Immunoglobulin during pregnancy

In some cases, it becomes necessary to administer immunoglobulin during 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, a natural decrease in the level of immune protection occurs, which is an extremely necessary process for the preservation of the fetus. If such a process does not take place, then the woman's immunity will direct all its efforts to terminate the pregnancy, since it considers the fetus to be a foreign agent. A number of cases are known in which a woman needs the introduction of immunoglobulin.

Do I need immunoglobulin during pregnancy?

Pregnancy is always associated with many risks - both for the female body and for the growing fetus. The first indicator of changes associated with this period is a decrease in immune defenses. At the same time, you need to understand that the body of the expectant mother independently launches this mechanism, deliberately and purposefully. This need is associated with the successful bearing of a child, because our immunity is configured in such a way 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 prevent her from carrying 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The direct action of immunoglobulin is based on the properties of the active substance withdrawn from plasma, purified and concentrated. The main focus of the drug is the correction of immunity, help in resisting infectious agents, as well as the restoration of the level of IgG antibodies. This allows the body to protect itself from infectious diseases in case of primary or secondary immunity deficiency.

Immunoglobulin during pregnancy: pros and cons

During pregnancy, the introduction of immunoglobulin will help preserve the fetus and prevent interruption of the gestation process. However, its effect on the baby and the expectant mother has not yet been fully studied, although negative consequences have not yet been registered. It follows from this that the drug can be used only when it is really necessary, and the risk from such treatment will be less than the existing danger of pathology.[1]

Without appropriate indications, the use of immunoglobulin during pregnancy is not recommended.

At what week of pregnancy is immunoglobulin administered?

When carrying out planned prenatal preventive measures in the period from 28 to 30 weeks of gestation, the doctor directs the woman for injection of immunoglobulin. Re-introduction should be carried out within 3 days after the birth of the child.

If a woman did not undergo prophylaxis during pregnancy, then when a Rh-positive baby is born, an injection of immunoglobulin after childbirth is performed for 72 hours.

In case of abdominal trauma or amniocentesis, immunoglobulin is used at any time.

Indications Immunoglobulin during pregnancy

There are different types of immunoglobulin, and each of them has its own indications, and can be prescribed only in case of emergency.

The basic indications are:

• critically weakened immunity of a woman;
• serious injuries to the abdomen during pregnancy;
• conducting a study of amniotic fluid (amniocentesis);
• carrying out any procedures in which it is possible to mix the blood of the fetus and mother;
• a real threat of spontaneous abortion;
• the threat of fetal rejection;
• infectious diseases that can harm both the unborn child and the expectant mother;
• the threat of Rhesus conflict;
• termination of an ectopic pregnancy.

Application features

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

When is it necessary to administer immunoglobulin during pregnancy?

When a woman finds out about her situation and first comes to the antenatal clinic, she is offered to take a blood test to determine the Rh affiliation. The same analysis must pass and the future father of the child. In the case when the woman's blood turns out to be Rh-negative, and the man's blood is Rh-positive, a special observation is established over the course of pregnancy: now the expectant mother will have to donate blood twice a month for analysis to determine the concentration of antibodies.[3]

Do I need immunoglobulin during the first pregnancy? As a rule, a negative Rh mother with a positive Rh baby does not pose a danger 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 during the second pregnancy, this response is many times stronger, which is associated with the massive appearance of antibodies in the bloodstream. A large number of antibodies enter the fetal circulatory system, which leads to a serious hemolytic disorder, which is the Rh conflict. Why is it dangerous? In fact, various complications can develop, from preterm birth, to spontaneous abortion or stillbirth.[4]

And, although immunoglobulin preparations are not used in many cases during the first pregnancy, it is necessary to monitor the content of antibodies throughout the entire gestation period. If they are determined in dangerous concentrations, then the decision to administer the drug can be made. This is a safety measure that will help keep the child safe.

Here are some women with a negative Rh factor, the introduction of immunoglobulin is especially indicated:

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

Immunoglobulin when planning pregnancy can be prescribed in different situations, and above all - with problems with bearing a fetus. Frequent miscarriages, missed pregnancies in history - this is an indication for the use of the drug. However, immunoglobulin in case of miscarriage is far from the only indication. In addition, the introduction of the drug is successfully practiced in the presence of a herpetic or cytomegalovirus infection in the body of a 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 undergoing a series of important diagnostic examinations in order to be able to identify and eliminate possible problems in advance for normal conception and pregnancy. So, a woman should donate blood for antibodies - protein structures of immunity produced by the lymphatic system. They are able to join erythrocytes and become aggressive towards "foreign" organisms.[5]

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

Immunoglobulin e during pregnancy also becomes quite indicative. It is a basic marker of allergic processes and helminthiases, therefore it is prescribed for screening in determining these pathologies.

Immunoglobulin during pregnancy with a tick bite is administered no later than within 96 hours after the insect bite. This is a specific drug against tick-borne encephalitis. A similar injection can be done in an emergency room, in a special vaccination center, or even in a hospital.

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

Anti-Rhesus immunoglobulin after pregnancy must be re-introduced - within 72 hours after the birth of the child (or after a miscarriage, placental abruption, ectopic pregnancy). Such an introduction is necessary, since during subsequent pregnancies, the woman's immunity will begin to produce antibodies in large quantities. Do not 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 an infant.

