Obstetric uses of intravenous immunoglobulin: Successes, failures, and promises

Intravenous immune globulin (IVIG) is approved for use in a number of condi tions that may occur in obstetrical patients, including autoimmune thromboc ytopenia and immune deficiency syndromes. IVIG also Is widely used in obste trics for nonapproved indications, such as fetal-neonatal alloimmune thromb ocytopenia, antiphospholipid syndrome, and recurrent miscarriage. This revi ew critically analyzes the use of IVIG for these indications based on the b est available information. The authors conclude IVIG is effective in the ma nagement of fetal-neonatal alloimmune thrombocytopenia. IVIG appears promis ing as a treatment for severe fetal-neonatal alloimmune hemolysis due to an tierythrocyte antibodies. A prospective multicenter trial should be underta ken. IVIG is no more effective than heparin and low-dose aspirin In the tre atment of pregnancies complicated by antiphospholipid syndrome but has not been adequately evaluated in refractory cases. Finally, pending convincing studies, IVIG is not effective and should not be used for the management of recurrent miscarriage.