Effective Treatment for Recurrent Pregnancy Loss

Abstract

Abstract:Understanding the etiology of recurrent pregnancy loss (RPL) has been increasing in importance in reproductive medicine, especially in societies with low birth rates. Since the cause of human miscarriage is often complicated and multifactorial, effective treatment for the successful maintenance of pregnancy requires the comprehensive clinical management of recurrent wastages. Immunology for the maintenance of pregnancy is a very attractive field; however, the role of immunology during human gestation cannot be confirmed in couples with a history of recurrent pregnancy loss unless other clinical causes of miscarriage are especially ruled out. Balanced chromosomal rearrangements have been found at an increased frequency in couples with recurrent pregnancy loss compared with the general population. The major anomalies are Robertosonian or reciprocal translocations, while most minor variants include pericentric inversion of chromosome 9. Both major and minor anomalies result in a spontaneous abortion rate of approximately 80-90%. Though the incidences of these chromosomal abnormalities vary in reported studies, a survey indicated an incidence of 9.8% (3.9% in male partners and 5.9% in female partners) among 1,639 couples with a history of recurrent pregnancy loss. Congenital uterine anomaly resulting in a suboptimal uterine environment may influence ovum implantation and early fetal development and may be a candidate in the etiology of reproductive wastage. A review on the relation between congenital uterine anomalies and the spontaneous abortion rate concluded that a precise diagnosis of uterine cavity deformity, especially arcuate uterus, is a key issue for determining the clinical prognosis during human gestation. After establishing diagnostic criteria for uterine cavity anomaly, 278 congenital uterine anomalies were detected in a series of 2,061 hysterosalpingographies (13.5%) performed in women with a history of recurrent pregnancy loss. Among these abnormalities, the incidences of spontaneous abortion were equally high among patients with arcuate uterus and those with partial septate uterus. A few studies on abortion mechanism in patients with congenital uterine anomalies have been reported. Histological findings using CD34-positive staining indicate the lack of a blood capillary system in both the uterine septum and the fundus muscle layer. The results of metroplastic surgery on congenital uterine anomaly are also controversial. Based on our fundamental findings of the maldistribution of uterine capillaries, we performed ideal metroplastic surgery in 173 women and significantly

An immunohistochemical study of metroplastic surgical specimens from patients with a septate uterus

“…The control group consisted of 47 randomly selected women with congenital uterine anomalies not treated by metroplasty. This study revealed that 152 out of 161 subsequent pregnancies (94.4%) terminated in spontaneous abortion [30]. Thus, metroplasty for the treatment of septate uterus appears to be an appropriate surgical intervention with the ability to improve the subsequent reproductive outcome.…”

“…Ayhan et al [29] evaluated the reproductive performance of 102 patients who underwent conventional metroplasty for the treatment of septate uterus and reported that the miscarriage rate was reduced from 90% before surgery to 17% after abdominal metroplasty. In our recent statistical data [30], we performed modified metroplastic surgery in 173 women: 101 with septate uterus, 59 with arcuate uterus, 10 with a T-shape uterus and 3 with a double uterus. As demonstrated in this study, the subsequent reproductive outcome was distinctly improved, with a reduction in the miscarriage rate from 93.2% to 12.5%, and an increase in the term delivery rate from 1.3% to 63.4%.…”