1
|
Carbonnel M, Pirtea P, de Ziegler D, Ayoubi JM. Uterine factors in recurrent pregnancy losses. Fertil Steril 2021; 115:538-545. [PMID: 33712099 DOI: 10.1016/j.fertnstert.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 12/29/2022]
Abstract
Congenital and acquired uterine anomalies are associated with recurrent pregnancy loss (RPL). Relevant congenital Müllerian tract anomalies include unicornuate, bicornuate septate, and arcuate uterus. Recurrent pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as, notably, intrauterine adhesions, polyps, and submucosal myomas. Initial evaluation of women with RPLs should include an assessment of the uterine anatomy. Even if proof of efficacy of surgical management of certain uterine anomalies is often lacking for managing RPLs, surgery should be encouraged in certain circumstances for improving subsequent pregnancy outcome. Uterine anomalies such as uterine septa, endometrial polyps, intrauterine adhesions, and submucosal myomas are the primary surgical indications for managing RPLs.
Collapse
Affiliation(s)
- Marie Carbonnel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France
| | - Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France
| | - Dominique de Ziegler
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France.
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France
| |
Collapse
|
2
|
Youssef A, Vermeulen N, Lashley ELO, Goddijn M, van der Hoorn MLP. Comparison and appraisal of (inter)national recurrent pregnancy loss guidelines. Reprod Biomed Online 2019; 39:497-503. [DOI: 10.1016/j.rbmo.2019.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
|
3
|
Shweta B, Nupur G, Archana A, Inderjeet G, Suman G, Manisha B, Thakur D, Shakir R, Shashi K. The serological profile of herpes virus amongst patients with bad obstetric history. APOLLO MEDICINE 2015. [DOI: 10.1016/j.apme.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
4
|
Jeve YB, Davies W. Evidence-based management of recurrent miscarriages. J Hum Reprod Sci 2014; 7:159-69. [PMID: 25395740 PMCID: PMC4229790 DOI: 10.4103/0974-1208.142475] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/03/2014] [Accepted: 08/05/2014] [Indexed: 11/15/2022] Open
Abstract
Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based.
Collapse
Affiliation(s)
- Yadava B Jeve
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester LE1 5WW, Northampton, UK
| | - William Davies
- Department of Obstetrics and Gynaecology, Northampton General Hospital, Northampton, UK
| |
Collapse
|
5
|
Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minim Invasive Gynecol 2013; 20:22-42. [PMID: 23312243 DOI: 10.1016/j.jmig.2012.09.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 01/09/2023]
Abstract
The introduction of hysteroscopy to diagnose and treat intrauterine conditions, specifically to divide the uterine septum, or metroplasty, has replaced the traditional laparotomy approach, and objective results demonstrate its salutary effects in women treated. Hysteroscopic metroplasty averts the implications of major invasive abdominal surgery, with good and satisfactory results in pregnancy and live-birth rates, despite the lack of prospective, randomized, controlled studies. A careful review of the published results supports this type of treatment when the uterine septum adversely affects normal reproductive function.
Collapse
|
6
|
Takakuwa K, Higashino M, Ueda H, Yamada K, Asano K, Yasuda M, Ishii S, Kazama Y, Tanaka K. Significant Compatibility Does Not Exist at the HLA-DQB Gene Locus in Couples With Unexplained Recurrent Abortions. Am J Reprod Immunol 2013; 28:12-6. [PMID: 1358093 DOI: 10.1111/j.1600-0897.1992.tb00750.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) method was used for both examining compatibility at the HLA-DQB1 gene locus and determining HLA-DQ antigen polymorphism in spouses of unexplained recurrent abortions. Genomic DNA samples were prepared from peripheral mononuclear cells from patient and control couples. Two hundred and thirty base pair fragments of the second exon of the HLA-DQB genes were selectively amplified. Amplified DNAs were digested with the restriction endonucleases, Fok I, Hae III, Hha I, Rsa I and Sau3A I, and subjected to electrophoresis in a polyacrylamide gel. The RFLPs showed that habitual aborters and their husbands had neither significantly frequent alleles nor shared common alleles at the HLA-DQB locus when compared to the control group. Since significant HLA-DQB compatibility was not observed between the spouses and unexplained recurrent aborters, in order to determine whether or not HLA compatibility is responsible for the genesis of unexplained recurrent abortions, it is imperative to further examine the compatibility between other HLA gene loci.
