Anti-Rhesus immunoglobulin during pregnancy, we weigh the pros and cons. Anti-Rhesus immunoglobulin during pregnancy for and against

Pregnancy is always a burden on a woman's body, even if it proceeds without complications. One of the conditions for the normal course of pregnancy is a decrease in immunity. This is due not only to increased requirements for the work of all systems, but also to the fact that a decrease in immunity contributes to the fact that the fetus, which, in its essence, is a foreign object, will not be rejected. A vicious circle arises on the one hand, a decrease in immunity is necessary, on the other hand, low immunity can be the cause of infectious and other diseases, as well as cause a deterioration in the general condition of a pregnant woman, which does not contribute to the bearing of a child.

For problems with gestation during pregnancy, a woman may be prescribed normal human immunoglobulin. The active substance of this drug is released from human plasma, purified and concentrated. Possesses immunomodulatory and immunostimulating properties. The introduction of immunoglobulin during pregnancy helps to resist various infectious pathogens, replenishes the insufficient amount of JgG antibodies. This is especially important for women with initial immunodeficiency. However, in any case, human immunoglobulin during pregnancy is prescribed according to strict indications, in cases where it is really necessary.

If there is a Rh-conflict between the mother and the fetus (which happens when a woman is Rh-negative, and a conceived child is Rh-positive), anti-D-immunoglobulin (anti-Rh immunoglobulin) is prescribed.

If necessary, human immunoglobulin is administered from the first pregnancy, and anti-rhesus immunoglobulin is aimed at preventing conflict in the second pregnancy and subsequent ones. At the first - the Rh-conflict does not develop due to the fact that the mother has not yet developed a large amount of antibodies to the antigen. The antibodies she produces are not harmful to the mother, but their effect on the child can be fatal. He is at risk of being born with severe mental disabilities, brain damage, and severe hemolytic jaundice. Therefore, it is advisable to administer anti-D-immunoglobulin within 72 hours after the first birth. If the first pregnancy was preceded by abortions, miscarriages at any time, amniocentesis or abdominal trauma, in which it was possible for the fetal blood to enter the mother's bloodstream, and also if a Rh-positive blood transfusion was carried out, then the introduction of anti-Rhesus immunoglobulin is advisable in the first pregnancy. It is best to be under the supervision of a doctor and regularly take a blood test for the presence of antibodies, and in the event of a threat of Rh-conflict, take the necessary measures. Sometimes the risk of Rh-conflict also arises at the 28th week of pregnancy, which will be seen during the examination. In this case, the immunoglobulin is administered additionally.

Immunoglobin is administered by intramuscular injection or intravenous drip. The dosage is calculated by the doctor strictly individually. After the introduction (especially the first), side effects can be observed:

• shortness of breath, dry cough, bronchospasm;
• dyspeptic symptoms: nausea, vomiting, stomach pain;
• general weakness, drowsiness;
• tachycardia and chest pain;
• joint aches;
• skin rash, itching and more.

In addition, the effect of this drug on the body of a pregnant woman and the fetus has not been studied for certain. Therefore, it is necessary to administer immunoglobulin during pregnancy only when the risk of disease is higher than the risk of drug administration.

Herpes and pregnancy

The herpes virus has the vast majority of the population in its body. During pregnancy, favorable conditions are created for the exacerbation of herpes infection. It is very dangerous if the expectant mother becomes infected with herpes during pregnancy, since the virus can cross the placenta and cause malformations in the child or provoke a miscarriage. Infection in the third trimester of pregnancy is fraught with stillbirth or total brain damage in the child. A less dangerous situation is when a woman has already had herpes before pregnancy, since antibodies produced during previous infections and protecting the fetus circulate in her blood. For the treatment of herpes during pregnancy, approved antiviral drugs and ointments are used. If immune deficiency is diagnosed, then herpes during pregnancy is treated with immunoglobulin.

Immunoglobulin human normal contains an active ingredient - an immunoglobulin fraction. It is initially released from human plasma, after which it is purified and concentrated. The drug does not contain human immunodeficiency viruses and hepatitis C, it does not. The protein concentration is 4.5% - 5.5%. There is a low anti-complementary activity of the drug.

Release form

Immunoglobulin preparations are available in two forms. This is a solution for intramuscular injections and a dry powder for infusion (Immunoglobulin IV). The solution is a clear or slightly opalescent liquid without color.

pharmachologic effect

This medicine has immunostimulating and immunomodulatory action ... It contains many opsonizing and neutralizing antibodies. Their presence provides effective resistance to bacteria, viruses and a number of other pathogens.

