Immunoglobulin in pregnancy

In some cases, it is necessary to administer immunoglobulin in pregnancy. This is a specific drug, the action of which is aimed at improving the quality of the body's natural defenses. This drug is synthesized from donor blood plasma.

With the onset of pregnancy, there is a natural decrease in the level of immune defense, which is a very necessary process for the safety of the fetus. If this process does not take place, the woman's immune system will direct all its energies towards the termination of pregnancy, as it considers the fetus to be a foreign agent. There are a number of cases in which a woman requires the administration of immunoglobulin.

Is immunoglobulin needed in pregnancy?

Pregnancy is always associated with many risks, both for the woman's body and for the growing fetus. The first indicator of changes associated with this period is a decrease in immune defense. It should be understood that the body of the future mother independently triggers this mechanism, deliberately and purposefully. This necessity is related to the successful carrying of the child, because our immune system is configured so that it can perceive the fetus as a foreign organism and reject it.

Often immunoglobulin is used as a supportive agent if a woman has problems that do not allow her to bear a baby. In such a situation, the drug is administered by injection or intravenous drip.

The direct action of immunoglobulin is based on the properties of the active substance extracted from plasma, purified and concentrated. The main focus of the drug is the correction of immunity, help in resisting infectious agents, as well as restoring the level of IgG antibodies. This allows the body to protect itself from infectious diseases in case of primary or secondary immunity deficiency.

Immunoglobulin in pregnancy: pros and cons

In pregnancy, the administration of immunoglobulin will help to preserve the fetus and prevent interruption of the process of carrying. However, its effect on the baby and the expectant mother has not yet been fully studied, although no negative effects have been registered so far. It follows that the drug can be used only when it is really necessary, and the risk of such treatment will be less than the existing danger of pathology. [1]

It is not recommended to use immunoglobulin in pregnancy without appropriate indications.

At what week of pregnancy is immunoglobulin administered?

For routine prenatal prophylaxis between 28 and 30 weeks of gestation, the doctor will refer the woman for immunoglobulin injection. A second injection should be given within 3 days after the birth of the baby.

If a woman was not given prophylaxis during pregnancy, then when a Rh-positive baby is born, immunoglobulin injection after delivery is performed for 72 hours.

Immunoglobulin is used for abdominal trauma or amniocentesis at any term.

Indications Immunoglobulin in pregnancy

There are different types of immunoglobulin and each has its own indications and can only be prescribed if absolutely necessary.

The baseline readings are considered to be:

• a woman's critically compromised immune system;
• serious trauma to the abdominal area during pregnancy;
• Amniotic fluid testing (amniocentesis);
• Performing any procedure that may mix fetal and maternal blood;
• a real threat of spontaneous abortion;
• threat of fetal rejection;
• infectious diseases that can harm both the unborn child and the expectant mother;
• the threat of Rh conflict;
• terminating an ectopic pregnancy.

Features of application

Pharmacists have many varieties of immunoglobulin available, but only two are used in pregnancy - Anti-D and human normal immunoglobulin. They are all antibodies, a special type of protein produced by human beta-lymphocytes to provide protection against foreign attack, such as viral or bacterial. Most often used immunoglobulin in pregnancy with a negative Rh factor: we are talking about the so-called anti-Rhesus immunoglobulin, or Anti-D, which is produced from the donor blood of a Rh-immunized person. The basic composition of the drug is represented by antibodies to the protein substances of the Rh factor, provoking a fetal rejection reaction. This drug is used during pregnancy, if the future mother is determined to be Rh negative and there is a risk of Rh conflict. [2]

In what cases is it necessary to administer immunoglobulin in pregnancy?

When a woman finds out she is pregnant and comes to the antenatal clinic for the first time, she is offered a blood test to determine her Rh blood type. The future father of the child must also take the same test. If the woman's blood is Rh-negative and the man's blood is Rh-positive, the pregnancy will be monitored in a special way: the future mother will now have to have her blood tested twice a month to determine the concentration of antibodies. [3]

Is immunoglobulin needed in the first pregnancy? As a rule, a negative rhesus mother with a positive rhesus baby is not dangerous if such a pregnancy is the first, since the strength of the immune response is still insufficient for the development of a conflict. However, already in the second pregnancy, such a response is many times stronger, which is due to the massive appearance of antibodies in the bloodstream. A large number of antibodies get into the fetal circulatory system, which leads to a serious hemolytic disorder, which is the Rh conflict. What is the danger of this? In fact, various complications can develop, from premature labor, to spontaneous abortion or stillbirth. [4]

And, although immunoglobulin preparations are not used during the first pregnancy in many cases, it is necessary to monitor antibodies throughout the pregnancy. If they are detected in dangerous concentrations, the decision to administer the drug can be made. This is a safety measure that will help to save the baby.