Collapse
Affiliation(s)
- K Takakuwa
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Berger DS, Merhi Z, Hogge WA, Ferrell RE. Mannose binding lectin genotypes are not associated with increased risk of unexplained recurrent pregnancy loss. J Assist Reprod Genet 2013; 30:723-7. [PMID: 23563916 DOI: 10.1007/s10815-013-9985-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/15/2013] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Immune response to infections has been associated with recurrent pregnancy loss (RPL). Low plasma mannose binding lectin (MBL) levels, an innate immunity factor in infections, has been related to RPL. In this study, we tested the hypothesis that MBL genotypes that are known to cause reduced plasma MBL levels are significantly more frequent among women experiencing unexplained RPL. METHODS This study included 219 Caucasian women diagnosed with unexplained RPL and 236 control women. All participants were genotyped for two promoter (-550 C > G and -221 G > C) and three missense (R52C, G54D and G57E) mutations in exon 1. These mutations are known to be associated with variations in plasma MBL levels. Genotype frequencies were estimated by gene counting and were compared to the expectation of Hardy-Weinberg equilibrium by chi-squared (X(2)) analysis and Fisher's exact test. Allele and genotype frequencies were compared in cases and controls using X(2) contingency table analysis. RESULTS There was no difference in demographics between cases and controls. The number of miscarriages in the participants with RPL ranged from 2 to 10 spontaneous abortions (SAB's) per participant. Populations genotyped were in Hardy-Weinberg equilibrium. There was no association between a history of RPL and multi-SNP genotypes at the MBL locus. In unexplained RPL, the number of SAB's and live birth rates were unaffected by MBL genotype. There was no association between MBL genotype and the risk of unexplained RPL. The occurrence of live birth was not associated with MBL genotype. CONCLUSION Genotypes known to cause low MBL plasma levels are not associated with an increased risk of unexplained RPL.
Collapse
Affiliation(s)
- Dara S Berger
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | | | | | | |
Collapse
|
8
|
HPV-16 exposed mouse embryos: a potential model for pregnancy wastage. Arch Gynecol Obstet 2013; 287:1093-7. [PMID: 23307167 DOI: 10.1007/s00404-013-2711-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Placentas from spontaneous abortions and preterm deliveries have a higher prevalence of Human papillomavirus (HPV) compared to placentas from elective abortions and term births. The objective was to determine the effects of HPV-16 on the adhesion and implantation properties of early embryo trophoblasts. METHODS Two-cell mouse embryos were cultured (medium G2, 5 % CO2, 37 °C) for 72-96 h and exposed to either HPV-16 rich SiHa cell lysates which were refrigerated after mechanical lysis, thawed lysates which had been frozen for freeze/thaw lysis method, or control medium, incubated (4-5 days) and evaluated by microscopy (N = 96 embryos, 3 repeated experiments). Trophoblasts were stained and images were digitized. Adhesion and dimension data were analyzed by Chi-square and t test, respectively. RESULTS HPV-16 exposed embryos exhibited less adhesion through reduced implantation compared with the control (combined lysates 53.8 vs. 85.7 %, P < 0.05). Refrigerated and thawed lysate groups had similar reduced implantations (58.3 vs. 50.0 %). Of the embryos with implantation, 100 % in the refrigerated lysates were noted to have loose or abnormal adhesion. This was measured when embryos were noted to be lost after washes with HTF. There was no difference in trophoblast viability among the groups. Total trophoblast area was greater in the HPV-16 exposed frozen lysate group (1,881.8 ± 605.3 vs. control 848.8 ± 298.0 square units, mean ± SEM). CONCLUSIONS HPV-16 inhibited trophoblasts adhesion needed for normal implantation, but not embryo development. Total trophoblast spread was increased after HPV-16 exposure suggesting that HPV-16 altered trophoblast migration. These results suggest that HPV-16 may induce abnormal placental growth resulting in pregnancy wastage.
