High-Dose Intravenous IgG for the Treatment of Severe Rhesus Alloimmunization

Authors

  • Prof. Miguel Margulies MD,

    Corresponding author
    1. Department of Maternal-Fetal Medicine, Juan A. Fernández Hospital, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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  • Liliana S. Voto,

    1. Department of Maternal-Fetal Medicine, Juan A. Fernández Hospital, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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  • Elena Mathet,

    1. Department of Maternal-Fetal Medicine, Juan A. Fernández Hospital, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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  • Máximo Margulies

    1. Department of Maternal-Fetal Medicine, Juan A. Fernández Hospital, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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Av. Pueyrredón 1746, 2A 1119-Buenos Aires (Argentina)

Abstract

Abstract. The value of intravenous immunoglobulin (IVIG) in the treatment of 24 severely Rh-sensitized pregnant women was studied. IVIG was infused at a daily dose of 0.4 g/kg maternal body weight for 4–5 consecutive days, and was administered again 15–21 days later until delivery, depending on the evolution of the hemolytic disease. Our population was divided into 3 groups according to the time of onset of therapy: group 1 (n = 8), before 20 weeks' gestation; group 2 (n = 7), 20–28 weeks, and group 3 (n = 9), after 28 weeks. Initial mean anti-D level was significantly higher in group 1 (25.9 ± 12.9 IU/ml) than in the other 2 groups, whose mean values were, however, higher than 10 IU/ml. Amniotic-fluid total bilirubin levels before the onset of therapy were pathologic, and in 55% of the cases they coincided with zone 3 of Liley's chart. Hydrops fetalis at the onset of treatment accounted for the only 3 fetal deaths in groups 1 and 2. None of the fetuses developed hydrops during treatment. Six of the 9 neonates in group 3 were depressed at birth (1-min Apgar below 7). However, at 5 min only 1 newborn showed an Apgar below 7. Mean birth weight was over 2,500 g in all the cases. Neonatal hematological condition in group 2 (50% of the babies required only phototherapy) was better than in the other 2 groups (transfusional therapy). There was a significant fall in maternal anti-D titers and intrauterine hemolysis after IVIG treatment. In order to further evaluate the response to IVIG therapy, the 13 cases in our population with a history of fetal/neonatal death in the previous pregnancy were analyzed separately. The results obtained in this particular group of patients demonstrated again the effectiveness of IVIG treatment.

Conclusions: There were no adverse effects on the mother or fetus, and there was no need for neonatal intensive care. Results were more favorable if treatment was started before 28 weeks' gestation in nonhydropic fetuses.

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