The issue of prevention of sensitization during pregnancy – a very important but not yet solved the problem. Basically avoid sensitization caused by transfusion of Rh-positive blood.
In cases when you need urgent blood transfusion and no way to determine the Rh-factor, better pour Rh-negative blood group of the same name. Reliable prevention does not yet exist.
Mothers who have children definitely have to be born with symptoms of hemolytic disease, pregnancy can be interrupted for 10-15 days before delivery, but not before.
The birth of premature babies is also dangerous, because such children are initially defective. Termination of pregnancy is made dependent on antibody titer. Currently not recommend termination of pregnancy by cesarean section, but prefer natural childbirth.
Impact mixed vaccines (whooping cough and typhoid vaccines vaccine) so as to cause competition with respect to the Rh-antigen not only fails, but even increases the sensitization.
Noteworthy proposed R. Polivanov desensitization of pregnant women through the introduction of small amounts (0.5-4 mL) fresh citrate, but incompatible in the group against Rh-negative blood.
It is believed that the A and B antigens prevent the formation of Rh-antibodies in the mother’s blood, as the ABO system antigenically more. Prevention is important and immunobiological way.
Experiments in recent years show that the antiglobulin or high titer anti-D-gamma-globulin, injected intramuscularly during labor may prevent sensitization in the first pregnancy, all of Rh-positive red blood cells (fetal), have fallen to the mother, are eliminated for 3-12 h).
We have production and use of anti-D-gamma-globulin involved N. Doytchinov. Bulgarian anti-D-gamma-globulin is used by many large obstetrical and gynecological offices in Bulgaria with great success, and not only at the first, but the next pregnancy if the fetus of Rh-positive and Rh-negative mother who has no signs of isoimmunization.
The usual dose – 1 ml intramuscular injection in the first 72 hours after birth. Usually the fetal red blood cells pass from the fetus to the mother in late pregnancy and early childbirth. With this method reduces the number of cases of hemolytic disease in newborns and mothers isoimmunization.
In pregnant women with the presence of Rh-antibodies Ognyanov K., N. and D. Doytchinov Shinko report good results of combined treatment with cortisone and non-specific gamma globulin. Treatment starts with a 16-week pregnancy and continue until the end of it.
Designate the first month, 20 mg of prednisone per day and 3 ml intramuscular gamma globulin. Every day 10 20-25 E ACT is administered intramuscularly.
In the following months of prednisone dose is 20 mg per day, and non-specific gamma globulin is administered at 3 ml a day. After the 34th week produced spectrometric study of amniotic fluid to clarify the optimal term abortion. The exact mechanism of action of anti-D-gamma globulin, high titer is not known. Does this by disrupting fetal erythrocyte antigen and sustainable blocking antigen or by altering the mother’s immune reactivity was found.
For the purpose of suppression of antigen responses – an antibody in the last months of pregnancy prescribe ACTH or prednisone. To prevent the development of kernicterus in the newborn immediately after birth it is prescribed prednisone 5-10 mg per day in the course of 10 days. It is desirable that when a pregnant woman receives food rich in vitamins, iron and so on.
Needed early registration of pregnant women antenatal clinics, early examination of their blood group and Rh-affiliation.