Under the influence of this agent, the amount of missing IgG antibodies is replenished. As a result, the risk of developing infection in people diagnosed with primary and secondary is reduced. Immunoglobulin replenishes and replaces natural antibodies in human serum.

To understand the essence of the effect of this drug on the body, one should understand how immunoglobulin works in the human body, what it is. Wikipedia testifies that immunoglobulins are unique immune molecules that are capable of neutralizing a number of toxins and many pathogens in the human body.

To neutralize a certain type of virus or bacteria, the body produces unique types of immunoglobulins. There is a classification according to which classes of immunoglobulins are determined depending on antigenic characteristics, properties, structure.

If necessary, a blood test for immunoglobulin, general and specific, is performed. Such an examination allows you to determine the presence allergic diseases and prescribe the correct treatment. A specialist can decipher the results of the analysis in detail, determining whether the immunoglobulin is elevated (the rate of its content depends on the age of the person). If a certain class of it is raised, what this means will be explained in detail by a specialist.

Pharmacokinetics and pharmacodynamics

When conducting intravenous infusion the bioavailability level is 100%. The highest concentration of antibodies in human blood is observed for 14 days. The half-life of antibodies is 4-5 weeks. The agent crosses the placenta, passes into breast milk.

Indications for use

Normal human immunoglobulin is indicated as a substitution treatment if the patient needs to undergo substitution treatment in order to replace and replenish natural antibodies.

In order to prevent infections, it is prescribed in the following cases:

• when carrying out a bone marrow transplant;
• with agammaglobulinemia;
• in the case of primary and secondary immunodeficiency, with variable immunodeficiency;
• at chronic in nature;
• with children;
• with thrombocytopenic purpura, which is of immune origin;
• with severe bacterial and viral infections;
• with Kawasaki Syndrome;
• with Guillain-Barré Syndrome;
• with erythrocyte aplasia;
• with neutropenia of autoimmune origin;
• with demyelinating polyneuropathy of the chronic type;
• with hemolytic anemia and thrombocytopenia, which are of autoimmune origin;
• at , provoked and caused by the synthesis of antibodies to factor P;
• during the treatment of myastenia gravis;
• in order to prevent habitual ;
• for the prevention of infectious diseases in premature newborns.

Contraindications

The following contraindications for the use of this drug are determined:

• to human immunoglobulins;
• deficiency in IgA due to the presence of antibodies to it;
• in an acute form;
• for blood products.

When prescribing a remedy, one should take into account not only contraindications, but also those conditions and diseases in which treatment should be carried out with caution.

Very carefully the remedy is prescribed for people suffering from decompensated heart failure chronic nature, as well pregnant women , mothers during natural feeding ... With caution and only after the appointment of a doctor, therapy is carried out for people suffering from diseases, the origin of which is associated with immunopathological mechanisms ( collagenosis , nephritis , immune blood diseases ).

Side effects

If the patient is prescribed normal human immunoglobulin, and the correct treatment regimen, dosage and administration characteristics are observed, then pronounced side effects are rare. However, it should be borne in mind that side effects may appear several hours or even days after the drug has been administered. In most cases, negative manifestations completely disappear after the drug has been discontinued.

Basically, side effects are observed due to the too high rate of infusion of the drug. If you temporarily pause the introduction or reduce its speed, then most of the negative effects will disappear. If negative symptoms persist, symptomatic treatment should be practiced.

Most often, side effects are observed when Immunoglobulin is administered to a person for the first time, moreover, it develops within the first hour. These may be the following symptoms:

• flu-like syndrome ( increased body temperature , chills , weakness );
• , ;
• vomit, severe salivation, stomach pain;
• , cyanosis , flushing of the face, pain in the chest;
• weakness , sensitivity to light, impaired consciousness, in rare cases - signs of aseptic ;
• in rare cases, acute tubular necrosis is manifested, the condition may worsen in people with renal failure;
• allergic manifestations ;
• local reactions.

In addition to the above symptoms, there may be a feeling of aches in the joints, myalgia , sweating , backache. Loss of consciousness is very rare, collapse , severe hypertension. If the reaction to therapy is very severe, treatment should be discontinued. If necessary, you can enter, antihistamines, solutions that replace plasma.