Collapse
|
9
|
Berndsen MR, Erlendsdóttir H, Gottfredsson M. Evolving epidemiology of invasive Haemophilus infections in the post-vaccination era: results from a long-term population-based study. Clin Microbiol Infect 2011; 18:918-23. [PMID: 22070637 DOI: 10.1111/j.1469-0691.2011.03700.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Historically, Haemophilus influenzae (Hi) serotype b (Hib) caused most invasive Haemophilus infections worldwide, mainly in children. In 1989 routine childhood vaccination against Hib was initiated in Iceland. We conducted a population-based study of all patients in the country with Haemophilus spp. isolated from sterile sites (n = 202), from 1983 to 2008. Epidemiology, clinical characteristics of the infections and serotypes of the isolates were compared during the pre-vaccination (1983-1989) and post-vaccination era (1990-2008). Following the vaccination, the overall incidence of Hib decreased from 6.4 to 0.3/100,000 per year (p <0.05) whereas the incidence did not change significantly for infections caused by Haemophilus sensu lato not serotype b, hereafter referred to as non-type b Hi (0.9 vs 1.2, respectively). The most frequent diagnosis prior to 1990 was meningitis caused by Hib, which was subsequently replaced by pneumonia and bacteraemia caused by non-type b Hi. Most commonly, non-type b Hi were non-typeable (NTHi; 40/59), followed by Hi serotype f (14/59) and Hi serotype a (3/59). Pregnancy was associated with a markedly increased susceptibility to invasive Haemophilus infections (RR 25.7; 95% CI 8.0-95.9, p <0.0001) compared with non-pregnant women. The case fatality rate for Hib was 2.4% but 14% for non-type b Hi, highest at the extremes of age. Hib vaccination gives young children excellent protection and decreases incidence in the elderly due to herd effect in the community. Replacement with other species or serotypes has not been noted. Pregnant women are an overlooked risk group.
Collapse
Affiliation(s)
- M R Berndsen
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | |
Collapse
|
10
|
Shaarawy M, Nagui AR. Enhanced expression of cytokines may play a fundamental role in the mechanisms of immunologically mediated recurrent spontaneous abortion. Acta Obstet Gynecol Scand 2010. [DOI: 10.1111/j.1600-0412.1997.tb07846.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Kwak-Kim J, Park JC, Ahn HK, Kim JW, Gilman-Sachs A. Immunological Modes of Pregnancy Loss. Am J Reprod Immunol 2010; 63:611-23. [DOI: 10.1111/j.1600-0897.2010.00847.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
12
|
Gannon K. Psychological factors in the aetiology and treatment of recurrent miscarriage. a review and critique. J Reprod Infant Psychol 2007. [DOI: 10.1080/02646839408408868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Kenneth Gannon
- a School of Occupational Therapy, The London Hospital Medical College , Turner Street, London , El 2AD , UK
| |
Collapse
|
13
|
Hurst BS, Stackhouse DJ, Matthews ML, Marshburn PB. Uterine artery embolization for symptomatic uterine myomas. Fertil Steril 2000; 74:855-69. [PMID: 11056222 DOI: 10.1016/s0015-0282(00)01572-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the role of uterine artery embolization as treatment for symptomatic uterine myomas. DESIGN Medline literature review, cross-reference of published data, and review of selected meeting abstracts. RESULT(S) Results from clinical series have shown a consistent short-term reduction in uterine size, subjective improvement in uterine bleeding, and reduced pain following treatment. Posttreatment hospitalization and recovery tend to be shorter after uterine artery embolization compared with hysterectomy. Randomized controlled trials have not been conducted, and long-term efficacy has not been studied. A limited number of deliveries have been reported following uterine artery embolization for uterine myomas. CONCLUSION(S) Uterine artery embolization is a unique new treatment for symptomatic uterine myomas. Even without controlled studies, demand for this procedure has increased rapidly. Uterine artery embolization may be considered an alternative to hysterectomy, or perhaps myomectomy, in well-selected cases. At the present time, however, uterine artery embolization should not be routinely recommended for women who desire future fertility.
