Anti-rhesus immunoglobulin during pregnancy pros and cons. Anti-rhesus immunoglobulin

On the surface of erythrocytes - red blood cells that carry oxygen from the lungs to the tissues of the body, and in the opposite direction - carbon dioxide, contains a protein called the Rh factor.

Its presence is inherited - 85% of the population has this protein, and the blood of such people is considered Rh-positive. But the remaining 15% of people do not have this protein, so their blood is called Rh-negative.

The health of people with Rh-negative blood is not at all different from the health of people with Rh-positive blood. The presence or absence of the Rh factor matters only in some cases: during blood transfusion and during pregnancy.

Rhesus conflict - what is it?

If the blood of the future mother and father has the same Rh factor, that is, the blood of both is Rh-positive or Rh-negative, then for the fetus there are no bad consequences it won't have. If the mother's blood is Rh-positive, and the father's blood is Rh-negative, and the child inherits his blood, that is, Rh-negative, this will also not have any negative consequences.

But if mother's blood is Rh-negative, and the child receives father's blood - Rh-positive, there will be a Rh-conflict. After all, during childbirth, the blood of the fetus in a small amount enters the bloodstream of the mother (5 - 15 ml). The same thing happens when ectopic pregnancy, abortion, during a miscarriage, during transfusion, for example, with bleeding, Rh-positive blood to a woman with blood with negative Rh factor.

The woman's body reacts to a foreign protein and gives an immune response, producing antibodies to it. Moreover, during the first pregnancy, the immune response in most cases is not very strong and not as dangerous as in subsequent pregnancies. Indeed, in the future, a woman with Rh-negative blood will produce more and more antibodies.

What danger is the Rh conflict for the fetus?

What happens: in response to the Rh factor of the fetus, antibodies to this protein are produced in the mother’s blood, which enter the blood of the fetus through the placenta, causing the breakdown of red blood cells. The consequence of this is damage to the brain of the fetus, its kidneys, liver, development hemolytic disease.

Rhesus conflict can cause miscarriage, the birth of a premature or stillborn child, the birth of a child with jaundice, which requires an immediate blood transfusion.

Note that for women with Rh negative blood who have not had abortions, who have not had miscarriages or ectopic pregnancies, in which the blood of an Rh-negative fetus could enter their bloodstream, the first birth is likely to be successful, because antibodies will only begin to be produced and will not yet have time to cause harm. But the second pregnancy can end badly.

Of course, the condition of the newborn to a large extent depends on the amount of antibodies developed in the mother's blood. If there are too many of them, the fetal body will not have time to produce red blood cells. As a result, his liver and spleen increase, intrauterine anemia develops.

Why is anti-rhesus immunoglobulin administered?

To avoid the aforementioned problems, women with negative Rh blood after childbirth, abortion or miscarriage should have their blood tested for antibodies. If antibodies are detected, an injection of anti-Rhesus immunoglobulin should be given. The purpose of such an injection is to suppress the mother's defense system in response to the entry of fetal red blood cells into her blood and prevent the production of antibodies.

Anti-rhesus immunoglobulin is a ready-made antibody, the first dose of which is administered to a woman at the 28th week of pregnancy. The next one is within 72 hours after birth (if the baby's blood has a positive Rh factor).

The introduction of anti-Rhesus immunoglobulin does not harm anyone - neither the fetus, nor the newborn, nor the mother. However, at each next pregnancy the introduction of antibodies must be repeated at the same time, since they have an effect only on the pregnancy during which the treatment is carried out.

Every pregnant woman has several times lower immunity. So the body protects the fetus from possible rejection by its body. If a woman becomes very ill in the process of bearing a child due to constant weakness and fatigue due to the fact that her immunity is reduced, the doctor prescribes immunoglobulin during pregnancy. This drug is available in the form of a powder or ready-made solutions for injection. Released only by prescription. In this article, we will discuss in detail why a pregnant woman is injected with immunoglobulin, how it affects the child and the condition of the woman.

Immunoglobulin is a biological preparation that consists of many antibodies of purified human blood plasma. Its main task is to resist viruses, bacteria, strengthen the immune system.

