[Abortions of immunologic origin]

The immunology of pregnancy involves a series of systemic and above all local events, at the feto-maternal interface. These immunological events may explain the paradoxical non-rejection and development of the allogeneic conceptus within of the maternal body. The immunodeviation of the maternal immune system towards fetal tolerance may be altered or insufficient leading to true abortive diseases. The alteration of this tolerance may be the result of auto-immune abnormalities, particularly when autoantibodies are discovered in woman's serum. These antibodies are the antithromboplastin, antiphospholipid and antinuclear antibodies. They can be responsible for abortion even if the clinical symptoms of the lupus disease are absent. Abortive events occur at all stages of pregnancy. Table 1 shows that abortions with autoantibodies are more frequent when the accident occurs in the late stage of pregnancy. The therapy with corticoids and aspirin will be modulated in connection with the results. The second immune etiology is an insufficient production of immunological events usually involved in normal pregnancies. The current means available to detect this incompetency are imperfect because only systemic factors may be explored when local events are the most involved. We found a good correlation, in these women with recurrent early abortions of unknown etiology, between the production of anti-husband lymphocytes (AAP) and the success of a subsequent pregnancy. Women who suffer from recurrent spontaneous abortions of unknown etiology, without autoimmune abnormalities and without antipaternal antibodies (AAP), may profit from a therapy using the husband's leucocyte injections, which allows them to give birth to a normal child in 85% of the cases, whereas without treatment the success rate is only 37% of the pregnancies. When this therapy is applied in accurate conditions, its inocuousness seems well established. Another kind of this immunomodulator therapy has been reported: it uses unrelated donor leucocytes. Its efficiency seems to be similar to that of the husband's leucocyte injections.