Release form

• Human normal immunoglobulin during pregnancy is prescribed relatively often: the drug in the form of a solution is released in 1.5 ml ampoules, which corresponds to one dose. The recalculation of this dose for the content of the protein substance is 150 mg. As auxiliary components there are sodium chloride, glycine, water for injection. The solution should be clear, colorless or slightly yellowish.
• Anti-d immunoglobulin during pregnancy is prescribed to prevent the development of a Rh conflict: the injection solution is represented by specific antibodies to anti-Rh ₀  (D), as well as glycine and sodium chloride. One dose of the drug contains 300 mcg, with a titer of antibodies to anti-Rh ₀  (D) 1:2000. The solution is clear, slightly yellowish or colorless.

Pharmacodynamics

The active base of anti-Rhesus immunoglobulin is a substance specific for antigen D. In a single dose of the drug, 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 circulation. The danger of such a development of events is especially high at the birth of an Rh-positive child in a Rh-negative woman, when a pregnancy is terminated, when an amniocentesis is performed, or when a traumatic injury to the abdomen occurs during pregnancy.

Normal human immunoglobulin has immunomodulatory and immunostimulatory properties, includes neutralizing and opsonizing antibodies that allow you to resist viral, bacterial infections, etc. In addition, the agent compensates for the lack of IgG antibodies, successfully replaces and supplements the amount of natural antibodies in a woman's serum.

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 developing some side effects. But this happens extremely rarely, and the benefits of administering these medications are often much higher than the existing risk of adverse effects.

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

Consequences of immunoglobulin during pregnancy

I would like to clarify that adverse reactions in the body against the background of taking immunoglobulin develop very rarely. Treatment with medication occurs 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 disturbance of well-being, headache, weakness, and a slight increase in temperature.

In single patients, breathing difficulties, nausea, diarrhea, a short dry cough, hypersalivation, abdominal pain, peripheral circulatory disorders, sleep disorders, skin rashes, pulling pains in muscles and joints 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 one day after administration.

With intravenous infusion, the bioavailability of immunoglobulin equates to 100%. The redistribution of the active ingredient occurs gradually between the plasma and the extravascular space, while the equilibrium is found after about 1 week. The half-life of antibodies from the bloodstream can be 4-5 weeks.

Dosing and administration

The use of immunoglobulin is carried out taking into account such points:

• the woman must be Rh-negative, without sensitization to antigen D;
• the newborn child must be Rh-positive, with a negative result of the direct antiglobulin test;
• the introduction of immunoglobulin during pregnancy should be associated with repeated administration of the drug after childbirth - during the first 72 hours after the birth of a Rh-positive baby;
• if the baby's father also has a negative Rh, then the introduction of immunoglobulin is optional.

The drug is administered in an amount of 300 mcg, which corresponds to one ampoule, one-time, deep intramuscularly.

If there is a threat of miscarriage, then droppers and immunoglobulin injections during pregnancy are given at any time.

When performing amniocentesis, or if the abdomen is injured in the second or third trimester of gestation, a single dose of immunoglobulin is administered. If such situations occurred in the period from 13-18 weeks, then another dose of the drug should be re-introduced at 26-28 weeks.

Contraindications

Immunoglobulin during pregnancy is not used:

• in the presence of hypersensitivity to the medication;
• with a tendency to severe allergic processes that develop in response to the introduction of protein blood products;
• hemostatic disorders, severe thrombocytopenia.

Anti-Rhesus immunoglobulin is not administered if Rh sensitization is already present - that is, antibodies are found in the bloodstream of the expectant mother. In such a situation, preventive measures are no longer appropriate: one should start treating the Rh conflict in stationary conditions.

Side effects Immunoglobulin during pregnancy

Cases of side effects after the introduction of immunoglobulin during pregnancy are rarely recorded. The frequency of such manifestations depends, first of all, on the individual sensitivity of the organism.

Among the common side symptoms, fever, fever, mild back pain, and soreness in the injection site are sometimes found.

Additional undesirable features are:

• nausea, vomiting attacks;
• allergy;
• pain in the joints;
• pain in the head;
• hypotension.

Overdose

As a rule, immunoglobulin during pregnancy is administered in strictly calculated dosages and is never used for self-medication - this is strictly prohibited. Perhaps that is why so far not a single case of drug overdose has been recorded.

Interactions with other drugs

Immunoglobulin during pregnancy is allowed to be used in combination with other medicines and solutions, subject to its separate injection: mixing several drugs in one syringe or drip system is prohibited.

Vaccination with live viral sera can be carried out no earlier than 12 weeks after the last injection of immunoglobulin.

Storage conditions

Ampoules with immunoglobulin are stored only under certain conditions: in a dark place with an ambient temperature not lower than +2 and not higher than +8°C. Freezing and heating the drug is strictly prohibited.

Storage areas should be protected from access by children and mentally ill people.

Shelf life

Ampoules with immunoglobulin can be stored for up to two years under appropriate conditions.

The opened ampoule is used immediately: it is forbidden to store it. In case of non-use of the drug, it is immediately disposed of.

Analogues

An analogue of anti-Rhesus immunoglobulin can be a Resonative solution, identical in composition, which is produced in the UK by the pharmaceutical company Amaxa Pharma Ltd.

Normal human immunoglobulin can be represented by such similar preparations:

• Gamanorm, Kiovig preparations of Austrian production;
• Bioven, Bioven mono, Venoimun - preparations of Ukrainian production;
• Octagam - made in Great Britain;
• Phlebogamma - made in Spain.

The question of the possibility of using immunoglobulin analogues should be decided directly with the attending physician.

Reviews

Immunoglobulins during pregnancy are not prescribed for everyone and not always, but only for specific diseases, disorders or conditions. Such funds are necessary to support the immune system, and with a negative Rh factor in women, they can maintain pregnancy and give birth to a healthy baby.

Injections are carried out exclusively under the supervision of the attending physician. As a rule, this is the doctor who leads the pregnancy.

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