In total there are 2 types of this drug:

1. Human immunoglobulin, which during pregnancy can be prescribed to absolutely any woman who has experienced infectious disease. It should be noted that this happens in very rare cases when:

• the body of the expectant mother does not react in any way to antibacterial drugs, which are administered to her for treatment;
• the woman has a threat of termination of pregnancy;
• the pregnant woman feels so bad that she loses consciousness.

1. Anti-Rhesus immunoglobulin - during pregnancy, it is mainly injected into women who have a negative Rh factor. However, the introduction of immunoglobulin during pregnancy of such an action is prescribed to a woman only in special cases:

• if a woman with a negative Rh had an abortion, she had a spontaneous miscarriage, an amniocentesis was performed, which can provoke the penetration of the mother's blood to the child, which is very dangerous for the life of the fetus;
• if a woman is diagnosed with a Rh conflict (when the baby and mother different Rh factors, because of which the fetus can be rejected by the woman's body);
• if a woman has an immunodeficiency, anti-rhesus immunoglobulin is also prescribed.

Depending on what happens to the expectant mother, the doctor prescribes which immunoglobulin to inject during pregnancy and at what dosage. Some women take it intramuscularly, and some intravenously. It depends on how the expectant mother tolerates immunoglobulin.

Indications for an injection of immunoglobulin during pregnancy

Rh immunoglobulin during pregnancy or regular human immunoglobulin is administered to a woman who is carrying a child and she has a negative Rh factor, despite the fact that the future father has a positive one. Therefore, every woman expecting the birth of a child should definitely ask her doctor if immunoglobulin is needed during pregnancy in her specific case or you can do without it.

As a rule, immunoglobulin during the first pregnancy is administered to a woman if she is at risk of developing an Rhesus conflict either in the process of bearing a child (in the II trimester) or immediately after she gives birth (within 3 days). This is necessary so that a woman does not have problems with carrying a second pregnancy and each subsequent one (in this case, the woman will no longer need to inject immunoglobulin).

If a woman at the end of the second trimester has a threat of miscarriage, then she is prescribed immunoglobulin at the 28th week of pregnancy. Thanks to this drug, the red blood cells that have entered the mother's blood from the fetus are destroyed, because the antibodies necessary for this fall into it. In this case, the action of immunoglobulin will last for 3 months - just until the very birth. However, in this case, the expectant mother will have to be in the hospital for some time under the supervision of doctors so that they can control whether the pregnant woman responds normally to immunoglobulin. The fact is that this issue has not yet been fully studied by doctors, so many side effects.

Consequences of immunoglobulin during pregnancy

Researchers on the issue of immunoglobulin during pregnancy have arguments both “for” and “against” the introduction of the drug to the expectant mother. First of all, this is due to the large number of side effects that can overcome future mother. These include:

• the occurrence of shortness of breath - a woman simply cannot do even a few simple steps, it will be difficult for her to breathe;
• she will start severe pain in all joints, and especially in the chest;
• the expectant mother will feel sleepy, constantly tired;
• according to reviews, immunoglobulin during pregnancy can even provoke an increase blood pressure and body temperature;
• in addition, the drug can adversely affect the skin - rashes will appear, which will itch a lot;
• an intestinal disorder may occur, accompanied by vomiting and nausea in the expectant mother;
• a pregnant woman may begin to cough (she may even experience bronchospasm);
• immunoglobulin can also affect the normal functioning of the heart (most often, pregnant women develop tachycardia after the administration of immunoglobulin at any week).

Prevention of Rh conflict with immunoglobulin

As a rule, women with a negative Rh factor are given an immunoglobulin vaccine long before pregnancy in case she has to:

• have an abortion (or the pregnancy will fail arbitrarily);
• go through an invasive intervention;
• get an emergency blood transfusion.

The most the main task this vaccine - to prevent the development of Rh-conflict during pregnancy. But keep in mind, even if you get such a vaccination, the doctor will still send you every month to take a blood test to detect antibodies. If they are determined, then you will be prescribed the introduction of immunoglobulin, as well as many other studies that will monitor the condition of the child.

