After 5 years of fetal stopping, abortion, and test tube failed, after accurate fetal protection, he finally wished, and he was happy!

Ms. Huang has been married for many years and has always wanted to have a healthy baby, but she has not been as long as she wants, and it is difficult to get pregnant because of physical reasons. It is not easy to walk along the way.

In 2016, I saw the fetal heart stopping since 12 weeks of pregnancy.In 2017, since the 22nd weeks of pregnancy, due to the incompetent cervical ring of the cervical function, there was an abortion after 2 weeks, and the placenta implantation was removed for uterine laparoscopy.

In the end, Professor Chen was found before the natural cycle test tube transplantation was planned in 2021. After detailed understanding of Ms. Huang’s situation, Professor Chen formulated a detailed tire protection plan.

Hysteroscopic hysteroscopy is not abnormal before transplanting; 6.5%↑ of hemoglobin; ANA1: 640; NK cells 65%↓; B cells 22%↑; progesterone: 18.840NG/ml; ultravisive C reactive protein: 1.41ng//L, anti -nuclear antibody: nuclear particles (1.160)+nuclear average (1:80); the remaining inspection inspection and inspection are normal.

After a detailed inspection, Professor Chen gave a drug plan before transplantation: aspirin once a day; sulfate pine chlorine tablets twice a day.

Take medicine one week before transplantation:

1. Circinoplastin 3 times a day.

2. Inject the injecting the sodium sodium sodium injection every day before transplantation; use Yinoin sodium sodium injection every morning after transplantation, and use sodium sodium injection of sodium sodium in the afternoon.

3. The reorganized human granulocyte stimulation factor injection was injected once on the 5th and 3rd day before the transplantation of the injection, and the subcutaneous injection was injected on the night after transplantation.

4. The day before the transplantation of heylin paddic acid, he started taking it, 3 times a day for 6-8 days in a row.

5. Five days before transplantation and transplantation 2 days after the vein, one immunoglobulin.

6. Check the blood HCG 6, 8, and 10 days after transplanting the blastocyst, stop the medicine without pregnancy, and continue to take medicine after pregnancy.

Patients asked: I always heard that they needed to play immunoglobulin, but I do n’t know what effect?

Professor Chen explained doubts:

Passive immunotherapy for immunoglobulin:

Passive immunotherapy is used to use the unique antibody and anti -independent antibody antibody of the anti -placental nourishing layer antigen in the anti -placental nourishing layer of antigen, which is used to make up for the lack of protective antibodies in RSA patients.Cell receptor binding, closed its killing function, and maintaining maternal immune tolerance.

Immunoglobulin (Ivig) contains a variety of antibody antibodies, which can neutralize pathological antibodies (even HLA-AB), reduce the titer of its own antibodies in the blood circulation, thereby protecting the embryo.Activated T cells that can participate in immune response and polyxonic B lymphocytes, choose immune response suitable for pregnancy.IVIG can reduce the generation of TH1 cytokine, reduce the number of peripheral blood NK cells, reduce NK cytotoxicity and inhibit the production of its own antibodies, induce the release of TH2 cytokines of peripheral blood immune cells, maintain the balance of TH1/TH2 cytokine, multiple waysPromote embryo bed and early pregnancy maintenance, and improve pregnancy ending.

Tip: For the number of abortion ≥ 2 times, the lack of APLA, the number of NK cells and the abnormal toxicity, the RSA patient APLA negative treatment or treatment of APLA is not transferred to pregnancy again, the mother’s immune recognition disorders RSA, the embryo loser repeats the bed loser should choose to choose fromPassive immunotherapy for immunoglobulin.

Immunoglobulin treatment:

Pre -pregnancy treatment: 5%IVIG10g ~ 25g on the 8th day of the ovulation -promotion cycle.

Treatment after pregnancy: The first dose of intravenous drop 5% IVIG 25g ~ 30g (0.5/kg), and then 20g of intravenous injection every 2 to 3 weeks, until 22 to 24 weeks of pregnancy.

