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Infectious complications after chorionic villus sampling (CVS) are rare (<0.1%) but can lead to maternal sepsis and spontaneous abortion. We report the first bacteremia with Atopobium vaginae and suggest A. vaginae to be a pathogenic microorganism that can lead to intrauterine infection and fetal death following CVS. CASE REPORTA 40-year-old woman, gravida 7, para 3, underwent transcervical chorionic villus sampling (CVS) in the 12th week of pregnancy for advanced maternal age. Her obstetric history revealed three healthy children, one spontaneous miscarriage, one induced abortion, and an ectopic pregnancy with tubal removal. Her medical history revealed a mild diaphragmatic hernia for which she used acid secretion inhibitors. The CVS was done under ultrasound guidance using a biopsy forceps. In a single attempt, 30 mg of villi were obtained without complications.In the days following the CVS procedure, the patient developed fever with temperature up to 40°C and vomiting. Seven days after the CVS, she visited the emergency room for ongoing fever and chills; there was no abdominal pain or vaginal blood loss. Laboratory results were as follows: Hb, 10.8 g/dl; white blood count, 2.5 ϫ 10 9 /liter (89.6% neutrophils); C-reactive protein, 222 mg/liter. On X-ray and abdominal ultrasound no signs of pneumonia or abdominal focus were found and a normal fetal heartbeat was observed. The patient was admitted. A blood culture (including two bottles, for aerobic and anaerobic incubation, respectively) and a cervix sample were taken, after which antibiotic treatment was initiated with intravenous cefuroxime (750 mg, three times a day [t.i.d.]). Three days later, the patient developed cramping abdominal pain and had blood-stained vaginal discharge. By ultrasonography, fetal death was observed. The abortion started spontaneously but had to be completed by aspiration curettage. Following the procedure, the temperature normalized and cefuroxime therapy was ended (day 4). The patient was discharged from the hospital at day 5 after admission. At the day of discharge, the anaerobic blood culture bottle became positive with Atopobium vaginae (see below), after which amoxicillin (1 g, four times a day [q.i.d.]) was prescribed for 2 weeks.Microbiological data. No cultures of the cervix or vagina were done before the CVS procedure since the patient had no symptoms of vaginitis or bacterial vaginosis.At hospital admission, a sample of the cervix and one set of blood cultures were taken before antibiotics were initiated. A urinary culture and three more blood cultures were taken in the next 14 h. Microscopic examination and culture of the urinary sample were not indicative for an infection. The culture of the cervix smear yielded no Neisseria gonorrhoeae, no group B beta-hemolytic streptococci, and no yeasts. However, a culture of small grayish nonhemolytic colonies grew on the blood plate in an anaerobic environment. Gram staining showed Gram-positive rod-shaped organisms which were considered a nonpathogenic component of the vaginal fl...

Recently there is an increasing interest in aspects of a more specific immunoregulation during pregnancy. Understanding these mechanism might have a broader application not only for reproductive immunology but also in general for biology and medicine. Especially the induction, already before conception, of feto-specific T cells with a possibly regulatory function gives a biological explanation of local immunotolerance at the maternal fetal interface, supporting the epidemiological evidence of a feto/paternal-specific immuneregulation. Understanding the expression of specific HLA-classes on trophoblast and the crosstalk of these antigens with various cell types, specifically modulated in the decidua, resulting in the secretion of cytokines and (angiogenic) chemokines has given us a more and more detailed understanding of this regulation. This regulation could be induced by fetal cells circulating in the mother (microchimerism) and from the interaction with fetal subcellular fractions as exosomes, but also from paternal antigens present in seminal fluid. Molecular interaction between paternal and fetal antigens and receptors in endometrium and the decidua are discussed. This review highlights besides uNK cells, especially the function of CD4+ and CD8+ T cells with a regulatory function in the context of recurrent miscarriage and pre-eclampsia. Besides HLA, also male-specific minor histocompatibility antigens and the genetic background for these pregnancy complications are discussed.

The major rate-limiting step in in vitro fertilization (IVF) success appears to be the implantation of the semi-allogeneic embryo into the maternal endometrium. To determine possible risk factors of recurrent failure of embryos to implant, we investigated immunogenetic determinants as level of human leukocyte antigen (HLA) histocompatibility, frequency of killer-cell immunoglobulin-like receptors (KIR) and HLA-C alleles and HLA-G polymorphism. We DNA typed women with recurrent implantation failure (RIF) and their partners for classical HLA Class I, HLA Class II, HLA-G and KIR alleles and compared these results with couples with successful embryo implantation after their first IVF and normal fertile couples. No association was found between RIF and the degree of histocompatibility between partners or sharing of a specific antigen. Also, no significant difference in KIR haplotype or combination of HLA-C group and KIR was observed. We did find a higher frequency of HLA-C2 and a higher frequency of 14 base pair (bp) insertion in HLA-G in women with RIF. Therefore we conclude that the degree of histocompatibility between partners is not a determining factor for the occurrence of RIF. However, presence of the HLA-C2 allotype and the HLA-G allele with a 14 bp insertion is a significant risk factor.