Collapse
Affiliation(s)
- B S Hurst
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
| | | | | | | |
Collapse
|
14
|
Reply. Am J Obstet Gynecol 1992. [DOI: 10.1016/0002-9378(92)91384-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
15
|
Schubring C, Grulich-Henn J, Burkhard P, Klöss HR, Selmayr E, Müller-Berghaus G. Fibrinolysis and factor XIII in women with spontaneous abortion. Eur J Obstet Gynecol Reprod Biol 1990; 35:215-21. [PMID: 2335256 DOI: 10.1016/0028-2243(90)90165-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the present study, parameters of the fibrinolytic system and factor XIII were determined in 26 women with spontaneous abortion and in 21 women with intact pregnancies to gain insight into the role of fibrinolysis in spontaneous abortion. Both groups of women did not significantly differ from each other in age or weeks of pregnancy. There were no differences in euglobulin lysis time (ELT), tissue plasminogen activator (t-PA) antigen, and plasminogen activator inhibitor type 1 (PAI-1) antigen between the study group and the control group. Factor XIII activity was significantly decreased in patients during abortion. In the present study, changes of fibrinolytic parameters measured in teh cubital vein blood of patients with abortion were not observed although local changes in fibrinolytic activity had been associated with spontaneous abortion. The pathophysiological role of the decrease in factor XIII activity observed in the present study remains to be elucidated.
Collapse
Affiliation(s)
- C Schubring
- Department of Obstetrics and Gynecology, Evangelisches Krankenhaus, Giessen, F.R.G
| | | | | | | | | | | |
Collapse
|
16
|
Carey SW, Klein NW. Autoantibodies to laminin and other basement membrane proteins in sera from monkeys with histories of reproductive failure identified by cultures of whole rat embryos. Fertil Steril 1989; 51:711-8. [PMID: 2924939 DOI: 10.1016/s0015-0282(16)60626-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Head-fold-stage rat embryos cultured on sera taken from monkeys with histories of reproductive failure had an abnormality frequency of 97% compared with only 7% on sera taken from monkeys with excellent reproductive histories. For a group of these poor reproducers, the toxicity of their sera was associated with the immunoglobulin G (IgG) fraction. These IgG fractions bound to Reichert's membrane and other basement membranes of the embryo. For one monkey, the IgG specifically reacted with a 41 kDa polypeptide of Reichert's membrane, while for two others binding was to laminin, type IV collagen, and several other minor polypeptides of Reichert's membrane. For serum from one monkey, the toxicity to cultured rat embryos was eliminated by absorption with laminin but not type IV collagen.
Collapse
Affiliation(s)
- S W Carey
- Center for Environmental Health, University of Connecticut, Storrs 06269-4039
| | | |
Collapse
|
17
|
Macdonald RR. Does treatment with progesterone prevent miscarriage? BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1989; 96:257-60. [PMID: 2653412 DOI: 10.1111/j.1471-0528.1989.tb02382.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R R Macdonald
- Department of Obstetrics and Gynaecology, General Infirmary, Leeds
| |
Collapse
|
18
|
Maier DB, Parke A. Subclinical autoimmunity in recurrent aborters**Supported by a grant from the University of Connecticut Research Foundation. Fertil Steril 1989. [DOI: 10.1016/s0015-0282(16)60491-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Balasch J, Coll O, Martorell J, Jové IC, Gayá A, Vanrell JA. Further data against HLA sharing in couples with recurrent spontaneous abortion. Gynecol Endocrinol 1989; 3:63-9. [PMID: 2658473 DOI: 10.3109/09513598909152453] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Class I human leucocyte antigens (HLA-A, -B) and class II (HLA-DR) antigens were determined in 57 couples with primary recurrent abortions of unknown origin and in 57 normal fertile couples. No difference between abortion and control fertile couples was observed regarding HLA sharing. Analysis of 10 series in the literature, including our own results, is against the concept that compatibility in determinants of the major histocompatibility complex has a major role in recurrent spontaneous abortion (RSA).