Instructions for use of Immunoglobulin (Way and dosage)

The instruction for Immunoglobulin provides for the possibility of drip intravenous and intramuscular administration of the drug. As a rule, the dose of the drug is prescribed on an individual basis, taking into account the severity of the disease, condition, etc.

Instructions for using the drug for children provide for the introduction of 3-4 ml of the drug per 1 kg of the child's weight, while the dose should not exceed 25 ml. Before the introduction, Immunoglobulin must be diluted with 0.9% sodium chloride solution (sterile) or 5% glucose solution, respectively 1 part of the drug and 4 parts of the solvent. It is injected intravenously, and the rate should be 8-10 drops per minute. Infusions are carried out over 3-5 days.

Adult patients receive a single dose of 25-50 ml. Dilution of additional drug is not required, it is injected intravenously, while the rate of administration is 30-40 drops per minute. For the course of treatment, 3-10 transfusions are prescribed, which are carried out in 24-72 hours.

If the question arises of where to put the dropper, it should be borne in mind that the drug can be administered intravenously only in a hospital, while it is important to strictly observe the requirements of asepsis. Where you can get an injection of Immunoglobulin, you can find out at the nearest medical institution. You can also get information under what conditions Immunoglobulin is administered to children free of charge.

Before introducing the product, the bottle must be kept at a temperature of 18 to 22 ° C for at least 2 hours. If the solution is cloudy or contains sediment, it cannot be injected.

Overdose

The manifestation of signs of an overdose of the drug when administered intravenously is possible. These symptoms are hypervolemia and high blood viscosity ... Overdose symptoms are more likely to occur in the elderly and in patients with kidney disease.

Interaction

The pharmaceutical incompatibility of the drug with other medicines is noted. It should not be mixed with other drugs; a separate dropper should always be used for Immunoglobulin.

The effectiveness of the drug can be reduced if it is administered at the same time as immunization drugs at, at, at.

If there is a need to apply parenterally live viral vaccines for chickenpox, etc., it is permissible to use them 1 month after treatment with Immunoglobulin, but it is desirable to withstand a break of 3 months.

Do not use the product at the same time in the treatment of infants.

Terms of sale

It is sold by prescription in pharmacy chains.

Storage conditions

It is necessary to transport and store the drug in accordance with SP 3.3.2.038–95, temperature regime - 2-8 ° C. Cannot be frozen.

Shelf life

Expiration date 1 year. Cannot be used after this period has expired.

special instructions

Patients who have been diagnosed with diseases, the origin of which is associated with immunological mechanisms, can use Immunoglobulin only after consulting a doctor who treats such diseases.

The administration of the drug must be registered in the appropriate registration form, in which you must indicate the series, number, date of manufacture, expiration date, date of administration, dosage and response to receiving the drug.

The use of the drug is not allowed if the container with it has been damaged. After opening the container, the medicine is used in a cut, it cannot be stored open.

The protective effect of the drug is noted after 24 hours and lasts for 30 days.

After the use of Immunoglobulin, a passive increase in the amount of antibodies in the blood is noted. Therefore, when blood is donated for analysis, subsequently decoding the blood test for immunoglobulin may be incorrect.

Patients diagnosed with allergic diseases or celebrated tendency to allergic manifestations should receive antihistamines on the day of administration of the solution and for eight days after receiving it.

After the drug has been administered to the patient, it is necessary to observe him for another half an hour. The specialist must have access to anti-shock therapy.

For children

You can prescribe the drug to children if there are indications, while it is important to strictly adhere to the dosage described in the instructions.

With alcohol

Immunoglobulin and alcohol are incompatible, since alcohol is an immunosuppressive agent, it impairs the functioning of the human immune system. When drinking alcohol against the background of treatment with this drug, the likelihood of side effects increases sharply. In addition, diseases and conditions requiring the appointment of Immunoglobulin imply a categorical prohibition on alcohol consumption.

Immunoglobulin during pregnancy and lactation

Information about harm when prescribing a remedy for pregnant absent. However, intravenous administration or injection of Immunoglobulin during pregnancy is performed only if there are clear indications.

Discussing the effectiveness of Immunoglobulin, women leave different reviews, noting that the drug can alleviate the condition in many diseases, in particular, and others. When using the drug, it is practiced carefully, since it passes into breast milk and ensures the transmission of antibodies to the baby. For women after childbirth, the drug is administered if indicated.

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

What is immunoglobulin?

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

Why is immunoglobulin used during pregnancy?

