History Of Recurrent Abortion Research Articles

Increased Plasma Concentrations of Antiprothrombin Antibodies in Women with Recurrent Spontaneous Abortions

Antiphospholipid antibodies are associated with recurrent fetal loss, but the clinical relevance of antiprothrombin (aPT) antibodies remains controversial. This study was designed to evaluate the relationship of plasma concentrations of aPT antibodies (IgG, IgM, and IgA isotypes) and recurrent spontaneous abortion (RSA) not associated with antiphospholipid-antibody syndrome. In this retrospective case-control study, we measured plasma aPT antibodies in 100 pregnant women at 8-12 weeks of gestation who had histories of recurrent abortion not associated with antiphospholipid-antibody syndrome. The controls were 200 healthy gestational-age-matched women with uncomplicated gestations. The mean (SD) plasma aPT concentrations were significantly (P <0.001) higher in women with histories of recurrent abortion than in healthy controls [7.97 (0.79) and 2.08 (0.07) kU/L]. Similarly, the concentrations of IgM aPT were significantly (P <0.001) higher in patients than in controls [5.73 (0.85) and 1.83 (0.05) kU/L]. No differences were found for IgA aPT (P = 0.358). High concentrations of aPT antibodies (IgG and IgM isotypes) are associated with pregnancy loss in women with RSA. We suggest that the antibodies may have a relevant role in the etiology and pathogenesis of the condition.

OC53: The effect of low dose aspirin and omega‐3 fatty acids on uterine artery Doppler flow velocity in women with impaired uterine perfusion having a history of recurrent abortion

OC53: The effect of low dose aspirin and omega‐3 fatty acids on uterine artery Doppler flow velocity in women with impaired uterine perfusion having a history of recurrent abortion

Dydrogesterone in threatened abortion: Pregnancy outcome

Objective To determine whether therapy with dydrogesterone in threatened abortion during the first trimester of pregnancy will improve pregnancy outcome. Design Prospective open study. Subjects Pregnant women presenting to the obstetric and gynaecology clinic admitting center with vaginal bleeding before 13 weeks gestation were evaluated for entry into the study. Women were excluded if they had a history of recurrent miscarriage. Method Eligible subjects were randomized to receive either dydrogesterone 40 mg stat dose followed by 10 mg twice a day for one week or conservative therapy. Results One hundred and 54 women were recruited. There was no statistically significant differences between the two groups with regard to pre-treatment status. The continuing pregnancy success rate was significantly ( p = 0.037) higher in women treated with dydrogesterone (95.9%) compared with women who received conservative treatment (86.3%). The odds ratio of the success rate between dydrogesterone treatment and non-treatment was 3.773 (95% confidence interval: 1.009–14.108). Conclusion Corpus luteal support with dydrogesterone has been shown to reduce the incidence of pregnancy loss in threatened abortion during the first trimester in women without a history of recurrent abortion.

Pregnancy outcome following recurrent spontaneous abortions

Objective: The purpose of the present study was to examine the association between spontaneous consecutive recurrent abortions and pregnancy complications such as hypertensive disorders, abruptio placenta, intrauterine growth restriction and cesarean section (CS) in the subsequent pregnancy. Methods: A population-based study comparing all singleton pregnancies in women with and without two or more consecutive recurrent abortions was conducted. Deliveries occurred during the years 1988–2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders. Results: During the study period 154,294 singleton deliveries occurred, with 4.9% in patients with history of recurrent consecutive abortions. Using a multivariate analysis, with backward elimination, the following complications were significantly associated with recurrent abortions—advanced maternal age, cervical incompetence, previous CS, diabetes mellitus, hypertensive disorders, placenta previa and abruptio placenta, mal-presentations and PROM. A higher rate of CS was found among patients with previous spontaneous consecutive recurrent abortions (15.9% versus 10.9%; OR = 1.6; 95% CI, 1.5–1.7; P < 0.001). Another multivariate analysis was performed, with CS as the outcome variable, controlling for confounders such as placenta previa, abruptio placenta, diabetes mellitus, hypertensive disorders, previous CS, mal-presentations, fertility treatments and PROM. A history of recurrent abortion was found as an independent risk factor for CS (OR = 1.2; 95% CI, 1.1–1.3; P < 0.001). About 58 cases of inherited thrombophilia were found between the years 2000–2002. These cases were significantly more common in the recurrent abortion as compared to the comparison group (1.2% versus 0.1%; OR = 11.1; 95% CI, 6.5–18.9; P < 0.001). Conclusion: A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions. Careful surveillance is required in pregnancies following recurrent abortions, for early detection of possible complications.