There are so many Rh negative women who have successfully given birth to not one child, but several. All this suggests that you should not worry too much about the fact that you will have to be under special control doctors for 9 months. Chance to give birth healthy and strong kids you have a very big one if you follow all the doctors' orders. We wish you mild pregnancy and happy birth! Stay healthy and take care of your kids!

Video: "Anti-rhesus immunoglobulin during pregnancy"

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. Pathological condition in 90% of cases, it 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 for different terms. 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 birth with an unsuccessful outcome.
• During gestation this remedy used if chorionic villus sampling or amniocentesis is being 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 caesarean 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 prevention should be carried out 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 using it, you may experience the following complications:

• even if such hypersensitivity has never been observed before. It could be hives anaphylactic shock, angioedema. 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. Arsenal of drugs in the fight against similar states 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.

Topic related to immunoglobulin administered postpartum in Rh negative women is widely discussed. Perhaps because there are many incomprehensible points, both concerning the Rh factor itself and the Rh conflict, and immunoglobulin. Why is it administered after childbirth, and not before? In which cases? And what is its effectiveness?

When does Rhesus conflict occur?

IN modern science about 35 blood systems have been recognized. In order of importance, the first place is given to the AB0 system, the second to Rhesus. Rhesus is a whole system of protein factors or blood antigens, there are about 50 of them. The concept of "Rh-positive" and "Rh-negative", and "" refers to only one of them - D:

1. In the presence of this antigen, a person is considered Rh-positive. There are many such people on earth.
2. In the absence of factor D, the person is Rh-negative.

The conflict occurs when the mother's body is sensitized, that is, "tuned" to react, as if to a foreign agent (excessively), on fetal erythrocytes that have antigen D. This means that there are special protein compounds in the mother's blood that are sensitive to factor D. They can detected during blood sampling. Sensitization occurs when fetal red blood cells enter the mother's bloodstream. Most often this happens:

• during childbirth:
• or in case of abortion and miscarriage.

To prevent sensitization (and future conflict), it is recommended to administer anti-Rhesus immunoglobulin after childbirth (self-abortion, abortion) to women who are not sensitized to the Rh factor. It is recommended to inject within 2 hours of the event. This will save you from conflict in the next pregnancy. Such an injection is allowed within 1-3 days after childbirth or abortion, if for some reason it could not be done immediately (before the development of sensitization). After sensitization, immunoglobulin is not effective.

Anti-rhesus immunoglobulin: what is it and how does it work?

Rh immunoglobulin is a serum containing passive Rh antibodies. It is prepared from the plasma of a human donor. When foreign proteins and a passive antigen to them enter the woman's blood, her body does not produce its own active antibodies. This avoids Rhesus conflict in the future.

Additional Reasons for Prescribing Immunoglobulin

Such a serum can prevent not only postpartum or postabortal sensitization, but also sensitization, which can develop due to other provoking factors:

• pregnancy;
• microinvasive manipulations in the gestational period (amniocentesis, chorionic villus biopsy, cordocentesis);
• injuries of the peritoneum received during the period of bearing a child;
• infections, previous diseases, pregnancy complications that can cause red blood cells to enter the mother's blood.

In this case, immunoglobulin is injected after the event to avoid sensitization of the mother's body.

When is the vaccine given?

When a woman contacts a consultation about her first pregnancy, if she is Rh-negative, a test for the presence of antibodies to factor D is mandatory. Such an analysis should be repeated every 2 weeks, for later dates 1 time per week. A small amount of antibodies in the blood of a future mother is not a reason for panic, but a sharp increase in antibody titer should be alarming.

It is recommended to inject the drug for a period of . This is due to the fact that at early birth after this period, the fetus survives. Allow to inject the drug up to (inclusive). The second injection of immunoglobulin will need to be done after childbirth.

When are injections not prescribed?

If after childbirth the blood turns out to be Rh-negative, the injection is not necessary. Do not prescribe anti-Rhesus immunoglobulin if both parents are Rh-negative. Do not use this preventive measure if the woman's blood is already sensitized to the D antigen, do not inject newborns.

If a pregnant woman has an Rh-negative blood type, and the father of the unborn child is positive, and the fetus inherits his Rh factor, an Rh conflict may occur. To exclude the development of complications against this background, a woman is given immunoglobulin during pregnancy.