Collapse
Affiliation(s)
- J Balasch
- Department of Obstetrics, Hospital Clínico y Provincial, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
20
|
Damewood MD, Rock JA. Reproductive Uterine Surgery. Obstet Gynecol Clin North Am 1987. [DOI: 10.1016/s0889-8545(21)00601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
21
|
Rock JA, Murphy AA, Cooper WH. Resectoscopic techniques for the lysis of a class V: complete uterine septum. Fertil Steril 1987; 48:495-6. [PMID: 3622797 DOI: 10.1016/s0015-0282(16)59426-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
22
|
Recurrent spontaneous abortion and early pregnancy loss. Eur J Obstet Gynecol Reprod Biol 1987. [DOI: 10.1016/0028-2243(87)90184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
23
|
|
24
|
Denegri JF, Altin M, McConnachie P, Peterson J, Benny WB, Zouves CG, Wilson D. Immunotherapy of primary immunological aborters: rationale for the use of pooled cryopreserved purified normal peripheral blood mononuclear cells. AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY AND MICROBIOLOGY : AJRIM 1986; 12:65-9. [PMID: 3812854 DOI: 10.1111/j.1600-0897.1986.tb00066.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients with recurrent spontaneous abortions have been successfully treated in many centers with third-party immunization directed to a putative TLX antigen system. This immunotherapy requires the screening of a large number of donors to match the patients' red blood cell (RBC) phenotype and has the potential risks associated with transfusions from 30 to 50 donors. Our modified approach to third-party immunization is to use irradiated frozen-stored purified lymphocytes pooled from five normal donors. Mononuclear cells from normal donors are obtained in a cell separator. After sedimentation and Ficoll-Hypaque separation, the cells are stored in liquid N2. The RBC depletion of the final preparation is of the order of 5 to 6 logs, theoretically decreasing the need for RBC phenotyping except for the Rh system. Using a highly sensitive fluorescence-activated cell sorter technique and an ADCC assay, we found that ABH, Rh, Fya Fyb, Jka Jkb, MNS, and Kell antigens are either not expressed by cryopreserved human mononuclear cells, or, if so, they are below the level of detection of these highly sensitive assays. We conclude that the use of pooled frozen mononuclear cells is an adequate alternative for immunotherapy. It decreases the transfusion risks associated with exposure to a large number of donors and the need for RBC phenotyping, making this modality of treatment more accessible.
Collapse
|
25
|
Abstract
Although at least 15% of clinically recognized pregnancies end in spontaneous abortion, a much higher loss varying from 8-78% probably occurs subclinically during very early gestation. This 'early reproductive loss' is largely presumptive and may be caused by factors such as chromosomal abnormalities, infections, endocrine deficiencies, uterine disease, and immunological factors. Little may be offered by way of treatment; but more recently, immunotherapy appears an attractive possibility in selected cases.
Collapse
|
26
|
Abstract
Fifty women with 2 or more previous first-trimester abortions and 300 infertile patients underwent a luteal phase evaluation by basal body temperature, plasma progesterone, estradiol and prolactin determination, and endometrial biopsy (repeated in a later cycle when the first was defective). An endometrial luteal phase deficiency was detected in 15 (30%) of aborting patients. In 13 (26%) of these women the endometrial defect was associated to normal hormonal levels. This condition was only present in 36 (12%) of the infertility cases (P less than 0.01). We conclude that the possible etiologic role of luteal phase defects in repeated abortion, is by a secretory insufficiency in the endometrial pattern despite normal plasma hormonal levels.