Natural Killer cell cytotoxicity in recurrent abortion

It has been postulated that a proportion of recurrent abortion might be due to immune causes. We attempted to determine whether Natural Killer (NK) cells cytotoxicity in peripheral blood is altered in patients with a history of recurrent abortion.

Obstetric Outcome after Endoscopic Transection of the Uterine Septum

Study Objective To analyze results of endoscopic transection of uterine septum in women with primary infertility and history of recurrent abortion or late abortion. Design Observational study over 6 years (Canadian Task Force classification II-2). Setting University hospital. Patients Seventy women, 21 with primary infertility, 33 with recurrent abortions, and 16 with late abortion or preterm delivery. Intervention Hysteroscopic metroplasty with transection of uterine septum. Measurements and Main Results Hysteroscopic metroplasty was possibly effective for women with primary infertility, none of whom had had abortions. It was also effective in reducing the early abortion rate and in increasing term deliveries in the group with late abortion. Conclusion Endoscopic transection of uterine septum may improve obstetric outcomes in women with late abortion, decrease abortion rates in those with recurrent abortions, and avoid pregnancy loss for patients with primary infertility.

Lupus Anticoagulatiuon African Women With Recurrent Abortions

Objective: The presence of the lupus anticoagulant (LA) an auto antibody has been implicated as a marker for first trimester spontaneous abortions as well as second and third trimester foetal death in the Caucasians. There is paucity of information on LA in African women where recurrent abortion and obstetrics complications are still common. Our aim therefore is to determine the prevalence of lupus anticoagulant in Nigerian women with recurrent abortion Subjects and methods: A total of seventy – three pregnant women were studied. Twenty three of them had history of recurrent abortions; they were compared with 50 without obstetrics complications as controls. Coagulation studies using the kaolin clotting time were carried out on their plasma sample. Mixing experiments were conducted on samples with prolonged clotting time in order to detect the presence of the lupus anticoagulant. The anticoagulant was considered present if the kaolin clotting time ratio is greater than or equal to 1.2. Result: Nineteen {82.62%} of the patients with recurrent abortion had normal kaolin clotting time, one {4.35%} had subnormal clotting time. The kaolin clotting time ration was greater than 1.2 in one (4.35%) of the patients with recurrent abortions signifying the presence of the lupus anticoagulant. Four (8%) of the pregnant controls had subnormal kaolin clotting time, 44 (88%) had normal clotting time while 2 (4%) had prolonged clotting time. The lupus anticoagulant was present in one (2%) of the pregnant controls. Conclusion: A 4.35% prevalence of LA among Nigerians with recurrent foetal loss may necessitate the screening of pregnant women with history of recurrent abortion for the lupus anticoagulant. We recommend that screening for lupus anticoagulant should be part of the routine investigation for women with recurrent spontaneous abortions KEY WORDS: Recurrent Abortions, Pregnant Women, Lupus Anticoagulant, Kaolin clotting time Nigerian Journal of Clinical Practice Vol.6(1) 2003:26-29

Biochemical and sonographic values in early pregnancy in women with a history of early spontaneous abortion

