Intravenous Immunoglobulin as Primary Therapy or Adjuvant Therapy to Intrauterine Fetal Blood Transfusion: A New Approach in the Management of Severe Rh-Immunization


DII/41, Ansari Nagar, New Delhi-110029, India


Maternal high dose intravenous immunoglobulin (IVIG) has shown promise in the management of severe Rh-immunization. Intravenous immunoglobulin, blocks Fc mediated antibody transport across the placenta and blocks destruction of fetal red cells and reduces maternal antibody levels. We have tried this new therapy in 6 patients with severe Rh-immunization, with high maternal antibody titres and previous hydrops and intrauterine deaths. Intravenous immunoglobulin was given from 13–18 weeks of gestation 3–4 weekly, till intrauterine transfusion (IUT) or delivery. Intensive fetal monitoring was done. No fetal hydrops or deaths occurred in any of the 6 cases. Only 2 cases needed intrauterine transfusion. IVIG delayed the onset of fetal anemia by 8–17 weeks thus deferring the need for IUT. All pregnancies continued till 32–36 weeks and all 6 babies did well in the neonatal period.