OBJECTIVE: To explore a new method for the treatment of mother-child Rh blood group incompatibility during pregnancy. METHODS: Five pregnant women with severe Rh blood group incompatibility were treated with intravenous immunoglobulin (IgG) in addition to plasma removal during pregnancy. Each time 10 g, and according to the maternal antibody titer, the interval of 7-20 days once. Results: 5 pregnant women were injected with IgG for 12 times, 1-5 times per case, with an average of 2.4 times per case, without side effects. The plasma was removed for 18 times, 1～8 times per case, average 3.6 times per case, and none of them was stillborn. 5 newborns were treated with intravenous IgG drip and blood exchange, and all of them survived. Conclusion: IgG can adjust fetal immunity, relieve and reduce the degree of fetal hemolysis. ?Rh blood group incompatibility is the main cause of fetal and neonatal death and cerebral nuclear jaundice. And besides D antigen, EpC antigen can also cause Rh system mother-child blood group incompatibility. In order to explore a new method for the treatment of Rh blood group dyscrasia during pregnancy, our hospital has applied intravenous c-immunoglobulin (IgG) and achieved satisfactory results. It is reported as follows. DATA AND METHODS I. Source of information From July 1996 to February 1998, 5 Rh-negative pregnant women were treated in our hospital and systematic anti-D antibody titers were measured (before 20 weeks of pregnancy, 1 time every 2 weeks. After the 28th week of pregnancy, the titers were measured once a week.) When the antibody titer reaches l:32～l:64 or 1～2 times higher than the original titer, plasma removal is started and IgG treatment is added. The pregnant women were 25-36 years old, with an average age of 29.8 years. 2 cases had a history of blood transfusion before marriage. Methods 1. Antibody titer detection: Maternal antibody titer was detected, if the indirect anti-human globulin method was higher than l:64 or the modified Coomb’s test was higher than 1:32, plasma was collected by the American closed single-use, sterile, heat-free PCS2 single plasma-collecting instrument, and at the same time, the blood cells and other components were reintroduced back into the mother’s body. According to the antibody titer and the rate of rise, plasma removal was carried out in a timely manner. 18 times of plasma removal were carried out in 5 pregnant women, and the success rate was 100%. 2.Intravenous infusion of IgG:All 5 pregnant women were given IgG treatment after admission to the hospital (22-33 weeks), 10g each time, at intervals of about 7-20 days, 12 times in total. A total of 12 times were used. The average was 2.4 times per case. Specific method: 10 g of IgG was dissolved in 100 ml of water for injection and injected intravenously. Dexamethasone 5 mg should be given before use according to the requirement of blood transfusion. Results I. Results of plasma removal and antibody titer test A total of 18 plasma removals were performed in 5 pregnant women. The total amount of plasma removed was 10,211 m1, with a minimum of 400 ml and a maximum of 600 ml each time, with an average of 567 ml each time. Antibody titers before and after plasma removal decreased 2-fold in 4 cases and 3-fold in 1 case. II. Intravenous infusion of IgG All five cases were given IgG treatment after admission to the hospital (22-33 weeks, mean 27.8 weeks). 10 g each time, 1 time at an interval of 7-20 days, 12 times in total. The average was 2.4 times per case. The decrease in antibody titer after plasma removal was maintained for about 10 to 15 days. Fetal condition Fetuses delivered in 5 cases were free of edema and ascites.4 cases had normal amniotic fluid and 1 case had low amniotic fluid.2 cases had edema of the placenta with a thickness of 4.5-5.2 cm.1 case had intrauterine growth retardation.After 5 courses of treatment, ultrasound monitoring of fetal development was in the normal range. The remaining 4 cases had normal growth. Fetal heart monitoring was normal in 4 cases and abnormal in 1 case, which returned to normal after 24 hours of review. Biochemical monitoring, pregnancy-specific β-glycoprotein (SP1) and placental prolactin (HPL) were in the normal range. Delivery mode and neonatal conditions All five cases were terminated by cesarean section. In 3 cases, the antibody titer was 2-3 times higher than the original one; 1 case had low amniotic fluid and 1 case had abnormal fetal cardiac monitoring. The gestational weeks of delivery were 34 weeks in 2 cases, 35 weeks in 1 case, and 36 weeks in 2 cases.The postnatal Apgar scores of the 5 newborns were all 10 points. Neonatal weight ranged from 2,350 to 3,200 g, with an average of 2,710 g. All 5 neonates developed jaundice between 1 and 35 minutes after birth, which progressively worsened. 3 cases had amniotic fluid yellow staining, 2 cases showed mild edema without pleural or abdominal fluid, 4 cases had hepatosplenomegaly, and 4 cases had edema in the placenta. Total umbilical serum bilirubin ranged from 38.3 μmol/L to 141.2 μmol/L, with a mean of 106 μmol/L. Neonatal hemoglobin ranged from 84 to 156 g/L, with a mean of 119 g/L. Reticulocytes ranged from 2.1% to 6.0%. Neonatal blood transfusion was performed at 2.5-9 hours after birth. Discussion I. Pathophysiology of Rh blood group incompatibility Fetal erythrocytes carry antigens from the father into the mother, so that the lack of the same antigen of the mother to occur in the alloimmune reaction. The corresponding antibodies will pass through the placenta to the fetal circulation, causing fetal red blood cells to agglutinate and destroy, resulting in hemolysis. intrauterine hemolysis can cause severe fetal anemia, cardiac failure, fetal edema, and even stillbirth. 