The aim of this study was to examine interconnections between changes in serum levels of biochemical parameters during pregnancy and sonographic parameters relevant for evaluation of early pregnancy. We analyzed serum levels of human chorionic gonadotropin (hCG), estradiol (E2), progesterone (PRG) and prolactin (PRL) using ELISA method, in cases of complicated pregnancies with symptoms of imminent miscarriage, and in patients with uncomplicated pregnancies. We evaluated their impact on mean gestational sac diameter (MSD), crown-rump length (CRL), inner diameter of the vitelline sac (SV), trophoblast (Trf) thickness and embryonic heart rate (STP). All results were correlated using Pearson's test and regression. Changes in biochemical parameters of pregnancy correlate significantly with dimensions of analyzed sonographic parameters. Levels of chorionic gonadrotropin affect production of ovarian and placental steroidogenesis. Interrelations were also discussed. Changes in biochemical values of pregnancy hormones affect dimensions of analyzed sonographic parameters. During uncomplicated pregnancy, levels of chorionic gonadotropin, progesterone and estradiol affect mean gestation-sac diameter, embryo length, depth of trophoblast invasion and formation and function of vitelline sac, and thus they alter the embryonic heart rate.

Lead Toxicity in Pregnancy and Newborns: A Case Report

In 1991, the Centers for Disease Control and Prevention (CDC) recommended that blood lead levels of 10 µg/dl or more in children be regarded as detrimental to health and that intervention be initiated to reduce blood lead levels in such cases. Lead crosses the placenta throughout pregnancy. Exposure of the fetus to lead affects it and the pregnant state of the mother in a multitude of ways, including an increased risk of abortions and premature labor. We describe a case of high lead levels in a woman with a history of recurrent abortions and her subsequent normal pregnancy and delivery after reduction of the lead levels through education and dietary interventions.

Value of flow cytometric assay for the detection of antisperm antibodies in women with a history of recurrent abortion.

To verify the proposed relationship between recurrent spontaneous abortions and the presence of maternal antisperm antibodies (ASA) in women as detected by a sensitive and reliable method. The presence of maternal antipaternal immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were determined against three different paternal antigens comprising T, B lymphocytes and semen cells by a sensitive flow cytometric crossmatch method to examine their possible correlation with pregnancy outcome. Group 1 consisted of sera obtained from 24 women with a history of abortion, and lymphocytes and semen samples collected from their husbands at the same time of visiting the in vitro fertilization (IVF) Clinic at King Faisal Specialist Hospital and Research Center. Sera, lymphocytes and semen samples were also collected from six couples with no history of abortion who served as controls (Group 2). Using a sensitive flow cytometric assay to analyse the samples, without knowledge of clinical status, elevated levels of both IgG and IgM were detected in Group 1. However, no significant association was found when compared with normal females who had healthy pregnancies. Flow cytometry is a highly sensitive and specific tool for the detection of alloantibodies in human sera from patients with rejected transplanted organs. Our findings suggest that maternal antipaternal antibodies with respect to IgG and IgM classes do not play a major role in women with a history of recurrent abortions, despite the presence of increased levels of antibodies against three different sources of paternal antigens.

In vitro fertilization and embryo transfer for the treatment of couples with secondary infertility and a history of recurrent abortion.

