RECURRENT MISCARRIAGE
Re-evaluation of immunomodulator treatments for recurrent abortions.
Rev Med Brux 1998 Apr;19(2):69-72 (ISSN: 0035-3639)
Dupont E; Moriaux M; Lambermont M; Englert Y
Services d'Immunologie et de Transfusion, Hopital Erasme, U.L.B.
Immunotherapy of spontaneous recurrent abortion is still a matter of controversy.
Since 1985, 117 patients were treated in our center. Transfusions of paternal
leucocytes (PL) were given to 56 patients and intravenous immunoglobulins (i.v.Ig)
to 61 patients. The allocation of the two treatments was not randomised.
Respectively 74% and 71% normal pregnancies were achieved. In two cases treated
by paternal leucocytes, the appearance of anti-erythrocytes alloantibodies (anti c
and anti Jkb + C) was noted. Two patients receiving i.v.Ig had a transient allergic
reaction (urticaria). In the five patients presenting with spontaneous abortion in
the setting of in vitro fecondation, four normal pregnancies were achieved. These
encouraging results from a single center are still to be considered as preliminary
but urge us on continuing this approach. One of the drawback of i.v.Ig is their cost.
Use of paternal leucocytes constitutes an adequate alternative provided that a strict
immunological selection of the father is performed to avoid lymphocyte or platelet
alloimmunisation. Our results are discussed in the light of recent controlled studies
emphasizing the importance of the placebo effect and in the light of the new
concepts in pregnancy immunology (protective action of trophoblastic HLA-G and
Th2 cytokines; antagonistic effect of endometrial NK cells.
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