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

Side effects

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

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

For any woman, pregnancy is a happiness and a gift from above. But the body does not always think so. Sometimes it happens that the female body begins to reject the fetus. This happens if a Rh conflict arises: the woman has a negative Rh, and the father has a positive, while the fetus also takes on a positive Rh. The immune system of the pregnant woman pushes the fetus out as a foreign body. To avoid this, doctors inject the woman with Anti-Rhesus Immunoglobulin.

What it is?

Rhesus immunoglobulin is a human compound that stimulates the immune system. It is difficult to do without it when it comes to serious complications in the form of miscarriages, premature birth, bleeding.

The only purpose of the drug is rhesus conflict during pregnancy. In no other cases is it prescribed.

What is the pathology, and at how many months of pregnancy does it appear?

In the seventh month of pregnancy, the child's circulatory system is formed. If the baby borrows a positive Rh from his father, a Rh conflict arises. The maternal organism perceives the child as an intrusion of a foreign body and begins to vigorously attack it with antibodies. If the anti-rhesus immunoglobulin is not administered on time, the pregnancy will end in miscarriage.

This situation occurs in 15% of pregnancies. This is the percentage of people on the planet who have negative rhesus. To relieve negative symptoms, sometimes one injection is enough. If the conflict is strong, anti-rhesus immunoglobulin will have to be administered in courses of therapy.

If we talk about the testimony in more detail, then the following can be indicated:

• abortion;
• surgery for ectopic pregnancy;
• the postpartum period, when the blood of an Rh-positive baby enters the mother's blood.

It should be noted that the complete safety of the drug for the fetus has not been approved. Research on this has not been carried out, so doctors are still relying on the results of past practice.

Side effects and contraindications

Anti-Rhesus immunoglobulin is a drug to which there are almost no contraindications. It consists of human fluids, therefore it has a composition as close as possible to the human body.

During pregnancy, the administration of the drug is stopped only if the tests show a sharp increase in antibodies to the opposite Rh. In this case, the introduction of anti-rhesus immunoglobulin only aggravates the situation.

At the same time, anti-rhesus immunoglobulin may have contraindications:

• digestive disorders;
• shortness of breath and weakness;
• bronchospasm;
• allergic rashes;
• disturbances in the work of the heart, tachycardia.

The severity of side effects for each woman is determined individually.

How and when is it introduced?

Anti-Rhesus immunoglobulin is administered starting at week 28. Standard drug administration regimen:

• the first vaccination - from 28 to 32 weeks of pregnancy;
• the second vaccination - three days after childbirth.

The introduction of immunoglobulin in Rh-conflict is not dangerous for the fetus. It is much more dangerous if the doctor does not prescribe the drug on time and does not offer the pregnant woman to inject. In this case, serious complications may arise not only for the mother, but also for the child:

• bleeding with miscarriage and loss of the fetus;
• jaundice, anemia, dropsy in a child;
• fetal death.

Your best bet is to agree to get vaccinated: your baby's life is at stake.

Care should be taken if anti-rhesus immunoglobulin was administered to a woman after childbirth. The drug enters milk on the third day after administration. It can be dangerous when feeding a baby if he has the opposite rhesus.

Prevention of Rh-conflict

It is impossible to completely prevent and prevent Rh-conflict. Prevention implies a rational attitude towards pregnancy and its preservation.

The fact is that during the first pregnancy, the woman's body does not react violently to the blood of a baby with the opposite Rh, therefore, in most cases, the first pregnancy proceeds without complications.

Prevention means:

• refusal to abortion, especially during the first pregnancy;
• analyzes for the Rh factor of blood;
• refusal from operations before and after childbirth unless absolutely necessary.

It should be remembered that the human immunoglobulin in the preparation is not a panacea for negative rhesus, and situations may arise when even he will not allow a woman to keep the child. Therefore, the first pregnancy, under whatever circumstances it took place, must be preserved.

Price

The price of the drug justifies itself, although the drug costs a lot. Much of the price depends on the manufacturer. Immunoglobulin is supplied from the following countries:

• Austria;
• Israel;
• Russia.

It is quite difficult to find a foreign medicine in pharmacies, and the Russian one is not cheap. The price depends on the dosage and concentration of the main substance. The drug can be purchased for both 800-900 rubles and 5-6 thousand rubles. This price justifies itself, because we are talking about the life of a child and a far from popular drug for general use.

Due to the fact that the price of immunoglobulin is high, a woman should think twice about keeping her first pregnancy. The next one will cost her much more.