These are the women with Rh-negative factor that immunoglobulin administration is especially indicated for:

• with a second pregnancy;
• If the woman has had previous abortions, spontaneous miscarriages, or ectopic pregnancies;
• if the patient has had a previous blood transfusion.

Immunoglobulin in planning pregnancy can be prescribed in different situations, and above all - with problems with carrying the fetus. Frequent miscarriages, frozen pregnancies in the anamnesis - this is an indication for the use of the drug. However, immunoglobulin for non-pregnancy is not the only indication. In addition, the introduction of the drug is successfully practiced in the presence of herpetic or cytomegalovirus infection in the body of the future mother, with any infections that can harm the health of the fetus, as well as for immune correction. Before planning a baby, doctors always recommend a number of important diagnostic examinations to be able to identify and eliminate possible problems in advance for normal conception and pregnancy. So, a woman should take blood for antibodies - protein structures of immunity, produced by the lymphatic system. They are able to attach to red blood cells and become aggressive towards "foreign" organisms. [5]

Immunoglobulin g in pregnancy, as well as in its planning, is an important marker for assessing the state of immunity - because it is the main serum immunoglobulin involved in the formation of the immune response.

Immunoglobulin e in pregnancy also becomes quite indicative. It is a basic marker of allergic processes and helminthiasis, so it is prescribed for screening in the determination of these pathologies.

Immunoglobulin in pregnancy with a tick bite is administered no later than 96 hours after the insect bite. This is a specific drug against tick-borne encephalitis. Such an injection can be made in a trauma center, in a special vaccination center or even in a hospital.

Another pathology that can occur, including in pregnancy, is chickenpox. The virus - the causative agent of this disease - can cause quite serious complications, so it is important to prevent them. Immunoglobulin in pregnancy with chickenpox can be administered at any term, and in contact with the patient, this injection is performed even for prophylactic purposes. The specific drug is administered intramuscularly, no later than 72 hours after contact with a sick person, in an amount of 125 units/10 kg of body weight.

Antiresuse immunoglobulin after pregnancy must be administered again within 72 hours after the birth of the child (or after miscarriage, placental abruption, ectopic pregnancy). Such an introduction is necessary, because in subsequent pregnancies, the woman's immune system will begin to produce antibodies in huge quantities. There is no need to be afraid of this medication: there is no need to stop breastfeeding after the injection. Multiple studies have demonstrated the complete safety of immunoglobulin for the breastfed baby.

Release form

• Human normal immunoglobulin in pregnancy is prescribed relatively often: the medicine in the form of a solution is produced in ampoules of 1.5 ml, which corresponds to one dose. Recalculation of this dose to the content of the protein substance is 150 mg. As auxiliary components there are sodium chloride, glycine, water for injection. The solution should be transparent, without color, or slightly yellowish.
• Anti-D immunoglobulin in pregnancy is prescribed to prevent the development of Rh conflict: the injectable solution is represented by specific antibodies to _anti-Rh0 (D), as well as glycine and sodium chloride. One dose of the medication contains 300 mcg, with an _anti-Rh0 (D) antibody titer of 1:2000. The solution is clear, slightly yellowish or colorless.

Pharmacodynamics

The active base of anti-rhesus immunoglobulin is a substance specific to the D antigen. In a single dose of the medicine, the antibody titer is less than 1:2000, which can be determined using the Coombs reaction.

Anti-rhesus immunoglobulin prevents Rh sensitization of Rh-negative patients, which can occur when Rh-positive fetal blood enters the mother's circulatory system. The risk of such a development is particularly high when a Rh-negative woman gives birth to a Rh-positive child, when pregnancy is terminated, when amniocentesis is performed, and when traumatic abdominal injury occurs during pregnancy.

Normal human immunoglobulin has immunomodulatory and immunostimulating properties, includes neutralizing and opsonizing antibodies, which allow to resist viral and bacterial infection, etc. The product also replenishes the numerical deficiency of IgG antibodies, successfully replaces and supplements the amount of natural antibodies in a woman's serum. In addition, the product replenishes the numerical deficiency of IgG antibodies, successfully replaces and supplements the amount of natural antibodies in the serum of a woman.

The effect of immunoglobulin on the fetus

Both human normal and anti-rhesus immunoglobulin are considered absolutely safe for the fetus, for the newborn baby, and for the patient herself. Of course, there is a possibility of some side effects. But this happens very rarely, and the benefits of administering these drugs are often much higher than the risk of adverse effects.

In any case, if the doctor prescribes immunoglobulin, you should not panic and worry about this issue. This is just a necessary measure that will allow you to bear and give birth to a healthy baby.

Consequences of immunoglobulin in pregnancy

I would like to clarify that adverse reactions in the body against the background of taking immunoglobulin develop very rarely. Treatment with the drug is carried out with strict adherence to the dosage and rate of administration, and only if indicated.