Objective: Management of couples with recurrent abortion and secondary infertility using assisted reproductive techniques has been reported in the past. Although the initial study reported promising pregnancy rates and outcome the results were not substantiated. The aim of this study was to assess the role of IVF-ET in couples with three or more abortions with no demonstrable cause.Design: Prospective case series.Materials/Methods: A total of 21 couples with secondary infertility and a history of unexplained recurrent abortion were enrolled. All couples were evaluated with a hysterosalpingogram/hysteroscopy, measurement of anticardiolipin IgG, IgM and lupus anticoagulant, and male and female karyotype analyses. Standard infertility evaluation with semen analysis and documentation of ovulation was performed for all couples. Of the 21 couples, laparoscopy had been performed in 16. IVF-ET or ICSI was performed according to semen analysis of the male. All women were down regulated with a luteal start GnRH analogue and stimulated with pure or recombinant FSH. Up to 4 embryos were replaced depending on embryo quality and female age. Preimplantation genetic diagnosis was not carried out due to the unavailability of the technique at the time of the study.Results: Of the 21 couples, 5 had mild-moderate male factor, 6 had endometriosis, and 3 had anovulation. Women with endometriosis had their lesions fulgurated during surgery. Mean female age was 33.5 years (26–44) and mean duration of infertility was 4.5 years (1–11). Mean number of previous abortions was 3.9 (3–9). A total of 25 cycles of IVF/ICSI was performed. A mean of 11.1 oocytes (3–26) were retrieved and 2.8 (1–4) embryos were transferred. One cycle was cancelled due to empty follicles. Clinical pregnancy per initiated cycle was 32% (8/25). Of the 8 pregnancies 2 delivered (1 singleton, 1 twin) and 5 ended in first trimester miscarriages. One twin pregnancy was terminated at 22 weeks due to severe preeclampsia. Take home baby rate was 8% (2/25) per cycle and 8.3% (2/24) per embryo transfer. At the same time period, clinical pregnancy rate per embryo transfer in our institution was 41% for all age groups included.Conclusions: Etiology of recurrent abortion is most probably multifactorial and complex. In couples with a history of recurrent abortion and secondary infertility, IVF/ICSI appears to yield very low delivery rates with most of the pregnancies achieved ending in spontaneous abortions. Preimplantation genetic diagnosis appears to be the approach of choice in these couples. Objective: Management of couples with recurrent abortion and secondary infertility using assisted reproductive techniques has been reported in the past. Although the initial study reported promising pregnancy rates and outcome the results were not substantiated. The aim of this study was to assess the role of IVF-ET in couples with three or more abortions with no demonstrable cause. Design: Prospective case series. Materials/Methods: A total of 21 couples with secondary infertility and a history of unexplained recurrent abortion were enrolled. All couples were evaluated with a hysterosalpingogram/hysteroscopy, measurement of anticardiolipin IgG, IgM and lupus anticoagulant, and male and female karyotype analyses. Standard infertility evaluation with semen analysis and documentation of ovulation was performed for all couples. Of the 21 couples, laparoscopy had been performed in 16. IVF-ET or ICSI was performed according to semen analysis of the male. All women were down regulated with a luteal start GnRH analogue and stimulated with pure or recombinant FSH. Up to 4 embryos were replaced depending on embryo quality and female age. Preimplantation genetic diagnosis was not carried out due to the unavailability of the technique at the time of the study. Results: Of the 21 couples, 5 had mild-moderate male factor, 6 had endometriosis, and 3 had anovulation. Women with endometriosis had their lesions fulgurated during surgery. Mean female age was 33.5 years (26–44) and mean duration of infertility was 4.5 years (1–11). Mean number of previous abortions was 3.9 (3–9). A total of 25 cycles of IVF/ICSI was performed. A mean of 11.1 oocytes (3–26) were retrieved and 2.8 (1–4) embryos were transferred. One cycle was cancelled due to empty follicles. Clinical pregnancy per initiated cycle was 32% (8/25). Of the 8 pregnancies 2 delivered (1 singleton, 1 twin) and 5 ended in first trimester miscarriages. One twin pregnancy was terminated at 22 weeks due to severe preeclampsia. Take home baby rate was 8% (2/25) per cycle and 8.3% (2/24) per embryo transfer. At the same time period, clinical pregnancy rate per embryo transfer in our institution was 41% for all age groups included. Conclusions: Etiology of recurrent abortion is most probably multifactorial and complex. In couples with a history of recurrent abortion and secondary infertility, IVF/ICSI appears to yield very low delivery rates with most of the pregnancies achieved ending in spontaneous abortions. Preimplantation genetic diagnosis appears to be the approach of choice in these couples.

