THE THREAT OF Rh IMMUNISATION FROM ABORTION (original) (raw)
Related papers
Reproductive immunology: laboratory tests for analysis of recurrent spontaneous abortion
Clinical Immunology Newsletter, 1995
Beer AE, Semprini AE, Zhu X, Quebbemann JF: Pregnancy outcome in human couples with recurrent spontaneous abortions: HLA antigen profiles HLA antigen sharing female MLR blocking factors and paternal leukocyte immunization. Exp Clin Immunogenetics 2:137-142. 1985. Branch DW. Rote NS, Dostal DA, Scott RA: Association of lupus anticoagulant with antibody against phosphatidylserine. Clin Immunol Immu-nopathol42:63-75, 1987. Coulam CB: Alternative treatment to lymphocyte immunization for treatment of recurrent spontaneous abortion-Immunotherapy with intravenous immunoglobulin for treatment of recurrent pregnancy loss: American Experience. Am J Repmd Immunol 32:286-289, 1994. Coulam CB. Clark DA, Collins J, Scott JR, Schlesselman JS: Worldwide collaborative observational study and meta-analysis on allogenic leukocyte immunotherapy for recurrent spontaneous abortion. Am J Reprod Immunol32:55-72, 1994. Cross JC, Werh Z, Fisher SJ: Implantation and the placenta: Key pieces of the development puzzle. Science 266:1508-1518, 1994. Ellis SA, Palmer MS, McMicbae.1 AJ: Human tmphoblasts and the choriocarcinoma cell line BeWo express a truncated HLA class I molecule. J Immunol 144:731, 1990. Gill TJ III: Immunogenetics of spontaneous abortions in humans Transplantation 35:1-4, 1983. Gilman-Sachs A, Lubinski J, Beer AE, BrendS, Beaman KD: Patterns of anti-phospholipid antibody specificities. J Clin Lab Immunol35:83-88, 1991. Gilman-Sachs A, Luo S-Y, BeerPAE, Beaman KD: Analysis of anti-lymphocyte antibodies by flow cytometry or micmlymphocyto~oxicity in women with recurrenl spontaneous abortions immunized with paternal leukocytes. J Clin Lab lmmunol 30:53-59, 1989. Hunt JS, Orr HT: HLA and maternal-fetal recognition FASEB 6~2344-2348, 1992. Jokhi PP. King A, Sharkey M, Smith SK, Loke Y: Screening for cytokine messenger ribonucleic acids in purified human decidual lymphocyte populations by the reverse-transcriptase polymerase chain reaction. J Immunol 153:4427-4435, 1994.
Immunological evaluation of patients with recurrent abortion
Journal of Reproductive Immunology, 2002
In a prospective study, we performed immunological tests in patients with recurrent abortion. Nine couples with two or more fetal losses of no apparent cause were selected as the patient group, and nine volunteer couples with at least two children and without a history of abortion were used as controls. The frequency of major histocompatibility complex (human leukocyte antigens, HLA) antigen sharing was determined by serological methods, antipaternal antibodies by microlymphocytotoxicity, lymphocyte phenotypes (CD4, CD8, CD19, CD16, CD56 and HLA-DR positive cells) by flow cytometry and natural killer (NK) cytotoxicity by 51 Cr release. NK activity was correlated to the degree of HLA-C sharing and to the percentage of CD16 + and CD56 + cells and to progesterone levels measured by radioimmunoassay. No difference in class I or class II HLA antigen sharing was detected between couples with and without recurrent abortion. Antipaternal antibodies were not found in the serum of any woman of the study. A higher absolute number of CD8+ cells (P=0.01) and a trend to increased CD19 + cells (P= 0.05) were observed among patients. NK activity did not differ between the two groups when expressed as specific cytotoxicity and it was reduced among patients with recurrent abortion when expressed as lytic units/10 7 cells (P =0.04).
Open Journal of Obstetrics and Gynecology, 2013
The implementation of a program on routine antenatal anti-D prophylaxis (RAADP) in the developed world has led to a significant decline in the residual numbers of Rhesus negative women becoming sensitized. However, a significant number of Rhesus D negative women in SSA are not fortunate because of lack of access to prophylactic immunoglobulin D and thus they continue to be affected. The management of Rhesus negative pregnancy in Sub-Saharan Africa is associated with several daunting challenges: absence of a policy on universal access to Rh D immunoglobulin, lack of fetomaternal testing facilities, unaffordability of prophylactic anti-D immunoglobulin, poor uptake of quality antenatal care, poor health infrastructure, sub optimal management of potentially sensitizing events during pregnancy, shortage of qualified medical personnel, poor data management, high incidence of illegal abortion and quackery. There is a need for the formulation of necessary guidelines on Rhesus immunoprophylaxis in SSA. Health authorities need to implement evidenced-based policy on universal access to anti-D immunoglobulin. There is also the need to optimize the knowledge of obstetricians on anti-D prophylaxis, implementation of the readily available and affordable Kleihauer fetomaternal haemorrhage testing for all women who experience a potentially sensitizing event antenatally post 20 weeks gestation and postnatally. These factors can facilitate the effective management of Rh negative pregnancy in the region and reduce the risk of Rhesus D immunization and Rhesus D haemolytic disease of the foetus and newborn.
