Abstract
The high neonatal and maternal morbidity and mortality associated with the extremes of birth weight is referred to as the obstetric dilemma. Pre-eclampsia and other conditions that lead to low birth weight are considered as the Great Obstetrical Syndromes (GOS). At the other extreme is high birth weight resulting in obstructed labour. Fetal weight largely depends on placental function and defective placentation is a common feature of the GOS. There is evidence that the local uterine immune system (KIR and HLA-C) regulates placentation, with racial differences noted. These differences may be responsible for the striking obstetric dilemma in Africans.
Highlights
The high neonatal and maternal morbidity and mortality associated with the extremes of birth weight is referred to as the obstetric dilemma
Unlike transplantation, natural killer (NK) cells in the uterus mediate allorecognition of the fetus by the mother using receptors known as killer immunoglobulin-like receptors (KIR) that can distinguish between variants of HLA-C molecules displayed by the placental cells that invade the uterus
Consistent findings in UK and African cohorts are that certain combinations of maternal KIR genotypes with fetal HLA-C groups are associated with pre-eclampsia and other Great Obstetrical Syndromes (GOS).[9,10]
Summary
The high neonatal and maternal morbidity and mortality associated with the extremes of birth weight is referred to as the obstetric dilemma.
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