may be influenced by external factors.

The drug is not prescribed to all expectant mothers, but only in cases dangerous for pregnancy failure. Not used if the woman has a positive Rh factor. The circulatory systems of the mother and fetus function separately from each other, risks arise if the placental barrier is damaged. Only a doctor prescribes drug therapy; the treatment regimen is calculated on an individual basis.

In what cases is immunoglobulin prescribed to pregnant women:

if spontaneous miscarriages, developmental arrest, or ectopic pregnancy have occurred;
with injuries to the internal organs of the small pelvis;
abortions;
birth of a child with Rh+ to a mother with Rh-;
presence of infectious diseases;
after amniocentesis - sampling of amniotic fluid;
the couple has a Rh conflict, the woman has Rh-, the man has Rh+;
gestosis, toxicosis;
diabetes.

The main contraindications for prescribing immunoglobulin are a positive Rh factor in the expectant mother, sensitivity to the drug's antibodies, as well as individual intolerance.

The effect of immunoglobulin preparations on the body has not yet been sufficiently studied. Therefore, a course of treatment is prescribed on an individual basis if there are threats to the health or life of a woman or child.

Treatment and therapy

Before use, the drug is kept at a temperature of 18-22°C for a couple of hours; using a needle with a wide bore will help avoid the formation of foam. After opening the ampoule, the contents are used immediately; subsequent storage is unacceptable. Immunoglobulin is administered only intramuscularly, once during the entire pregnancy. The standard dosage is considered to be 300 mcg or 600 mcg, depending on the results of tests for antibody markers.

If there are no antibodies in the blood test, the drug is administered at 28 weeks of pregnancy. Repeatedly, within 2 days after the birth of a child with Rh+, if the newborn has a negative Rh factor, the drug is no longer used. If there is a threat of miscarriage in an Rh-negative woman, a single dose of the drug is administered during the gestation period. To prevent risks after the amniocentesis procedure, immunoglobulin is also used; after collection, treatment is carried out according to the standard regimen.

Consequences of treatment

The drug has allergenic properties, so after administration, the woman’s condition is monitored. If a severe allergic reaction or anaphylactic shock develops within an hour, the pregnant woman is given medications to stabilize the condition.

Possible consequences after immunoglobulin:

on the first day the body temperature rises;
chills, headache, general deterioration of health;
decreased blood pressure;
sore throat, cough;
increased heart rate, tachycardia;
chest pain;
the injection area becomes noticeably red;
There are digestive disorders - vomiting, diarrhea.

Despite a number of side effects, the use of immunoglobulin allows you to preserve and bear a healthy baby.

Prevention

To prevent Rh conflict, a woman with Rh- and a man with Rh+ need to plan pregnancy. The spouses are examined, routine tests must be taken, and corrective medications may be prescribed. To reduce the risk of developing hemolytic disease in a child, treatment is carried out at 28 weeks.

Prevention measures:

a woman must register early;
a balanced diet and a healthy lifestyle will reduce the risk of developing infections;
It is mandatory to take tests and undergo examinations for timely diagnosis of dangerous diseases.

Treatment with immunoglobulin during pregnancy is carried out under the strict supervision of a doctor. There may be different methods of administration - intramuscularly or using droppers. The chosen method and dosage will depend on the woman’s individual characteristics. Timely use of the drug will help maintain pregnancy and avoid risks to the baby’s health.