Collapse
|
27
|
BEER ALANE. New Horizons in the Diagnosis, Evaluation and Therapy of Recurrent Spontaneous Abortion. ACTA ACUST UNITED AC 1986. [DOI: 10.1016/s0306-3356(21)00158-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
Abstract
The hypothesis that the Rh and ABO blood systems behave like the HLA system in relation to mother-conception tolerance-rejection mechanisms was tested in 25,501 mother-infant pairs. According to this hypothesis, heterozygotes carrying a paternal gene that is not present in their mothers should be better tolerated than homozygotes. Significantly more BO infants born to AO mothers. AO infants born to BO mothers, Rh(+) heterozygotes born to Rh(-) mothers, and less significantly AO infants born to OO mothers confirm the hypothesis. Fewer homozygotes occurred in Rh(-) infants born to Rh(+) mothers and in O infants born to non-O mothers. Deviations from the Hardy-Weinberg equilibrium found in the ABO system were modified by the Rh and sex of the infant. These data strongly support the hypothesis that at least two feto-maternal systems influence the destiny of pregnancies: the classical known incompatibility system which operates late in pregnancy and a new one which is based on the induction of maternal tolerance early in pregnancy: maternal tolerance seems to be better elicited by heterozygous eggs or embryos carrying a gene not present in the mother. The data also support the hypothesis that the sex ratio is influenced by feto-maternal tolerance-rejection mechanisms associated with the ABO and Rh systems.
Collapse
|
29
|
Taylor CG, Faulk WP, McIntyre JA. Prevention of recurrent spontaneous abortions by leukocyte transfusions. J R Soc Med 1985; 78:623-7. [PMID: 4020795 PMCID: PMC1289832 DOI: 10.1177/014107688507800804] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
One hundred and thirty-nine couples referred because of recurrent abortions with no obvious cause were assessed for genetic similarity using the HLA major histocompatibility system. Comparison with 103 fertile control couples demonstrated that a much higher proportion of couples in the abortion group shared two or more HLA antigens. Using this criterion, 44 wives out of the 139 couples referred, when compared with a child-bearing group, appeared to share a greater than expected number of histocompatibility antigens and were therefore considered suitable for treatment. Twenty-eight wives have received treatment with white cell infusions from erythrocyte-compatible donors and so far they have delivered 17 babies plus 2 second babies. Another 3 wives are pregnant beyond their previous dates for abortions (1 first and 2 second pregnancies). There have been 5 failures (4 first pregnancy and 1 second pregnancy); one of these was treated a second time and has now successfully delivered. Seven couples are awaiting conception. Of the patients who have become pregnant, 81.5% have had successful deliveries. No adverse transfusion reactions have been observed.
Collapse
|
30
|
Abstract
Congenital uterovaginal anomalies can have adverse effects on pregnancy outcome. Early diagnosis and an aggressive evaluation of any patient presenting with mid-trimester abortion, premature labor, malpresentation, or retained placenta may prevent additional pregnancy wastage and maternal morbidity. With more timely and accurate diagnosis, appropriate management is likely to provide the best possible outcome for all such patients.
Collapse
|
31
|
Honoré LH. The negative effect of the IUCD on the occurrence of heteroploidy--correlated abnormalities in spontaneous abortions: an update. Contraception 1985; 31:253-60. [PMID: 3995962 DOI: 10.1016/0010-7824(85)90095-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Two prior studies done in the seventies had shown that spontaneous abortions in current IUCD-wearers were never associated with morphologic abnormalities, previously demonstrated to correlate significantly with cytogenetically proven heteroploidy. This study, carried out in the early eighties and based on 45 IUCD-associated and 882 IUCD-unrelated non-molar spontaneous abortions, confirmed this negative effect of the IUCD with a difference. Structural abnormalities, suggestive of heteroploidy, were seen for the first time in IUCD-associated spontaneous abortions but their prevalence (9.8%) was significantly lower than that observed in the IUCD-unrelated abortions (54.1%). The clinical relevance of this finding is briefly discussed.
Collapse
|
32
|
Mendizábal AF, Quiroga S, Farinati Z, Lahoz M, Nagle C. Hormonal monitoring of early pregnancy by a direct radioimmunoassay of steroid glucuronides in first morning urine. Fertil Steril 1984; 42:737-40. [PMID: 6489546 DOI: 10.1016/s0015-0282(16)48199-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The usefulness of the direct 4-hour radioimmunoassay of estriol-16-glucuronide (E3G) and pregnanediol-3-glucuronide (P2G) in first morning urine (FMU) for establishing a prognosis of the early pregnancy outcome was evaluated in 106 patients that became pregnant. Microaliquots of FMU were serially assayed from day 3 of the conception cycle until day 80 of pregnancy. The E3G and P2G profiles of 19 pregnancies which terminated in spontaneous abortion with either a diagnosis of the blighted ovum syndrome (n = 11) or presumption of a corpus luteum/trophoblast failure (n = 8) have been compared with those of clinically normal pregnancies (n = 87). Normal pregnancies displayed typical patterns of E3G and P2G development, while variations were observed in abortive events that reflected changes of the fetoplacental unit.