1945, blood exchange was used for neonates. 1963, intrauterine blood transfusion was used for fetuses (22-36 weeks). 1981, Beijing Red Cross Blood Center began to carry out plasmapheresis for Rh blood group dyscrasia. In 1981, Beijing Red Cross Blood Center started plasmapheresis for Rh blood group incompatibility. It was later changed to plasma removal. Due to the strongest antigenicity of the D antigen in the Rh system, it often involves the fetus after 22 weeks of gestation. Therefore, it causes the most stillbirths and neonatal hemolytic disease as well. In our group, five pregnant women, all Rh-negative, lacked D antigen and had a history of poor pregnancy and labor. Re-pregnancy caused severe perinatal hemolysis. In the past, China’s treatment of Rh hemolytic disease using vitamin E, phenobarbital drugs and traditional Chinese medicine and other poor results, often occurring fetal edema, fetal death in the womb. 80’s began to change to plasma removal treatment. Better results have been achieved, but fetal edema occurs from time to time. Second, the role of plasma removal to reduce maternal antibody titer plasma removal without replacement fluid. In addition to plasma, other components are one-time closed transfusion. It is the most effective method to prevent and control fetal hemolysis and stillbirth in pregnant women with Rh blood group incompatibility. When to start plasma removal before and after pregnancy, the amount and frequency of removal, etc., need to depend on the level and dynamic changes of anti-D antibodies in pregnant women and clinical conditions [5]. Plasma removal performed at the right time and in the right amount can lead to a decrease in maternal antibody titers. It reduces and mitigates the immunolytic effect on fetal erythrocytes, reduces the degree of intrauterine fetal damage, prolongs the gestational week, and improves the survival rate of perinatal infants. Plasma removal is not damaging to the mother. Plasma volume in pregnant women should not exceed 600 ml at any one time. and can be self-regulated. It has been reported in the literature that the protein lost by removing 250 ml of plasma can be regenerated and replenished within 16 to 18 hours, and 15 minutes after the removal of 514 ml of plasma, the proteins infiltrated into the blood vessels outside the blood vessels can accelerate the synthesis and regeneration, and reduce the metabolism and decomposition, so that the protein content in the blood is basically restored to the original level. Third, the maternal antibody titer on fetal hemolytic disease In Rh homozygous immunity, the initial immunity to the newborn has a small effect, but when pregnant again, only 0.5 ml of fetal blood with anti-D antigen can cause secondary immunity, with the fetal blood after the mother’s blood, the antibody titer gradually rises, and the serum with high affinity to the Rh antigen can cause red blood cells to agglutinate within 15 seconds, so that once combined with fetal red blood cells, hemolysis occurs [1]. Therefore, once combined with fetal red blood cells, hemolysis occurs [1]. There are no natural antibodies to Rh. Therefore, the dynamic changes in the titer of Rh antibodies in the blood of pregnant women are directly related to the antigens of fetal erythrocytes in this pregnancy. Therefore, the level of antibody titer during pregnancy can directly reflect the degree of intrauterine hemolysis in the fetus. Fourth, the role of intravenous infusion of IgG in the treatment of Rh blood group incompatibility In recent years, the research of perinatal medicine and obstetric immunology has made great progress. People recognize and treat certain diseases in obstetrics (such as hyperemesis gravidarum, etc.) from the perspective of immunology.The treatment of Rh hemolytic disease during pregnancy has received more and more attention from the clinic and is being actively explored.After intravenous drip of IgG, it can increase the level of IgG in the body very quickly[5] and enter the fetal blood circulation through the placenta to play a role in protecting the fetal red blood cells, delaying the destruction of the fetal red blood cell membranes and the intrauterine damage of fetus, prolonging the The role of the gestational week, to create favorable conditions for neonatal blood exchange. Side effects of IgG treatment Intravenous IgG is used for the treatment of newborns with Rh blood group incompatibility, and the effect is good. However, a large dose (1 g/kg) of intravenous drip lasting 6-8 hours can cause immunogenic hemolytic jaundice in newborns. The clinical manifestation is a persistent rise in bilirubin. The analysis may be that some globulin products are impure and contain antibodies against blood group antigens that cause hemolysis. Therefore, the presence of such antibodies must be checked before application.