A High Dose Intravenous Immunoglobulin Therapy for Women with Four or More Recurrent Spontaneous Abortions

Hideto Yamada,Shigeki Shimada,Yasuhiko Ebina,Masamitsu Takeda,Yoko Maezawa,Yukio Wakui,Ryoichi Hazama,Kenji Tanimura

doi:10.5402/2012/512732

Abstract

Recurrent spontaneous abortion (RSA) may have immunological etiology. The aim of this study was to assess the efficacy of a high dose intravenous immunoglobulin (HIVIg) therapy, in which 20 g of intact type immunoglobulin was infused daily for 5 days during early gestation, for women who had a history of four or more consecutive spontaneous abortions of unexplained etiology. A total of 60 pregnant RSA women underwent HIVIg therapy, and the pregnancy outcome was assessed. The live birth rate was 73.3% (44/60). Fifteen pregnancies ended in spontaneous abortion, and one ended in intrauterine fetal death. In 11 of the 15 spontaneous abortions, fetuses had abnormal chromosome karyotype. When the 11 pregnancies with abnormal chromosome karyotype were excluded, the live birth rate was as high as 89.8% (44/49). The HIVIg therapy may be effective for severe cases of unexplained RSA.

Highlights

Recurrent spontaneous abortion (RSA) is defined as the loss of three or more consecutive pregnancies in the first trimester [1]
No standard therapeutic modality for unexplained RSA have been established so far, despite several lines of evidence indicating some therapeutic efficacy of unfractionated heparin or low molecular weight heparin with or without low dose aspirin, paternal lymphocyte immunization, intravenous immunoglobulin (IVIg), predonisolone, and progestin [5,6,7]
It is well acknowledged that intravenous use of immunoglobulin is practically effective, and this therapy has long been applied to a wide variety of immune-mediated diseases such as idiopathic thrombocytopenic purpura, Guillain-Barresyndrome, Kawasaki’s disease, and myasthenia gravis [12, 13]

Summary

Introduction

Recurrent spontaneous abortion (RSA) is defined as the loss of three or more consecutive pregnancies in the first trimester [1]. The etiology in approximately 50% of RSA is unknown, designated as unexplained RSA. The precise mechanism underlying the pathology of RSA remains poorly understood. In this context, no standard therapeutic modality for unexplained RSA have been established so far, despite several lines of evidence indicating some therapeutic efficacy of unfractionated heparin or low molecular weight heparin with or without low dose aspirin, paternal lymphocyte immunization, intravenous immunoglobulin (IVIg), predonisolone, and progestin [5,6,7]. We for the first time developed a high dose intravenous immunoglobulin therapy (HIVIg) during early gestation for severe cases with RSA of unexplained etiology in 1993 and previously reported the efficacy in a preliminary study [11]

Materials and Methods

Results

Discussion