Collapse
|
33
|
Stray-Pedersen B, Stray-Pedersen S. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 1984; 148:140-6. [PMID: 6691389 DOI: 10.1016/s0002-9378(84)80164-7] [Citation(s) in RCA: 340] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A diagnostic screening program was applied to 195 couples with a prior history of habitual abortion (i.e., three or more consecutive abortions). Abnormalities were identified in 110 (56%) of the couples. Such identification was significantly more frequent in couples with primary habitual abortion than in couples with secondary habitual abortion (p less than 0.001) and also more frequent in couples with second-trimester abortions than in those with first-trimester abortions (p approximately equal to 0.01). The abnormalities most commonly observed were anomalies of the uterine body (15%), endometrial infections (15%), and cervical incompetence (13%). Hormonal dysfunctions were detected in 5%, and there were chromosomal aberrations in 3% of the couples. The women in the group showing abnormalities were offered surgical or medical treatment, and 80% of those who subsequently conceived carried their pregnancies to term. Among the couples with no abnormal findings, women receiving specific antenatal counseling and psychological support had a pregnancy success rate of 86%, as compared to a success rate of 33% observed in women who were given no specific antenatal care (p less than 0.001).
Collapse
|
34
|
Abstract
People have many different reasons for wanting to know how the allogeneic relationship in normal human pregnancy is successful, but this question is far from being answered. Meanwhile, investigators will continue to use the ideas, approaches and tools with which they have experience and in which they have placed their confidence. Some study the factors which regulate immune functions in the fetus (for review see Murgita & Wigzel 1981); other focus more on the mother (for review see Rocklin et al. 1979); while yet others examine specialized aspects of abnormal pregnancies such as spontaneous abortion (Gill 1983). Although no one knows how the system operates to favor pregnancy, our particular bias is that trophoblast is the driving force which makes it work; for, without trophoblast, there is no pregnancy. This prejudice grew from our early observations of immunopathology in normal placentae (McCormick et al. 1971, Faulk et al. 1974, Faulk et al. 1980b, and reviewed by Faulk & Fox 1982) and was extended and amplified by experiments which showed that trophoblast, as well as antibodies to trophoblast, were able to impede allogeneic recognition as measured by specific inhibition of the mixed lymphocyte culture reaction (McIntyre & Faulk 1979 & 1979a). For a variety of reasons, many laboratories became interested in trophoblast-antigen biochemistry, and a burst of publications appeared on this subject (Faulk et al. 1977, Whyte & Loke 1979, Ogbimi et al. 1979, see review by Johnson et al. 1980). Some of this work confirmed and extended an earlier hypothesis from our laboratory that trophoblast membranes could serve as a hapten-carrier system where one group of trophoblast antigens (TA1) was the carrier, and a second group (TA2) was the hapten (Faulk et al. 1978). This hypothesis invoked a concept of trophoblast-lymphocyte cross-reactive antigens, an idea which was subsequently confirmed biochemically by showing human placental cell-surface antigens on peripheral blood lymphocytes (Hamilton et al. 1980). McIntyre and Faulk (1982, 1982a) later showed that these antigens were allotypic, and data have been provided in the above paragraphs to show that these components of trophoblast membranes are capable of serving as immunogens to stimulate the mother to mount immune recognition of her blastocyst. Indeed, it is presently our interpretation that successful nidation depends upon maternal recognition of the blastocyst, and that a lack of recognition results in spontaneous abortion, sometimes occurring so early that the mother is not aware that she was pregnant (Miller et al. 1980).(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
|
35
|
Stetten G, Rock JA. A paracentric chromosomal inversion associated with repeated early pregnancy wastage. Fertil Steril 1983; 40:124-6. [PMID: 6683201 DOI: 10.1016/s0015-0282(16)47190-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|