Document Detail


Multiple pregnancy failures: an immunological paradigm.
MedLine Citation:
PMID:  22380628     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recurrent spontaneous abortion (RSA), three or more pregnancy losses prior to 20 weeks, occurs in about 1% of all pregnancies, 50% of RSA cases remain unexplained and unresolved. Recently, immune pathways have been implicated in the pathophysiology of RSA. Immune tolerance of the fetal-placental unit and placental angiogenesis are mandatory for a successful pregnancy outcome. Unscheduled dysregulation of the placental vasculature is thought to be the pathophysiologic mechanisms underlying an array of pregnancy complications like infertility, miscarriage, pre-eclampsia, and fetal growth restriction and death. Investigations on mechanisms and management of RSA are mired by substandard design and lack of optimal randomized clinical trials and have resulted in disagreement on guidelines for evaluation and treatments for patients with multiple pregnancy losses of unknown etiology. The present review focuses on evidence-based research discussion with immunologic causes, and immune-regulatory therapies recommended for helping patients with a history of RSA. We highlight data that might support revalidation of low molecular weight heparin as a protective therapy in RSA. Newly launched growth factors, GM-CSF, and potentially novel agents to suppress inflammatory rejection, including regulatory T cells, human chorionic gonadotropin, and M-CSF/IL-10, may work in concert with tender-loving-care therapy and give hope to couples with multiple pregnancy losses.
Authors:
Leif Matthiesen; Satyan Kalkunte; Surendra Sharma
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-03-01
Journal Detail:
Title:  American journal of reproductive immunology (New York, N.Y. : 1989)     Volume:  67     ISSN:  1600-0897     ISO Abbreviation:  Am. J. Reprod. Immunol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-20     Completed Date:  2012-08-01     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  8912860     Medline TA:  Am J Reprod Immunol     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  334-40     Citation Subset:  IM    
Copyright Information:
© 2012 John Wiley & Sons A/S.
Affiliation:
Department Obstetrics and Gynecology, Helsingborg Hospital, Affiliated Lunds University, Sweden. leif.matthiesen@skane.se
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MeSH Terms
Descriptor/Qualifier:
Abortion, Habitual / immunology*,  therapy*
Chorionic Gonadotropin / therapeutic use
Female
Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Infant, Newborn
Interleukin-10 / therapeutic use
Macrophage Colony-Stimulating Factor / therapeutic use
Pregnancy
Pregnancy Outcome
T-Lymphocytes, Regulatory / immunology
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin; 0/Heparin, Low-Molecular-Weight; 130068-27-8/Interleukin-10; 81627-83-0/Macrophage Colony-Stimulating Factor; 83869-56-1/Granulocyte-Macrophage Colony-Stimulating Factor
Comments/Corrections
Comment In:
Am J Reprod Immunol. 2012 Sep;68(3):185-6; author reply 187-8   [PMID:  22882225 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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