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Recurrent spontaneous abortion: histocompatibility between partners, response to immune therapy, and subsequent
B van Iddekinge1, G J Hofmeyr, W R Bezwoda
1Department of Obstetrics and Gynaecology, South African Institute for Medical Research, Johannesburg.
Problem:
Immunological factors may account for previously unexplained cases of recurrent abortion.
Method:
After screening 76 couples for causes of recurrent spontaneous abortion and measuring maternal antipaternal immunity, 23 primary spontaneous recurrent aborters were immunized once with their husbands' leukocytes. Testing for antipaternal cytotoxicity was repeated in 21 couples. Seroconversion was significantly less frequent in couples who shared more than one human leukocyte antigen [one of five (20%) versus 13 of 16 (81%), P < .02].
Results:
Twelve of 16 women (75%) who became pregnant had live children and five of those have had a second live child. All 12 women who achieved successful pregnancies had become antipaternal cytotoxic antibody-positive after immunization, whereas all four patients who had repeat abortions had failed to seroconvert (P < .001). However, this relationship is not necessarily causative, as the successful group also tended to have fewer previous abortions and less human lymphocyte antigen sharing.
Conclusion:
Except for transient illness after immunization, one moderately small for gestational age baby and one premature labor at 32 wk, no complications were observed after immunization.