OGCO-C2.11 Use of IVIG in obstetrics for fetal and neonatal conditions

Question 1

Indications of IVIG in obstretics for fetal and neonatal conditions?

Answer 1

Fetal and neonatal alloimmune thrombocytopenia
* Results from development of maternal alloantibody after exposure to incompatible paternally derivef human placental antigen, leading to fetal thrombocytopenia. Severe fetal intracranial hemorrhage or perinatal death can occur in FNAIT
* Antenatal IVIG can effectively prevent 99% of intracranial hemorrhage. The reurrence rate could be up to 80% without antenatal treatment
* IVIG 1g/kg/week from 14-16 weeks until delivery can be used for previous affected pregnancy with fetal intracranial hemorrhage.
* Lower dose with shorter treatment course considered for women without prior fetal intracranial hemorrhage –> IVIG 0.5mg/kg/week from 24 weeks until delivery

Neonatal haemochromatosis
* Characterized by severe liver injury with hepatic and extrahepatic iron accumulation
* Gestational alloimmune liver disease is a major cause of neonatal haemochromatosis. Transplacental transfer of maternal antibodies directing against fetal hepatocyte antigen leads to severe liver injury –> acute liver faiure or neonatal death.
* Cases usually identified by previous affected pregnancy
* Success of antenatal IVIG to prevent recurrence is close to 100%. The risk of lethal recurrene is around 90% without antenatal treatment
* Course is IVIG 1g/kg at 14, 16 weeks than weekly from 18 weeks of gestation until delivery.

Question 2

Contraindications to IVIG?

Answer 2

1. Patients who have a true anaphylactic reaction to a human immunoglobulin preparation.
2. IgA-deficient patients with antibodies to IgA and a history of hypersensitivity.