Immuno therapy In Recurrent Spontaneous Abortion: Randomized and Non-Randomized Trials
The Internet Journal of Gynecology and Obstetrics, 2003
Objective: The present study was conducted to evaluate the efficacy of immunotherapy with husband's lymphocytes in women with recurrent spontaneous abortion (RSA). Methods: A total of 205 women with three or more consecutive abortions were screened for known causes of recurrent spontaneous abortion. Only 105 women were registered for immunotherapy after excluding the women who had one or the other known cause of abortion. 73 women were registered for immunotherapy against husband's lymphocytes. 32 women were registered under double blind randomized trial. These women were negative for antipaternal cytotoxic antibodies against their husband's cells. Success rate of immunotherapy was same in both the groups. Results: Immunotherapy with husband cells in 73 RSA women was carried out in non-randomized trial. Our results show that the success rate was significantly higher (86%) when compared to other groups of the present study i.e. RSA women who declined to enter the trial (33%), dropouts (50%) and antipaternal cytotoxicity negative RSA women (30%). Antipaternal cytotoxic antibodies (APCA) were taken as the measure of immuno-potentiation. Our results indicate that APCA can be taken as a good indicator for selecting patients for immunotherapy and also to measure whether the RSA women is adequately immunized or not. We have also seen the effect of husband's cells in double blind randomized trial group (32 RSA women). The success rate was 85%, which is comparable to non-randomized trial group. Conclusions: Our results indicate the importance of immunotherapy with husband's lymphocytes in RSA women and also show that APCA can be considered as one of the important immuno-potentiating factor.
Acta Obstetricia et Gynecologica Scandinavica, 2019
Introduction: The aim of this clinical pilot study was to examine the accuracy of noninvasive fetal RHD genotyping in early pregnancy (8 +0 to 11 +6 weeks) and to clarify whether targeted administration of Rhesus immunoglobulin (RhIg) is possible for women undergoing an induced abortion such that unnecessary injections can be avoided. The study examines the correlation between gestational age and the amount of cell-free fetal DNA in maternal plasma, the fetal fraction of DNA and whether transportation time or body mass index affects these parameters. Material and methods: Fifty-two RhD-negative women undergoing a surgically induced abortion were included. A maternal blood sample was collected prior to the abortion and a tissue sample was collected from the placental part of the abortion material after the intervention. Fetal RhD type was determined by PCR analysis of cell-free fetal DNA extracted from maternal plasma and on DNA from the tissue sample, with the latter providing a reference standard. Copies of RHD/mL were determined on RHD-positive samples and the fetal fraction of DNA was calculated. Results: We demonstrated complete concordance between results from plasma and tissue, with 31 RhD-positive and 21 RhD-negative samples, corresponding to 40% being RhD-negative, specificity 100% [95% confidence interval (CI) 88.8-100] and sensitivity 100% (95% CI 83.9-100). We found no significant correlation between gestational age and the amount or the fraction of cell-free fetal DNA in maternal plasma, nor did we find that transportation time or BMI significantly affected these factors in this setup. Conclusions: Fetal RHD genotyping can be accurately performed from the 8th week of gestation and unnecessary injections of RhIg can be avoided for women undergoing an induced abortion. A larger study is needed to determine a more accurate sensitivity for the analysis early in pregnancy. K E Y W O R D S cell-free fetal DNA, first trimester, real-time polymerase change reaction, RHD genotyping, rhesus prophylaxis | 1165
The Formation of HL-A Antibodies in Pregnancy. The Antigenicity of Aborted and Term Fetuses
BJOG: An International Journal of Obstetrics and Gynaecology, 1974
A total of 1201 maternal sera obtained before 20 weeks gestation were screened for lymphocytotoxic antibodies directed against HL-A antigens. Their incidence was 10 per cent in primigravidae, 17 per cent in the second and 22 per cent in third or subsequent pregnancies. Among secundigravidae, strong antibodies were found more often in women having had one live birth (14 per cent), than in those having had only a single abortion (5-6 per cent). It was concluded that the antigenic stimulus from a pregnancy ending in abortion is very weak compared with that of one which goes to term. The relationships between antibody formation and habitual abortion and grande multiparity were explored inconclusively.