It happens: the pregnant woman has a negative Rh factor, and the partner, who is also the father of the future baby, has Rh-positive blood. It is in arithmetic that minuses and pluses coexist peacefully and, when added, give a logical result; when a new life is born, a problem arises, which is called "Rh-conflict". The normal development of the fetus is threatened, and in order to save the baby, the woman is prescribed anti-rhesus immunoglobulin. Let's figure out what kind of medicine is and how safe it is for carrying a baby.

What is immunoglobulin, in which cases the drug is used

Blood plasma is 5% protein. 3% of blood proteins are immunoglobulins, substances that support the body's immunity. They also penetrate other fluids - for example, breast milk, saliva, urine.

A person has 5 classes of immunoglobulins that fight:

• with pathogenic bacteria, viruses and other harmful microbes;
• with toxic substances;
• with allergies.

As soon as the immune “guardians of health” detect foreign cells or pathogenic microorganisms, they attack the “enemies” and destroy them. At the same time, immunoglobulins do not carry any danger to other cells.

Immunoglobulins circulate in the bloodstream and vigilantly monitor the "purity" of the blood; when alien agents appear, they are mercilessly eliminated

The blood delivers immune proteins (also called antibodies) to distant parts of the body; for pest control - antigens - a low concentration of antibodies is required.

For the first time, immunoglobulin was obtained from the serum of donated blood in 1952 - to save the lives of people who had absolutely no antibodies. For deciphering the chemical composition of immunoglobulins, scientists J. Edelman and R. Porter were awarded the Nobel Prize in 1972.

The protein fraction responsible for immunity is isolated from the serum or blood plasma of healthy donors (first of all, they make sure that there is no AIDS, hepatitis B and C). Human immunoglobulin is widely used in medicine, used for:

• immunodeficiency;
• severe infections of a bacterial and viral nature;
• autoimmune diseases (for example, pathologies of the thyroid gland);
• pronounced allergies;
• AIDS in children.

Immunoglobulin is contained in vaccinations against rubella, measles, mumps.

A separate type of drug, with the unofficial name anti-Rh immunoglobulin, is prescribed exclusively to expectant mothers with Rh-negative factor, if doctors state a "conflict of interest" in the process of mixing blood that threatens the baby's development. In the composition of such a drug there are no antibodies that destroy bacteria or viruses; only immune cells to Rh-positive blood substances - the so-called D-antigens.

Let's figure out what the danger of a collision of "plus" with "minus" is.

Rhesus conflict in the womb

Erythrocytes - red bodies - circulate in human blood. In most people, on the surface layer of red blood cells "lives" a protein-antigen, which is called the Rh factor; since there is such an element, it means that a person has Rh-positive blood. When no protein is found on red blood cells, the blood is considered Rh negative.
The presence or absence of a protein called the Rh factor divides people into Rh-positive and Rh-negative.

Approximately every seventh inhabitant of the planet has a Rh negative factor. During surgical operations, this indicator is extremely important - if "positive" blood is mixed with "negative", the person will die.

In ordinary life, a negative Rh factor does not affect health, including mental activity; people go in for sports - and extreme sports too - experience other physical activities, make scientific discoveries, and so on. If only in case of severe injuries, the doctors were notified in time about their Rh factor.

Problems begin in a number of women - after conceiving a child.

Imaginary threat

So the pregnancy has come. The woman has Rh negative blood, the man has Rh positive. 50% chance that the unborn child will inherit his father's blood count. As a result, for maternal antibodies, the baby turns into a foreign object - they also found an element unfamiliar to them in the fetus - the Rh factor.

From 20 to 29 weeks of pregnancy, an urgent mobilization is announced in the female body: antibodies are intensively produced to eliminate the little "enemy". The attack of adult immunity threatens to be fatal for the fetus - its immune system is not yet capable of adequate protection. As a result, the child's red blood cells stick together and then collapse, which leads to the following consequences:

• fading of the fetus in the womb (actually death);
• premature birth;
• hypoxia (oxygen starvation) of the fetus;
• a child is born with hemolytic disease, the consequences of which are severe anemia (anemia), heart and liver damage, deafness, paralysis.

Jaundice is one of the signs of hemolytic disease of the newborn; occurs due to impaired liver function

Scientists have yet to find out why such a “blood feud” is not typical for different blood groups - for example, the mother has the first group, the father has the fourth, but the child is developing normally. It is assumed that the Rh factor as an evolutionary trait historically appeared not so long ago and nature has not yet developed a mechanism for adapting "warring systems" to each other.

