PurposeTo evaluate the efficacy of the use of oral Prednisolone and heparin versus the use of heparin alone in treatment of patients with unexplained recurrent miscarriage.MethodologyThe study was a double-blind placebo randomized control trial conducted on 160 patients with unexplained recurrent miscarriage. Patients recruited were randomized into two groups. The first group received oral Prednisolone in addition to low dose aspirin and heparin, while the other group received a placebo in addition to low dose aspirin and heparin. A peripheral venous blood sample was taken from all included patients before starting treatment and collected in heparinized tubes. Natural Killer (NK) cells were checked in each sample and then re-checked in another sample at 20 weeks of gestation.ResultsWe found that in the prednisolone group, 70.3 % of women had successful outcome (defined as an ongoing pregnancy beyond 20 weeks gestation), while 29.7 % miscarried before this gestation. On the contrary, among women in the placebo group, 9.2 % had successful outcome while 90.8 % miscarried before 20 weeks, which was statistically significant. On the other hand, we found that there were no significant paired differences between initial serum levels of the NK cells markers CD16 and CD56 and their levels at 20 weeks gestation in both groups.ConclusionThe addition of prednisolone to heparin and low dose aspirin might be beneficial in patients with unexplained recurrent miscarriage, and this effect might be due to a suppressive effect of steroids on the peripheral CD16 NK cells concentration.

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Objective:To evaluate the relation between uterine killer (uK) cells and unexplained repeated miscarriage (RM). Material and Methods: Eighty women with unexplained repeated miscarriage and missed miscarriage of current pregnancy were studied.Fetal viability and gestational age of the current pregnancy were confirmed by ultrasound, followed by suction evacuation to collect abortion specimens and uterine wall curettage to collect decidua specimens. Abortion specimens were collected for long-term monolayer cell culture and subsequent chromosome analysis using conventional G-banding. Decidua specimens were subjected to immunohistochemical staining using monoclonal antibodies specific to CD56+ and CD16+ expressed by uK cells.Results: CD56+ CD16+ uK cells were found in 85% [68/80] of the studied decidua specimens of women with unexplained repeated miscarriage; 88.5% [54/61] had normal abortion karyotyping and 73.7% [14/19] had abnormal abortion karyotyping. Moreover, 73.75% [59/80] of the studied women with a past history of early miscarriage had CD56+ CD16+ uK cells in their decidua specimens, and 66.25% [53/80] of studied women with a past history of late miscarriage had CD56+ CD16+ uK cells in their decidua specimens; the association between early and late miscarriage and CD56+ CD16+ uK cells in decidua specimens was significant. Conclusion:CD56+CD16+ uK cells were predominant in the decidua specimens of the studied women with repeated miscarriage. A significant association was found between the presence of CD56+ CD16+ uK cells in the studied decidua specimens and unexplained repeated miscarriage. (J Turk Ger Gynecol Assoc 2015; 16: 214-8) Keywords: Obstetrics, uterine killer cells, repeated miscarriage Received: 27 April, 2015 Accepted: 14 October, 2015 Relationship between uterine natural killer cells and unexplained repeated miscarriage Material and MethodsEighty women with unexplained repeated miscarriage and missed miscarriage of current pregnancy were included for evacuation and curettage because of a current missed miscarriage (>8 weeks, diagnosed by ultrasound). The women were studied after proper counseling, consent, and approval of the ethical committee. Unexplained repeated miscarriage was defined as ≥2 previous miscarriages after <20 weeks' gestation. A thorough history was obtained and a thorough examination was performed for all studied women, followed by trans-vaginal ultrasound to confirm fetal the viability and gestational age of the current pregnancy by a sonographer who was blinded to the patients' data. Peripheral venous samples were collected from the studied women for oral glucose tolerance tests; thyroid stimulating hormone assays; prolactin, serum anticardiolipin, and lupus anticoagulant assays; as well as activated protein C resistance tests, Leiden factor V and prothrombin gene mutations, and protein C, S, and anti-thrombin III deficiency tests. Women with septic miscarriage, documented endocrinopathies (diabetes, thyroid disorders, or hyperprolactinemia), uterine anomalies, p...

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