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PubMed · 14071634

PROGESTATIONAL AGENTS.

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J M ENGLISH. 1964-01-04. PROGESTATIONAL AGENTS.. https://pubmed.ncbi.nlm.nih.gov/14071634/

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Abnormal cytokine levels in non-pregnant women with a history of recurrent miscarriage.

OBJECTIVE: To compare cytokine levels in serum from non-pregnant women with a history of recurrent miscarriage with those found in non-pregnant women with no such history. STUDY DESIGN: Two patient groups were enrolled into the study. Group 1 comprised 25 non-pregnant women with no history of recurrent miscarriage. Group 2 comprised 50 non-pregnant women who had a history of at least three previous miscarriages. Fifteen of these women have since become pregnant again--10 had a successful pregnancy and five miscarried. Serum levels of IL-4, IFN gamma, IL-12 and IL-18 were measured. RESULTS: Results showed IFN gamma ( 0.68 +/- 0.72 versus 0.45 +/- 0.29 P < 0.05) and IL-12 levels (66 +/- 25 versus 51 +/- 24 P < 0.05) were significantly higher in Group 2 compared to Group 1. Levels of IL-18 were significantly lower in Group 2 patients (318 +/- 140 versus 246 +/- 219 P < 0.05). Of the 15 women who became pregnant, those who miscarried again had significantly higher IL-18 levels when not pregnant than those women whose next pregnancies went successfully to term (547 +/- 20 versus 274 +/- 129 P < 0.05). CONCLUSION: These results suggest that women with a history of recurrent miscarriage can have abnormal cytokine expression even when not pregnant. This may influence the potential for future successful immune modulatory therapy.

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CONTEXT: Patients with antiphospholipid syndrome and alloimmunity have poor pregnancy outcomes. Several diagnostic and therapeutic options exist for these disorders, although there is no consensus as to the best treatment. CASE REPORT: We present here the clinical course and treatment of a woman with a history of two miscarriages who joined our program 10 years ago and has been followed up ever since. After antiphospholipid syndrome and alloimmune failure were diagnosed, she was given preconceptional treatment using unfractionated heparin, aspirin, prednisone and lymphocyte immunizations. She delivered two premature babies in the following two pregnancies. At present both children are healthy and are attending school. The fifth pregnancy was unsuccessful, in spite of having undergone a similar but postconceptional therapeutic scheme. We discuss this case focusing on the pathogenic mechanisms and the therapeutic aspects of these disorders.

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Is there a higher prevalence of pregnancy complications in a live-birth preceding the appearance of recurrent abortions?

OBJECTIVE: The present study was designed to evaluate the prevalence of pregnancy complications in a live-birth preceding the appearance of recurrent abortions. METHODS: A case-control study comparing women who had at least two consecutive spontaneous abortions after one live birth with matched controls, without recurrent abortions, was performed. Cases were recruited from the Recurrent Abortions Clinic. The women in the control group were matched by the following parameters: age, pregnancy order and having had a live birth in the same year as the study group. Four controls were matched for each case. The analysis focused on the characteristics of the live-birth preceding the recurrent abortions of the study group and the births of the matched controls. RESULTS: From Jan 2001 through Dec 2002, 140 women were examined in the Outpatient Clinic for Recurrent Abortions. Of these, 58 women who had a live-birth prior to at least two consecutive spontaneous abortions comprised the study group, which was compared with 232 controls. A statistically significant higher rate of preeclampsia (mild and severe) was found in a live-birth preceding recurrent abortions than in the matched controls (10.3 vs. 3.9%, p=0.047). In addition, a nonsignificant trend was found for higher rates of non-reassuring fetal heart rate patterns (8.6 vs. 3.0%, p=0.055) in this group. No other significant differences regarding maternal or neonatal complications such as placental abruption, intrauterine growth restriction, and intrauterine fetal death were noted between the groups. CONCLUSIONS: A live-birth preceding the appearance of recurrent abortions is associated with a higher rate of preeclampsia.

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