Experimentation with ALG and ATG preparations from different sources followed, leading to testing of ATG derived from rabbit serum. Thymoglobulin was the first commercial rabbit-derived ATG to be introduced in Europe and the US in the 1980s. Due to its demonstrated efficacy as an immunosuppressive agent, it remains a commonly used ATG for induction therapy and treatment of other associated conditions, such as graft-vs.-host disease and aplastic anemia. Mechanism of immunosuppression
As an rATG, thymoglobulin consists of polyclonal antibodies, which, unlike monoclonal antibodies, target a large variety of immune cell surface proteins, including B and T lymphocyte, natural killer cell, and plasma cell surface antigens. However, its efficacy as an immunosuppressive agent is primarily through rapid induced apoptosis of CD3+ T cells present in the bloodstream. Even at low levels of concentration (up to 1 ug/mL), rATG T-cell depletive ability is still sound, but higher concentrations of ATG can induce lysis of T lymphocytes through the classical complement pathway along with B cell and NK cell depletion as well . Thymoglobulin has also demonstrated the ability to induce expression of a number of regulatory cell markers in vitro, including CD25, GITR, and CTLA-4 (aka CD152, functions as immune checkpoint, downregulates immune response). Recent research has suggested that Thymoglobulin may also contribute to T-cell anergy, in which T-cells remain inactive, though further research must be done to confirm this interaction. Clinical applications
Thymoglobulin is commonly used to prevent and treat acute rejection and increase graft survival in solid organ transplantation (SOT), especially kidney, liver, pancreas, and heart transplantation.
The continuous support may be provided either by hospital staff such as nurses or midwives, doulas, or by companions of the womans choice from her social network.There is increasing evidence to show that the participation of the childs father in the birth leads to a better birth and also post-birth outcomes, providing the father does not exhibit excessive anxiety.Continuous labour support may help women to give birth spontaneously, that is, without caesarean or vacuum or forceps, with slightly shorter labours, and to have more positive feelings regarding their experience of giving birth. Continuous labour support may also reduce womens use of pain medication during labour and reduce the risk of babies having low five-minute Agpar scores. Preparation
Eating or drinking during labour is an area of ongoing debate. While some have argued that eating in labour has no harmful effects on outcomes, others continue to have concern regarding the increased possibility of an aspiration event (choking on recently eaten foods) in the event of an emergency delivery due to the increased relaxation of the oesophagus in pregnancy, upward pressure of the uterus on the stomach, and the possibility of general anaesthetic in the event of an emergency cesarean. A 2013 Cochrane review found that with good obstetrical anaesthesia there is no change in harms from allowing eating and drinking during labour in those who are unlikely to need surgery. They additionally acknowledge that not eating does not mean there is an empty stomach or that its contents are not as acidic.