Low-Molecular-Weight Heparin for Thrombophilia in Pregnant Women

Abstract Objective: Low-molecular-weight heparin (LMWH) is the anticoagulant of choice during pregnancy because it is associated with a low incidence of osteoporosis and thrombocytopenia. Antithrombotic therapy has recently been used to prevent pregnancy loss in high-risk patients with evidence of acquired or congenital thrombophilia. The aim of the present study was to gain further information on the teratogenic potential of LMWH in this patient group. Methods: The study population included 46 patients with a history of recurrent abortions, intrauterine fetal death or intrauterine growth restriction (IUGR) and severe early-onset preeclampsia. Patients with a history of thromboembolism or positive findings for thrombophilia were prescribed LMWH (enoxaparin sodium, 40 mg daily) in combination with low-dose aspirin (100 mg daily) in the first trimester (group 1, n=14) or the second trimester (group 2, n=17); the remaining 15 patients received low-dose aspirin alone (group 3). Results: No significant differences were noted between the groups in the incidence of congenital malformations or abortions, IUGR or preterm deliveries. One infant in group 1 had familial bilateral postaxial polydactyly of the hands and one in group 3 had patent ductus arteriosus. Conclusion: Despite the small size of the study groups, our results support the assumption that the use of LMWH is safe, at least as a teratogenic agent, in patients with thrombophilia throughout pregnancy.

Effect of Thrombophylaxis on Uterine and Fetal Circulation in Pregnant Women with a History of Pregnancy Complications

Purpose: The aim of this study was to investigate the effect of thromboprophylactic therapy on fetal and maternal Doppler flow parameters in pregnant women with severe complications in previous pregnancies and evidence of acquired or congenital thrombophilia in the current pregnancy. Methods: Sixty-five patients with a history of recurrent abortions, intrauterine fetal death, intrauterine growth restriction (IUGR), and severe early-onset preeclampsia were tested for the presence of acquired or congenital thrombophilia. Those with positive findings were prescribed low-dose aspirin plus low-molecular-weight heparin (LMWH) (enoxaparin); the remainder received low-dose aspirin only. A Doppler flow study was performed before and after treatment and in the third trimester of pregnancy. Results: Of the 65 pregnancies, four ended in spontaneous abortion and were excluded from the analysis. Of the 61 women with completed pregnancies, 37 (61%) had evidence of acquired or congenital thrombophilia: 22 (36%) protein S deficiency; 1 (2%) protein C deficiency; 2 (3%) activated protein C resistance (APC-R); 2 (3%) IgG for antiphospholipid antibodies; 1 (2%) circulating anticoagulant; and 9 (15%) a combined defect. This group showed a significant decrease in mean uterine artery pulsatility index (PI) before and after treatment (1.32±0.36 vs. 1.04±0.23, P=.006), whereas the remaining 24 patients treated with low-dose aspirin only had nonsignificant changes. Pearson's correlation test yielded no correlations of the pregnancy outcome parameters with Doppler flow values in the umbilical or uterine arteries. Conclusions: Thromboprophylactic therapy transiently improves maternal circulation parameters in patients with thrombophilia at risk of fetal loss and other severe complications of pregnancy, but not in correlation with their pregnancy outcome. Therefore, Doppler examination of maternofetal circulation in the second trimester is not predictive of pregnancy outcome.

Low-molecular-weight heparin for thrombophilia in pregnant women

Objective: Low-molecular-weight heparin (LMWH) is the anticoagulant of choice during pregnancy because it is associated with a low incidence of osteoporosis and thrombocytopenia. Antithrombotic therapy has recently been used to prevent pregnancy loss in high-risk patients with evidence of acquired or congenital thrombophilia. The aim of the present study was to gain further information on the teratogenic potential of LMWH in this patient group. Methods: The study population included 46 patients with a history of recurrent abortions, intrauterine fetal death or intrauterine growth restriction (IUGR) and severe early-onset preeclampsia. Patients with a history of thromboembolism or positive findings for thrombophilia were prescribed LMWH (enoxaparin sodium, 40 mg daily) in combination with low-dose aspirin (100 mg daily) in the first trimester (group 1, n=14) or the second trimester (group 2, n=17); the remaining 15 patients received low-dose aspirin alone (group 3). Results: No significant differences were noted between the groups in the incidence of congenital malformations or abortions, IUGR or preterm deliveries. One infant in group 1 had familial bilateral postaxial polydactyly of the hands and one in group 3 had patent ductus arteriosus. Conclusion: Despite the small size of the study groups, our results support the assumption that the use of LMWH is safe, at least as a teratogenic agent, in patients with thrombophilia throughout pregnancy.