Journal of Pregnancy and Neonatal Medicine, 2017
Background: Fetomaternal haemorrhage may occur during pregnancy or at delivery and may lead to allo-immunization to the D antigen if the mother is Rhesus (Rh) negative and the baby is Rh-positive. Objectives: To determine the incidence, socio-demographic characteristics and pregnancy outcomes of Rh negative pregnant women in a Nigeria Tertiary health care institution. Methods: A review of the clinical records of all Rh-negative pregnant women, managed at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Southeast Nigeria between 1st January 2009 and 31st December 2013 was done. Data were entered into Excel Spread sheet and analysed using computer Epi-Info 2013 version 7. Results: There were a total of 5561 deliveries and 117 Rh negative pregnancies during the period, given an incidence of 2.1%. Of the 117 Rh negative pregnancies, only 89 (76.1%) case files were available for analysis. Majority, 55.1% of the women were of ABO Blood Group O while ABO blood group discordance occurred in 33.7% of male partners. Seventy-one (79.8%) of the women have had previous pregnancies and only 33(46.5%) of these received anti-D prophylaxis in the previous pregnancies. Sixty-three (70.8%) of the pregnancies were booked and 48 out of 63 (76.2%) of them booked after 20 weeks of gestation. Indirect Coombs test was done in 61 out of 63 (96.8%) women that were booked but only one (1.6%) woman tested positive. None of the women had a follow-up testing. Only the woman that tested positive for indirect Coombs test had her antibody titre subsequently determined. Forty-five (50.6%) pregnancies were carried beyond date while 88.5% of the women that had postdate were delivered via caesarean section (p<0.001) with the commonest indication being fetal distress (42.9%). Sixty-one (68.5%) babies were tested post-delivery while 49 (80.3%) of 61 babies were rhesus incompatible with the mother. Only 40 (81.6%) of the incompatible mothers had Rh anti-D immunoglobulin administered after delivery. Neonatal jaundice occurred in 21.3% of the babies. There were 14 (15.7%) perinatal deaths. Conclusions: The incidence of Rhesus negative pregnancies was 2.1% while Rh isoimmunization rate was 1.6% and the uptake of Rhesus Anti-D immunoglobulin is suboptimal. Rh negative primigravida's tend to be unbooked and had significantly higher still births than their multigravid counterparts. Rhesus negative pregnancies carried beyond their dates had a significantly higher caesarean section rates than those delivered at term or before the expected date of delivery. There is need for further studies to clearly explore these trends.
Impact of Immunization Prophylaxis on the Course of Pregnancy in Rh-Negative Women
Ukraïnsʹkij žurnal medicini, bìologìï ta sportu
The purpose of the work was to study the characteristics of the course of pregnancy in women who received Rh immunoprophylaxis. Materials and methods. 64 pregnant women were examined, the average age of whom was 30.55 ± 7.0 (18–43) years. Out of 64 pregnant women, 24 (37.5%) were pre-pregnant, 40 (62.5%) were re-pregnant. The somatic and obstetric anamnesis of all pregnant women included in this study was studied. The average number of pregnancies in 40 repeat-bearing women with Rh (-) blood was 2.34 ± 0.6 (1–5). The obtained results of the study were subjected to statistical processing. At the same time, a computer program "Statgraph" was used, designed for statistical data processing in a parametric and nonparametric way. The work was carried out on the basis of the Educational and Surgical Clinic of the Azerbaijan Medical University. Results and discussion. The study of the course of pregnancy in women with no Rh isosensitization made it possible to establish the presen...
Human Reproduction, 1995
The efficacy of immunotherapy in the prevention of habitual abortion remains controversial. It has been suggested that the benefits are predominantly due to psychological factors. We have evaluated the success of pregnancy outcome following immunotherapy with allogeneic lymphocytes, in relation to the subsequent development of anti-paternal cytotoxic antibodies (APCA). It was observed that in women who developed an APCA titre of s* 1:16, live births occurred in 16 out of 21 cases (76%), while only two out of seven (28%) women who failed to achieve an APCA titre of 5* 1:16 had successful pregnancies (P <0.05). In eight women who had an APCA titre of 1:16 on initial screening, and were, therefore, excluded from the trial, successful pregnancy outcome was noted in 62.5% of cases. Although these results are based on a small sample and on an open, non-randomized trial, they show that the efficacy of immunotherapy is related to immune response to allogeneic lymphocytes, and is not simply a placebo effect. Measurement of APCA titre could serve as a marker for immunopotentiation.