Antenatal immunoglobulin for fetal red blood cell alloimmunization

Pregnant women may develop antibodies in response to antigens on fetal red blood cells. The antibodies that result can cross the placenta to the fetus and break down red blood cells, leading to fetal anaemia. This has become less common with the routine use of anti D immunoglobulin in pregnant women with a Rhesus D-negative blood group and no pre-existing anti-D antibodies, but remains a cause of fetal death. Currently, standard management involves monitoring antibody titres in conjunction with ultrasound assessment of fetal well-being, and the use of intrauterine transfusion when fetal anaemia is diagnosed. Unfortunately, intrauterine transfusion poses significant risks because of its inherent invasiveness and procedure-related risks, including a risk of perinatal death.

Intravenous immunoglobulin has been proposed as an alternative form of treatment, with the advantage of being less invasive. There are no randomized trials of intravenous immunoglobulin given antenatally to women with severe fetal red blood cell alloimmunization to show if this offers any benefit over other forms of treatment or no treatment, but there are case series suggesting a possible role in delaying the onset of fetal anaemia requiring invasive intrauterine transfusion.

Authors' conclusions: 

No information is available from randomized trials to indicate whether the antenatal use of intravenous immunoglobulin is effective in the management of fetal red blood cell alloimmunization. Several case series suggest a beneficial role in delaying the onset of fetal anaemia requiring invasive intrauterine transfusion.

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Background: 

Red blood cell alloimmunization in pregnancy can lead to fetal anaemia with potentially disastrous consequences. Traditional management involves the use of intrauterine transfusion, which is associated with significant procedure-related risks. An alternative treatment that has been trialled is the use of immunoglobulin administered intravenously to the mother.

Objectives: 

The objective of this review was to assess the efficacy and safety of the use of intravenous immunoglobulin antenatally to women with severe fetal red blood cell alloimmunization.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group trials register (19 December 2012), and reference lists of articles.

Selection criteria: 

Randomized trials assessing the antenatal use of intravenous immunoglobulin administered at any dose, frequency or duration with a control group (using any other, or no treatment) in the management of fetal red blood cell alloimmunization.

Data collection and analysis: 

Two review authors independently assessed the available evidence.

Main results: 

There are no included studies.

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