Treatment of small doses after pregnancy: Early pregnancy is injected as early as possible, IVIG10g, once a week, once every 2 weeks after 10 to 12 weeks of pregnancy, once every 3 weeks after 20 weeks of pregnancy, until 26 to 30 weeks of pregnancy.

IVF-ET: 2 to 7 days before the fertilized egg transplantation, the venous drop IVIG 10g, and then the venous drip 10g after 1 week.Determine 10g per week after pregnancy, every 2 to 3 weeks after 10 to 12 weeks of pregnancy, and 26 to 30 weeks of pregnancy.

After pregnancy, IVIG treatments are generally applied after the pregnancy test is positive. The earlier the effect, the better.

Tip: After pregnancy, the length of immunoglobulin dosage and the length of treatment is mainly based on the history of RSA, the number of NK cells and activity after pregnancy, and comprehensive judgment of the results of the HCG, P and B -ultrasound.

The efficacy of passive immunotherapy:

According to the literature report, the negative pregnancy of the APLA patient in RSA patients is immediately given to IVIG vein, once every 2 to 3 weeks, until 26-30 weeks of pregnancy.About 76.2%of the pregnant woman Apla in 4 times after pregnancy, the total success rate of the fetal preservation was about 84%.

The experimental results prove that the embryo that merged HLA with high compatibility (≥3 HLA sites between couples) repeatedly failed to bed in the bed, and gave IVIG intravenously during the follicle raising stage and ultrasound exploration and fetal heart.It was found that the pregnancy rate increased significantly when embryo transplantation again.

The 202 fresh cycles of patients with repeated planting failures are divided into 4 groups. The CD56+ CD16+ cell level increases or normal, and patients with higher levels of TH1/TH2 or normal, according to whether IVIG therapy is divided into 4In each group, the planting rate, clinical pregnancy rate and live production rate between each group are compared.The results showed that repeated planting losers detected by CD56+ CD16+ cellular levels or/and and increased TH1/TH2 levels before pregnancy, which is beneficial to improving the end of pregnancy.

Studies have also found that the level of TH1/TH2 levels is more predictable than that of CD56+ CD16+ cellular levels, and the increase in TH1/TH2 levels is likely to affect the quality of embryos by affecting the growth of follicles.Therefore, IVIG is used before pregnancy to reduce tumor necrosis factor-A (TNF-A) level in the follicular fluid, improve TH1/TH2 level, and improve the quality of eggs and the number of eggs.In addition, IVIG may combine with IGG and regulatory T cell surface CD 200 receptor to media CD 200 immune tolerance signals, enhance the number of regulatory T cells, and reduce the TH1/TH2 ratio.

Due to the expensive cost of IVIG treatment, the starting treatment time is generally 7 days before the embryo transplantation, 0.2g to 1g/kg is injected every 2 to 4 weeks, and the medicine is stopped from 28 to 36 weeks of pregnancy.

The immunoglobulin passive immunotherapy does not have advantages compared to LIT. The combined application can achieve better curative effect and increase the live production rate.

Passive immunotherapy side effects and precautions:

IVIG’s application is highly safe and rarely causes serious adverse reactions.The main adverse reactions include headaches, myalgia, fever, cold, dizziness, chest tightness, nausea, vomiting, etc., and have not found teratogenic effects on the fetus.

IVIG contains a small amount of IgA. Patients with IGA deficiency can generate allergic reactions after entering IVIG. A few can occur in hemolysis. Therefore, IVIG is disabled in patients with IGA deficiency.However, IgA is not common for patients, so it is currently not routine to screen IGA clinically.Because intravenous dripping Ivig costs more expensive and the danger of potential hemogenous infection, there is still controversy to apply this treatment method.Due to the lack of clear immune indicators to identify and screen RSA patients suitable for IVIG, and there is no uniform treatment plan, IVIG has not yet been widely used clinically, so its efficacy needs to be further observed.

In the end, Ms. Huang used Professor Chen’s fetal protection plan before pregnancy. After a period of careful treatment, Ms. Huang finally got her wish and was happy in April this year.

Reminder: This article is only a science of medical science for readers for reference and learning. Disease treatment varies from person to person. If there is any symptoms of discomfort, please go to the hospital in time.

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