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Division of Recurrent Spontaneous Abortions PDF Print E-mail



Associate professor  S. Dendrinos












The division of Recurrent Spontaneous Abortions (RSA) is a special unit of the 2nd Department of Obstetrics and Gynecology of University of Athens, investigating and treating couples with history of repeated pregnancy loss or  patients with “unexplained infertility” or history of unsuccessful IVF attempts. The decision for a woman to undergo   specific immunotherapy is based on special immunological tests, which confirm or exclude  immunological problems.  Furthermore, possible classical causes  are ecluded by laboratory techniques, radiology and sometimes endoscopic examinations prior to initiation of therapy.

RSAs appear in  a frequency of 1-3%   during reproductive age.  RSAs usually occurs during the first trimester of pregnancy and the relative risk for RSAs increases with the number of previous abortions, so that after the first abortion the relative risk reaches 24%, after the   second 26% and after third abortion it rises up to 32%.   Several theories have been proposed for the explanation of this phenomenon suggesting genetic, anatomical, endocrine  or infectious etiologies.  Recently immunological theories have gained  acceptance and it seems reasonable since the fetus as well as the   trophoblast consist immunological targets because of the paternal antigen expression.

In case the mother’s immunological system produces antibodies against the fetus, the secretion of IFN-γ and other cytokines may lead to a possible immunological reaction against the fetus.  Similarities of HLA antigens between parents seem to increase the RSA percentage.

Anti parental cell antibodies (APCA), which are the maternal Abs against the HLA paternal antigens, are normally activated because of the fetus, but recent data show that women who don’t produce APCAs may also have a normal pregnancy.Therefore maternal’s immunization with parental lymphocytes has become a matter of dispute.  Conversely, in special cases, especially in cases of increased peripheral NKs, treatment with parental lymphocytes has shown very good results.

Antiphospholipid syndrome (APS)  is a disorder of coagulation that causes blood clots (thrombosis) in both arteries and veins as well as pregnancy-related complications such as miscarriage.  The syndrome occurs due to the autoimmune production of antibodies against phospholipid (aPL).  In particular, the disease is characterised by antibodies against cardiolipin (anti-cardiolipin antibodies) and  β2 glycoprotein I.  Women with APS seem to have a high risk for RSA, preterm delivery, stillbirth etc.



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