Thyroid autoimmunity and its association with non-organ-specific antibodies and subclinical alterations of thyroid function in women with a history of pregnancy loss or preeclampsia

Following the observation that non-organ-specific antibodies are related with pregnancy loss and preeclampsia, the role of organ-specific antibodies is currently being extensively investigated. The aim of this study was on the one hand to evaluate the incidence of antithyroid antibodies in a study group of 69 women with a history of early pregnancy loss (subgroup 1), foetal death (subgroup 2) or preeclampsia (subgroup 3) and in a control group, on the other hand to assess the possible association of these autoantibodies with non-organ-specific antibodies and subclinical alterations of thyroid function in the study group. Antithyroid antibodies were present in 26/69 (37.7%) women of the study group (37.9% in subgroup 1; 40.9% in subgroup 2; 33.3% in subgroup 3) and in 10/69 (14.5%) of controls, the difference being statistically significant. A significant difference in the distribution of antibodies to thyroglobulin and thyroid peroxidase was found in subgroup 2. In the study group, the incidence of antiphospholipid antibodies was not significantly different in women positive (26.9%) and negative (34.9%) for antithyroid antibodies. Also, the overall incidence of subclinical alterations of thyroid function in the study group was significantly different in women positive (53.8%) and negative (16.2%) for thyroid autoimmunity ( P<0.02). The results of this study seem to confirm the association between thyroid autoimmunity and obstetric complications and suggest the usefulness of undertaking prospective studies in order to evaluate the reproductive outcome of women with a history of recurrent abortion, foetal death or preeclampsia and positivity for antithyroid antibodies.

Proportion of CD56+3+ T cells in decidual and peripheral lymphocytes of normal pregnancy and spontaneous abortion with and without history of recurrent abortion.

The present study investigated the proportion of CD56+3+ T cells in maternal peripheral and decidual lymphocytes in normal pregnancy and spontaneous abortion with and without history of recurrent spontaneous abortion (RSA). Maternal peripheral blood and decidua were taken from normal pregnancies and missed abortions with and without RSA. Decidual lymphocytes were prepared from decidual tissue and analyzed by flow cytometry. In normal pregnancy, the percentages of CD56+3+ T cells in decidual lymphocytes did not differ from those in the peripheral blood. However, the proportion of CD56+3+ T cells in decidual CD3+ T cells increased higher than that in the peripheral CD3+ T cells. The percentages of decidual CD56+3+ T cells in missed abortions with and without RSA were lower than those in normal pregnancies. CD56+3+ T cells may play a role in the maintenance of pregnancy. The phenomenon, where the proportion of CD56+3+ T cells in decidual lymphocytes decreases, may be due to an immunologic event leading to missed abortion.

Endocrine abnormalities during the follicular phase in women with recurrent spontaneous abortion.

The frequency of endocrine abnormalities during the follicular phase in non-pregnant women with a history of recurrent abortion was investigated in a case-control study. A total of 42 consecutive women with recurrent spontaneous abortion (three or more consecutive abortions, mean +/- SD: 3.9 +/- 1.1 range 3-8) with no parental chromosome rearrangement or uterine abnormality were studied during the early follicular phase under standardized conditions. Serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, androstenedione, testosterone, dehydroepiandro-stenedione, 17-OH-progesterone, oestradiol, progesterone and thyroid stimulating hormone (TSH) were measured by commercially available radioimmunoassays. Controls were 42 nulligravid females with tubal or male factor infertility without miscarriage. Mean (SD) concentrations of prolactin and androstenedione were 14.2 +/- 6.7 ng/ml versus 10.5 +/- 3.5 ng/ml (95% CI 0.8-6.1) and 2.3 +/- 0.9 ng/ml versus 1.7 +/- 0.6 ng/ml (95% CI 0.2-0.9) in the study and control groups respectively. The other endocrine parameters were comparable in both groups. Obesity [BMI weight (kg)/height (m2) > or = 25] was more prevalent (23 versus 5 women, P = 0.0001) in the study than the control group. Recurrent spontaneous abortion is associated with abnormalities in prolactin and androgen secretion during the follicular phase, suggesting an endocrine aetiology in this disorder. Reduction of body weight and correction of hyperprolactinaemia and of hyperandrogenism may reduce the rate of miscarriage in a subsequent pregnancy in these women.