How does anti-rhesus immunoglobulin work?

The main task of the drug is to prevent the formation of antibodies that attack the elements of the baby's Rh-positive blood. More precisely, there is only one element - antigen D, against which the mother's immune cells take up arms; other rhesus antigens do not cause this aggressive reaction.

Anti-Rhesus immunoglobulin is saturated with antibodies designed to fight antigens D - that is, at first glance, there is no better way to "kill" the fetus completely. However, something else happens - the substances from the drug seem to "calm down" the woman's immune system: everything is in order, we have come to the rescue, there is no need to produce our own antibodies, please rest. And it works - maternal immunity, deceived by the drug, and does not think to create immunoglobulins to destroy the fetus. Substitution therapy gives the first result.

Meanwhile, antibodies from the drug, unlike maternal antibodies, are not able to penetrate the fetus - and this is another plus.
The placenta is a temporary organ that blocks the path of immunoglobulins from the drug to the fetus

After a while, medicinal substances are gradually removed from the body - accumulation is not provided. And their own production of antibodies is blocked. So the anti-rhesus immunoglobulin, acting on the principle of "lie to the rescue", leads the unwilling aggressor around the finger and saves the fetus.

Who needs the medicine first

The circulatory systems of the mother and the fetus are two separate systems; ideally, both blood flows do not mix until the blood with the D antigens of the future baby suddenly appears in the mother's body. Once on "enemy territory", fetal erythrocytes stimulate female immunity to the production of immunoglobulins. With the bloodstream, antibodies penetrate the baby through the umbilical cord and begin destructive work.

Fetal D antigens are found in maternal blood if:

• the woman had previously undergone an abortion for more than 8 weeks, when the fetus had already begun to produce its own red blood cells; then, during the termination of pregnancy, they penetrate the woman's bloodstream and provoke the synthesis of antibodies;
• the previous pregnancy ended in miscarriage after 8 weeks;
• an operation was performed to stop an ectopic pregnancy;
• the woman received a penetrating injury or abdominal contusion;
• the pregnant woman has impaired placental functions - fetoplacental insufficiency is observed, which is accompanied by a failure of normal blood flow, or partial placental abruption, leading to the same;
• before delivery, amniotic fluid began to leak;
• the woman underwent amniocentesis (diagnostic procedures with invasive intervention) - as a result, the tissue of the fetus was inadvertently injured; such procedures should be carried out only in cases of extreme necessity and always accompanied by treatment;
• the previous pregnancy ended happily with the birth of a baby.

Such expectant mothers with "negative" blood are placed in the risk group; the doctor prescribes the woman an injection of anti-rhesus immunoglobulin.

During the successful course of the first pregnancy, of course, you need to be on the lookout, but the likelihood of Rh-conflict is minimal, so you can do without the drug. Maternal immunity produces antibodies, but they are too large to cross the placenta or umbilical cord to the fetus. During delivery, the situation changes radically: the baby's blood inevitably mixes with the mother's blood, the mother's immune cells sound the alarm, the mechanism for the production of antibodies is triggered, which rush to attack the “outsiders”. The D antigens are destroyed, but the baby is already outside the womb, and therefore safe.

Problems come with a second pregnancy. Maternal antibodies are already on alert, and if the fetus has a positive Rh factor, the risk of conflict increases. Nothing will change the situation: once having produced antibodies to antigens D, the female body has forever "written" this Rh factor into enemies and is now doomed to fight.

After the first birth, so that the Rh-conflict does not occur during the next pregnancies, the woman is given an injection of anti-Rhesus immunoglobulin.

According to statistics, with each pregnancy of a Rh-negative mother, the likelihood of a "war" with D antigens, which means threats to the health, and even the life of the unborn child, increases by 10%. However, the risk to the fetus is reduced to zero when it inherits a negative Rh factor.

To make sure that she has started a Rh-conflict, the expectant mother takes a blood test for antibodies - first after 7 weeks, then - at 20 weeks; before giving birth, I have to go for tests every week. An ultrasound will also show that something is wrong: the placenta is thicker than normal, there is too much fluid in the abdominal cavity.

By an increase in the level of the coloring protein bilirubin in the blood, doctors judge the severity of the Rh conflict, since bilirubin shows how much red blood cells are destroyed.