This measure reduces the risk of hemolytic disease of the newborn. In addition, it gives the necessary protection in subsequent pregnancies and reduces the risk of Rhesus conflict between mother and fetus.

During the first pregnancy, conflict rarely occurs, since antibodies work like allergens when they first start to be produced. Further, their accumulation occurs and with each subsequent pregnancy, the titer of the content of antibodies increases, which leads to the destruction of erythrocytes in the fetus. All this leads to hemolytic disease, which is accompanied.

In order to prevent Rh conflict during pregnancy, anti-Rhesus immunoglobulin is used.

Anti-D-immunoglobulin is an active protein fraction of human plasma. Contains IgG with incomplete anti-Rho(D) antibodies. The maximum concentration of the drug reaches a day after administration.

If the mother has negative blood and the father has positive blood, it is necessary to register with antenatal clinic up to 12 weeks of pregnancy, when the first tests are done, so you need to ask your doctor about the need to administer immunoglobulin even when planning a pregnancy.

Subsequently, the antibody titer is determined once every 28 days with a negative content. After the 30th week of pregnancy, antibodies are determined once every 14 days, and after the 36th week - once every 7 days.

The introduction of the drug after childbirth is necessary to reduce the formation of antibodies during repeated pregnancies.

It is not necessary to administer immunoglobulin G during pregnancy and after childbirth if the father of the child has an Rh-negative blood type.

Indications and contraindications for the use of immunoglobulin during pregnancy

The circulatory systems of the mother and fetus work offline: their blood does not mix with each other. Rhesus conflict can occur when the placental barrier is damaged.

Human immunoglobulin during pregnancy is used to prevent isoimmunization of a woman with:

• amniocentesis;
• cordacentese;
• organ injuries abdominal cavity;
• the birth of a Rh-positive child;
• positive blood of the father of the child;
• prevention of Rhesus conflict during the first pregnancy in the absence of sensitization of the woman;
• premature;
• severe form;
• a number of infectious lesions;
• diabetes.

Among the contraindications to the use of immunoglobulin during pregnancy are:

• allergic reactions;
• negative blood type in women who are sensitized with the presence of antibodies;
• a positive Rh factor in a woman.

Application methods

Normal human immunoglobulin during pregnancy is administered intramuscularly once. One dose of the drug is 300 μg of anti-D immunoglobulin if the antibody titer is within 1:2000, or 600 μg if the antibody titer is 1:1000.

It is forbidden to give an intravenous injection of immunoglobulin G during pregnancy.

Before use, it is necessary to leave the drug at a temperature of 18-22 ° C for 2 hours. To avoid foam, the immunoglobulin is drawn into the syringe with a wide lumen needle. The opened ampoule should be used immediately. Keeping her in open form unacceptable.

Introduction medicinal product carried out according to the following scheme:

• a woman receives an injection within 48-72 hours after the birth of a child;
• an injection of immunoglobulin during abortion is performed after an abortion for a period of more than 8 weeks.

If there are no antibodies in blood tests, immunoglobulin is administered at the 28th week of pregnancy for prophylactic purposes. Further, the drug is injected after childbirth within 48 hours in the case when the Rh factor of the child is positive. If the child has negative blood, then repeated administration of immunoglobulin is not required.

If Rh negative woman there is a threat spontaneous miscarriage, it is necessary to introduce 1 dose of anti-D-immunoglobulin during pregnancy.

For prophylactic purposes, an additional injection is prescribed during the bearing of a child, if an amniocentesis is performed, or a woman has an abdominal injury. Further, the drug is administered at the specified time.

Consequences

The introduction of human normal immunoglobulin during pregnancy may be accompanied by a number of side effects, among which highest value have:

• redness of the injection site;
• an increase in body temperature up to 37.5 ° C in the first 24 hours after the injection;
• dyspeptic disorders;
• allergic reactions, including anaphylactic shock.

Due to the fact that the drug is highly allergenic, after its use, a half-hour monitoring of the woman's condition is established. If anaphylactic or allergic reaction, first aid drugs are introduced.