Intravenous immunoglobulin treatment of pregnant patients with unexplained recurrent abortions

Raziel, Arié; Herman, Arie; Bukovsky, Ian; Caspi, Eliahu; Ron-El, Raphaël

doi:10.1093/oxfordjournals.humrep.a019238

Cited by 9 publications

(7 citation statements)

References 51 publications

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“…63 In addition, treatment of women with recurrent abortion thought to be secondary to lack of blocking antibodies has had mixed success. [64][65][66][67][68][69][70][71] Thus, the role of blocking antibodies has yet to be precisely defined.…”

Section: Possible Role Of Blocking Antibodymentioning

confidence: 99%

Immunological Tolerance of the Human Fetus

Gaunt¹,

Ramin²

2001

Am J Perinatol

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Why is the fetus not rejected as foreign tissue? The maternal and fetal immune systems temporarily coexist; both are precisely tuned to detect and reject foreign invasion and yet somehow achieve a symbiotic relationship. This mutual state of tolerance is obviously critical for carrying pregnancy to full term. Two active arms of the immune system maintain protection of the host: the first of these involves a humoral immune system in which foreign tissue invokes an antibody response by recognition of antigenic surfaces by the B-cell, the second arm involves cell-mediated immunity in which T-cells and natural killer (NK) cells seek out and destroy foreign tissue. Several mechanisms are thought to invoke the immune tolerance of the fetus. These include: absence of major histocompatibility complex (MHC)-I antigens, presence of unique human lymphocyte antigen (HLA) surface molecules, nonspecific reduction of systemic immunoreactivity, possible role of blocking antibody, expressions of complement regulatory proteins, and factors of locally reduced immunoreactivity. Ultimately, developing regimens to control these elements in the clinical setting may help us overcome preterm labor, infertility, and preeclampsia. Available evidence regarding immune tolerance of the human fetus, integrated into a workable model, and focused at an overview level are systematically reviewed in this article.

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Section: Possible Role Of Blocking Antibodymentioning

confidence: 99%

Immunological Tolerance of the Human Fetus

Gaunt¹,

Ramin²

2001

Am J Perinatol

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“…Despite thorough examinations to exclude several well-known etiologic factors, the cause for recurrent spontaneous abortion can often not be found in almost 50% of cases [18]. These are termed unexplained recurrent miscarriages.…”

Section: Etiologymentioning

confidence: 99%

Recurrent Miscarriage: A Review

Barrenetxea¹

2017

RMGO

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pregnancy events [2]. Clinical miscarriages may be subdivided into early clinical pregnancy losses (before gestational week 12) and late clinical pregnancy losses (gestational weeks 12 to 21). The term miscarriage is preferred rather than abortion both by patients and physicians, although "spontaneous abortion" is still used in scientific literature [3,4].For more than 30 years, controversy has existed on the number of miscarriages required to define RM and when diagnostic testing is warranted [5] EpidemiologyEarly pregnancy loss is perhaps the most common obstetric complication, occurring in over two-thirds of human conceptions. Approximately 15 -20% of all clinically recognized pregnancies will end in a miscarriage [4,9,10]. However, prospective cohort studies using sensitive and specific daily urinary hCG assays in women trying to conceive have demonstrated that only around one-third of conceptions progress to a live birth. Most of the losses occur before the clinical recognition of pregnancy as implantation failures. An estimated 30% of human conceptions are lost prior to implantation and a further 30% following implantation but before the missed menstrual period, that is in the third or fourth week of gestation. These are often termed preclinical losses [11].The risk of sporadic miscarriage between 6 and 12 weeks of gestation in women less than 35 years of age is 9% to 12%. The risk increases with age. In women older than 40 years of age, the sporadic miscarriage rate approaches 50%. Late losses between 12 and 22 weeks occur less frequently and constitute around 4% of pregnancy outcomes [4,9].Compared to sporadic miscarriage the prevalence of RM is considerably lower irrespective of whether biochemical losses are included or not. Approximately 1% of all women trying to conceive have recurrent miscarriage, defined as three previous miscarriages; when recurrent miscarriage is defined as two previous miscarriages, the proportion rises to 3% [12,13]. EtiologyMultiple potential etiologies for RM have been described (Table 1). As a consequence, several recommendations have been published regarding the evaluation and management of RM [3].The potential etiologies of RM can be divided into embryologically driven causes (mainly due to an abnormal embryonic karyotype) and maternally driven causes which affect the endometrium and/or placental development [14,15]. Thus, studies that focus on RM have Barrenetxea G, et al., J Reprod Med Gynecol Obstet 2017 AbstractHuman reproduction is characterized by its inefficiency. The loss of pregnancy at any stage can be a devastating experience and particular sensitivity is required in assessing and counseling couples with Recurrent Miscarriage (RM). Recurrent Miscarriage (RM) represents a clinical challenge for physicians not only because there are multiple possible etiologies, but also because the diagnostic testing is costly and time consuming. Despite several well-known etiologic factors, the cause of RM cannot be determined in almost 50% of cases. Multiple potential etiolo...

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“…Despite thorough examinations to exclude several wellknown etiologic factors, the cause for recurrent spontaneous abortion can often not be found in almost 50% of cases [23,26]. These are termed unexplained recurrent miscarriages.…”

Section: Etiologymentioning

confidence: 99%

Endocrinological and Environmental Causes of Recurrent Miscarriage: A Review

Barrenetxea¹

2017

OAJE

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Early pregnancy loss is perhaps the most common obstetric complication, occurring in over two-thirds of human conceptions. Approximately 15-20% of all clinically recognized pregnancies will end in a miscarriage. Approximately, 1% of all women trying to conceive have recurrent miscarriage, defined as three previous miscarriages. Despite thorough examinations to exclude several well-known etiologic factors, the cause for recurrent spontaneous abortion can often not be found in almost 50% of cases In addition to genetic or auto-immune diseases, endocrine dysfunction and metabolic disorders have been implicated. The purpose of this review is to update potential endocrinological causes of RM including thyroid disease, diabetes mellitus, hyperprolactinemia and polycystic ovarian syndrome. Also, obesity, hyperandrogenism, luteal phase defects and environmental, occupational or personal habits, such as cigarette smoking or alcohol consumption, are assessed as potential etiologies of recurrent miscarriage.

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Intravenous immunoglobulin treatment of pregnant patients with unexplained recurrent abortions

Cited by 9 publications

References 51 publications

Immunological Tolerance of the Human Fetus

Immunological Tolerance of the Human Fetus

Recurrent Miscarriage: A Review

Endocrinological and Environmental Causes of Recurrent Miscarriage: A Review

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