Video: doctors about Rh-conflict in a pregnant woman

How is the drug used

Human immunoglobulin, which is responsible for the elimination of the Rh-conflict in a woman carrying a fetus, is obtained from donated blood. People are picked up by:

• physically healthy;
• with a negative Rh factor;
• immunity to D.

Dosage form, features of use

The drug with human immunoglobulin is released as a solution, which is administered intramuscularly. Immediately about the important rules:

• the injection is done only in a hospital, under the close supervision of an experienced doctor; self-medication is prohibited;
• the ampoules with immunoglobulin are kept before use for 2 hours at a temperature of + 18–22 ° С;
• the injection is performed with a needle with an enlarged hole - so that the medicine does not foam;
• intravenous administration is excluded;
• before the procedure, take a blood test for antibodies to antigen D;
• after the injection, the patient is left for an hour in the hospital, the woman is monitored by the medical staff.

Before injecting Rhesus Immunoglobulin, the nurse checks to see if foam is forming due to a too narrow passage in the needle.

The trouble is that when the mother's body has already begun to produce its own immunoglobulins, the drug is useless. Therefore, it is necessary to have time to introduce the medicine before the start of the process.

Let's say doctors suspect that a significant number of fetal red blood cells have entered the mother's bloodstream; then in the laboratory the level of red blood cells is calculated - for the correct calculation of the dosage of anti-rhesus immunoglobulin. One dose of the drug - 300 micrograms - can remove the threat of Rh-conflict if there are no more than 15 milliliters of erythrocytes with antigen D in the blood of a pregnant woman. At a higher concentration of red blood cells, the doctor prescribes two doses of the drug.

How long does the procedure take?

In the amount of one dose, the anti-rhesus drug is administered to the expectant mother with "negative" blood once, at 28 weeks, if:

• a woman has a second, third, and so on childbirth;
• there are no antibodies to the Rh factor;
• the state of the placenta is normal;
• no injuries happened.

A second injection is possible, before childbirth - if the doctor considers the procedure necessary.

The next injection is done after delivery, within 2-3 days (when the newborn has Rh-positive blood). It is at this time that the mother's body synthesizes antibodies that will harm the next child in the womb, and it is required to prevent such synthesis. However, the procedure is canceled, provided that the woman has already received a dose of the anti-rash agent less than three weeks before delivery. This also happens, because when not everything is in order with the pregnant woman, the drug is used according to a different schedule:

• if there is a threat of miscarriage for a period of more than 13 weeks - after the pregnancy continues or if a spontaneous abortion has occurred, the woman is prescribed a standard dose, 300 mcg;
• if the pregnancy is accidentally or intentionally interrupted for up to 13 weeks, as a rule, a mini-dose of the drug is injected - 50 mcg;
• after an abdominal trauma or unsuccessful amniocentesis, one dose of the drug is administered; when the accident happened before 28 weeks, a second procedure is needed at this time; with the development of a hematoma, you will have to inject immunoglobulin once a month until delivery;
• if abnormalities of the placenta or other "stimuli" for premature birth appear in the later stages, the injection is repeated - it turns out, after the planned one at 28 weeks.

The rate of action of the drug

The maximum level of "cheating antibodies" from anti-rhesus immunoglobulin appears in the blood a day after administration. The half-life is 23 to 26 days.

In 4–5 weeks, half of the medicinal substances are excreted from the body.

The level of donor immunoglobulin, which can prevent the appearance of antibodies hostile to the fetus, remains after the administration for three weeks.

Consequences of taking anti-rhesus immunoglobulin

The drug is considered safe for both mother and fetus, although clinical trials are lacking to support this opinion. They are based on the reviews of women who were injected with the drug. In the body, the medicine will destroy the D antigens that have got there with the child's Rh-positive blood - all the same, they will not take root; but the production of antibodies-aggressors is temporarily suppressed. There are also no threats to the baby - the placental barrier will not allow immunoglobulins from the medicine to pass through. As a result, both pregnancy and fetal health are saved.

Solution injections do not contradict other medications; allowed to use, including antibiotics.

Contraindications

There are almost no such for pregnant women. It has already been said that the drug will not help those Rh-negative expectant mothers who have their own Rh antibodies in their blood serum.

In addition, there are women with an increased sensitivity to human immunoglobulin - after all, it was obtained from a foreign donor and, given the widespread allergy that swept the world, it is quite capable of causing a negative reaction in a pregnant woman. This happens in exceptional cases, however, incidents have been recorded when women, after the administration of the drug, were subjected to anaphylactic shock. That is why the procedure is done in a medical facility where it is possible to carry out anti-shock therapy.

