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An update in recurrent spontaneous abortion

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Abstract

Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The etiology of recurrent spontaneous abortion is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Reasonably accepted etiologic causes include, genetics, anatomical, endocrine, placental anomalies, hormonal problems, infection, smoking and alcohol consumption, exposure to environmental factors, psychological trauma and stressful life event, certain coagulation and immunoregulatory protein defects. Detection of an abnormality in any of these areas may result into specific therapeutic measures, with varying degrees of success. However, the majority of cases of RSA remains unexplained and is found to be associated with certain autoimmune (APA, ANA, ACA, ATA, AECA) and alloimmune (APCA, Ab2, MLR-Bf) antibodies that may play major role in the immunologic failure of pregnancy and may lead to abortion. Alteration in the expression of HLA-G molecules, T-helper-1 (Th-1) pattern of cytokines and natural killer (NK) cells activity may also induce abortion. Various forms of treatment like antithrombotic therapies such as aspirin and heparin, intravenous immunoglobulin (IVIg) therapy, immunotherapy with paternal lymphocytes and vitamin D3 therapy are effective mode of treatment for unexplained cause of fetal loss in women with RSA.

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Acknowledgements

The authors thank the Indian Council of Medical Research (ICMR) and Council of Science and Technology, U.P., India for financial support of their laboratory work and library of Mayo Clinic, Rochester, MN, USA for providing the related references.

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  1. Division of Molecular Immunology, Cincinnati Children’s Hospital Medical Center, MLC 7021 TCH RF 5503 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Manoj Kumar Pandey

  2. Department of Biology, University of Texas, San Antonio, TX, USA

    Reena Rani

  3. Department of Medical Genetics, SGPGIMS, Lucknow, India

    Suraksha Agrawal

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  1. Manoj Kumar Pandey
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Pandey, M.K., Rani, R. & Agrawal, S. An update in recurrent spontaneous abortion. Arch Gynecol Obstet 272, 95–108 (2005). https://doi.org/10.1007/s00404-004-0706-y

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