In some cases, minor side effects are possible, which are detected during the first 50-60 minutes after the injection of the drug. As a rule, they are expressed in a general disorder of well-being, headache, weakness, slight increase in temperature.

In isolated patients, breathing difficulties, nausea, diarrhea, short dry cough, hypersalivation, abdominal pain, peripheral circulation disorders, sleep disorders, skin rashes, and pulling pains in muscles and joints may occur.

Pharmacokinetics

The active components of the drug are immunoglobulins - different specific antibodies with different kinetic properties, the content of which in the bloodstream reaches the maximum concentration a day after administration.

With intravenous infusion, the bioavailability of immunoglobulin equates to 100%. Redistribution of the active component occurs gradually between plasma and extravascular space, with equilibrium being detected after approximately 1 week. The half-life of antibodies from the bloodstream may be 4-5 weeks.

Dosing and administration

The use of immunoglobulin is done with these points in mind:

• the woman must be Rh-negative, without sensitization to D antigen;
• the newborn baby must be Rh positive, with a negative direct antiglobulin test result;
• administration of immunoglobulin in pregnancy should be paired with repeated administration after delivery - during the first 72 hours after the birth of a Rh-positive baby;
• If the father of the baby is also Rh negative, the introduction of immunoglobulin is optional.

The medicine is administered in the amount of 300 mcg, which corresponds to one ampoule, once a day, deep intramuscularly.

If there is a threat of miscarriage, then drips and shots of immunoglobulin in pregnancy are put at any term.

In case of amniocentesis or abdominal trauma in the second or third trimester of pregnancy, one dose of immunoglobulin is administered. If such situations occurred between 13-18 weeks, another dose should be administered at 26-28 weeks.

Contraindications

Immunoglobulin is not used in pregnancy:

• in the presence of hypersensitivity to the drug;
• if there is a tendency to severe allergic processes that develop in response to the administration of protein blood products;
• hemostatic disorders, severe thrombocytopenia.

Anti-rhesus immunoglobulin is not administered if Rh sensitization is already present - that is, antibodies are detected in the bloodstream of the expectant mother. In this situation, preventive measures are no longer appropriate: it is necessary to proceed to the treatment of Rh conflict in hospital conditions.

Side effects Immunoglobulin in pregnancy

Cases of side effects after the administration of immunoglobulin in pregnancy are rarely recorded. The frequency of such manifestations depends primarily on the individual sensitivity of the body.

Among the common side symptoms, fever, fever, mild low back pain, and soreness in the area of drug administration are sometimes found.

Additional unwanted signs are:

• nausea, vomiting episodes;
• allergies;
• joint pain;
• headaches;
• hypotension.

Overdose

As a rule, immunoglobulin in pregnancy is administered in strictly calculated dosages and is never used for self-medication - it is strictly forbidden. Perhaps that is why no cases of overdose of the drug have been recorded so far.

Interactions with other drugs

Immunoglobulin in pregnancy is allowed to be used in combination with other medicines and solutions, provided that it is separately injected: mixing several drugs in one syringe or drip system is prohibited.

Vaccination with live viral sera can be given no sooner than 12 weeks after the last immunoglobulin injection.

Storage conditions

Ampoules with immunoglobulin are stored only under certain conditions: in a darkened place with ambient temperature not lower than +2 and not higher than +8°C. It is strictly forbidden to freeze and heat the drug.

Storage areas should be kept out of reach of children and mentally unwell persons.

Shelf life

Ampoules of immunoglobulin may be stored for up to two years under appropriate conditions.

The opened ampoule is used immediately: it is forbidden to store it. If the drug is not used, it should be disposed of immediately.

Analogs

An analog of anti-rhesus immunoglobulin can be an identical solution Resonativ, which is produced in the UK by the pharmaceutical company Amaxa Pharma Ltd.

Human immunoglobulin normal may be represented by such similar preparations:

• Gamanorm, Kiovig are Austrian-made drugs;
• Bioven, Bioven mono, Venomun - preparations of Ukrainian manufacture;
• Octagam - manufactured in the UK;
• Phlebogamma - manufactured in Spain.

The question of whether immunoglobulin analogs can be used should be decided directly with the treating doctor.

Testimonials

Immunoglobulins in pregnancy are not prescribed for everyone and not always, but only for specific diseases, disorders or conditions. Such means are necessary to support the immune system, and in case of negative Rh factor in women allow to preserve pregnancy and give birth to a healthy baby.

Injections are carried out only under the supervision of the doctor treating you. As a rule, this is the doctor in charge of the pregnancy.

According to numerous positive feedback from women, it can be concluded that immunoglobulin in pregnancy can be administered without any fear - of course, if there are appropriate indications. Such means are safe, and in return can prevent a lot of troubles - from termination of pregnancy and stillbirth to the emergence of health problems in the future baby. Side effects also do not need to be afraid: as a rule, they occur rarely and do not last long.