When the patient knows that she cannot tolerate immunoglobulin, other methods of therapy have to be looked for.

In general, the drug has been used for exactly 50 years - the first injections of anti-rhesus immunoglobulin were made back in 1968. The drug has a good reputation thanks to the mass of positive reviews from doctors and patients.

Adverse Reactions

Alas, the "side effects" are not excluded. Occasionally, the injection is accompanied by:

In one in ten thousand cases of drug administration, the patient becomes infected with AIDS or hepatitis. Despite the manufacturers' strict control over donated blood, the factor of negligence plays its evil role.

Doctors exclude the risk of overdose: in the instructions for the drug, the doses of administration are clearly prescribed for different cases.

Drug analogs

The pharmaceutical market offers a number of products with a similar effect; the Russian drug is officially called Human Immunoglobulin Antiresus. As for the others, the names and countries of origin are different, but the principle is the same. It is difficult to say which medicine is better: imported ones have a reputation for better quality and are usually more expensive, although the active substance is the same everywhere - anti-rhesus human immunoglobulin.

All drugs are sold by prescription only.

Table: Human immunoglobulin Antiresus and its analogues

Title and manufacturer country	Release form and composition	Contraindications and adverse reactions	Price in pharmacies Moscow
Human immunoglobulin Antiresus - Russia	Solution for intramuscular introduction, placed in ampoules, packaged by cardboard packs (either 1 or 10 in each); composed only of the current substance.	Hypersensitivity to the drug; Availability Rh antibodies in "negative" blood. Rarely causes allergies, more often - temperature rise, difficulty with digestion of food.	from 3630 rubles (at 28 weeks it is supposed do free rhesus negative future mom in womens consultations)
KAMROU - Israel	Solution for intramuscular injections, sold in vials, together with a needle that has a filter; auxiliary components of the product - glycine, water for injection. Shelf life is 2 years.	Contraindications are the same - plus according to the instructions can not be used Rh-positive women; side effects are the same as Russian drug.	from 5775 rubles
HyperROU S / D - USA	Solution, injected intramuscularly, available in disposable syringes with a needle, packed in cardboard boxes; additional substances - glycine, water for injections. Validity period - 3 years.	Prohibitions and side reactions are the same what is CamROU;	from 3900 rubles
Resonative - Austria	Solution for injections intramuscularly, sold in ampoules of 1-5 pieces, laid out on plastic packaging; sodium chloride, sodium acetate, water for injection. Stored for 2.5 years.	One contraindication - allergy for substances from the drug; side effect: allergic reactions; cardiopalmus; headache; nausea, vomiting - rarely; decrease in pressure; chills, weakness.	from 3500 rubles
Partobulin SDF - Austria	Solution for intramuscular injection, contained in a syringe that is ready for use; auxiliary components - glycine, sodium chloride, macrogol, water for injection. Expiration date - 24 months.	Contraindications are the same as for side reactions: chills, malaise; itchy skin; tachycardia; nausea, vomiting - sometimes; arterial hypotension; occasionally - anaphylactic shock.	from 5500 rubles

Photo gallery: preparations with anti-rhesus immunoglobulin

Russian immunoglobulin does not contain excipients
The Israeli drug KamROU does not differ much from the Russian one, but it costs much more. The Austrian Resonative has several excipients, but the list of side reactions is longer

How to prevent Rh-conflict

To begin with, every woman who is planning a pregnancy needs to find out her Rh factor. If the indicator is negative, send the future dad for analysis: if the result is opposite, be vigilant. The first pregnancy is unlikely to cause problems, but when the newborn has "positive" blood, an injection of an anti-rhesus drug after childbirth is indicated.

Once you become pregnant again, do not neglect regular visits to the clinic and taking tests for antibodies. Keep the situation under control so that on time, at 28 weeks, you do not forget to give you an injection of a life-saving drug. Accidentally fell, got into a car accident and injured your stomach - demand to inject a dose of immunoglobulin.

Well, other "reminders" for those who have "negative" blood:

• avoid abortion, especially if you have not been pregnant before, protect yourself from unwanted conception;
• take care of yourself during pregnancy, drive carefully, get into the car with a reliable driver;
• do not resort to invasive intervention unless absolutely necessary; ask the doctor ten times how necessary the procedure is; it is better to use the services of a trusted doctor with a solid reputation.