Increased resistance to activated protein C and factor V Leiden in recurrent abortions. Review of other hypercoagulability factors

Objective To evaluate hereditary and acquired hemostatic abnormalities associated with recurrent spontaneous early (first-trimester) abortions.Method A group of 56 Greek women with two or more unexplained primary spontaneous abortions, and a reference group of 148 women without a history of recurrent abortions, were screened for hypercoagulability. A randomly selected population of first-trimester pregnant women was also chosen for factor V Leiden genetic screening.Results A total of 21% of the women with recurrent abortions, compared with 12% of the reference group, showed increased activated protein C resistance. Fourteen per cent had positive lupus anticoagulant, compared with 11.5% of the reference group. For the rest of the parameters, there was no difference between the two groups. Of 22 women studied for factor V Leiden, one was homozygous and one was heterozygous. Results were compared using Fisher' exact test and two-tailed Student' t tests.Conclusions Increased activated protein C resistance appears to be an important factor in women with recurrent abortions. These data indicate the need for routine investigation of activated protein C resistance in women with recurrent abortions.

Thyroid autoantibodies are not associated with recurrent pregnancy loss

Objective: Approximately 1% of all women have recurrent pregnancy loss, defined as ≥3 spontaneous losses of pregnancy; however, a cause is determined in only 50% of cases. Recent studies have associated the presence of thyroid autoantibodies during the first trimester of pregnancy with spontaneous abortion in the current pregnancy among women without a history of recurrent abortion. The objective of this study was to determine whether circulating thyroid autoantibodies were associated with recurrent pregnancy loss. Study Design: Sera from 74 nonpregnant women with a history of recurrent pregnancy loss and from 75 healthy, fertile control subjects of similar gravidity were tested for thyroglobulin and thyroid peroxidase antibodies by means of radioimmunoassay kits. All women had a third-generation thyroid-stimulating hormone assay performed. Samples were obtained ≥6 months after a pregnancy. Results: Twenty-two of the women with a history of recurrent pregnancy loss (29.3%) and twenty-eight of the control subjects (37%) had positive results for either one or both of the thyroid autoantibodies ( P > .05). Mean thyroid-stimulating hormone levels and the proportion of women with abnormal thyroid-stimulating hormone values did not differ between the 2 groups. Conclusion: Women with a history of recurrent pregnancy loss are no more likely than are fertile control subjects to have circulating thyroid autoantibodies. Testing for antithyroid antibodies is not clinically useful in the evaluation of patients with a history of recurrent pregnancy loss. (Am J Obstet Gynecol 1998;179:1583-6.)

Decrease in the proportion of granulated CD56+ T-cells in patients with a history of recurrent abortion

We investigated levels of CD56+ T-cells (CD3+ CD56+ cells) in peripheral circulation, which express one of the natural killer (NK) cell markers, by flow cytometry and with monoclonal antibodies in patients with a history of recurrent abortion. We compared these values with those obtained in normal women who were not pregnant as well as in normal pregnant subjects. The percentage of CD56+ T-cells in the peripheral blood of patients with a history of recurrent abortion was less than that in the non-pregnant or pregnant women. These results suggest that CD56+ T-cells with extrathymic properties may be associated with the maintenance of normal pregnancy in humans