Speciality
Spotlight

 




 


Immunology


 

 




Abortion

     

  • 1) B Jablonowska, et al (Univ Hosp, Linkoping, Sweden; Huddinge Univ Hosp, Sweden)

    Prevention of Recurrent Spontaneous Abortion by Intravenous Immunoglobulin: A Double-Blind Placebo-controlled study.

    Hum Reprod. 14:838-841, 1999 and

       


    2) H Yamada, et al (Hokkaido Univ, Sapporo, Japan)

    Massive Immunoglobulin treatment in Women with four or More Recurrent Spontaneous Primary Abortions of Unexplained Aetiology.

    Hum Reprod.13:2620-2623,

       

    Conclusion: Administration of intravenous immunoglobulin (IVIG) at intervals during early-pregnancy and mid-pregnancy as a treatment for unexplained recurrent miscarriage has been performed by several groups. In the majority of randomized controlled trials, such as the first one, the viable birth rate has not been found to be significantly greater with IVIG than when saline solution or albumin is infused in the control group. IVIG is expensive. Therefore, until its use has been shown to be significantly better than placebo, clinicians should not advise women to receive IVIG for the treatment of unexplained recurrent miscarriage.

         

  • Pregnancy Complications in Women with Recurrent Miscarriage Associated with Antiphospholipid Antibodies Treated with Low Dose Aspirin and Heparin.

    M Backos, et al (St Mary’s, London), Br. J Obstet Gynaecol 106:102-107, 1999.

      


    The late pregnancy and perinatal course in 150 women treated with low dose aspirin and low-dose heparin because of recurrent miscarriage associated with antiphospholipid antibodies was prospectively examined.

      


    There were 107 live births (71%) and 41 miscarriages (27%), most of which occurred in the first trimester.

      


    Conclusion : A high birth rate was observed among women with recurrent miscarriage and antiphospholipid antibodies who underwent combined treatment with aspirin and heparin. Successful pregnancies were susceptible to a increased risk of complications during all trimesters. These high-risk pregnancies should have close antenatal surveillance, and deliveries should occur in a unit with specialist obstetric and neonatal intensive care facilities.

        


    About 15% of women with recurrent miscarriage have antiphospholipid antibodies. The current therapy for these women is administration of 75mg aspirin daily as soon as human chorionic gonadotropin is detectable in the urine, and 5000 IU of subcutaneous heparin every 12 hours beginning when fetal heart activity is first observed sonographically. With this therapy the viable pregnancy rate is about 70%, significantly greater than the 40% rate when therapy consists of aspirin alone. 

      


    The results of this study of a large group of women treated with aspirin and heparin during their pregnancies found there was little effect on bone density, and no women developed thrombocytopenia. However, because there is a high incidence of pregnancy-induced hypertension, antepartum hemorrhage, and premature and low birth weight infants, pregnant women with antiphospholipid syndrome need to be monitored closely and frequently during their gestation.

        

 



 

 

Speciality Spotlight

 

 

Abortion
     

  • 1) B Jablonowska, et al (Univ Hosp, Linkoping, Sweden; Huddinge Univ Hosp, Sweden)
    Prevention of Recurrent Spontaneous Abortion by Intravenous Immunoglobulin: A Double-Blind Placebo-controlled study.
    Hum Reprod. 14:838-841, 1999 and
       
    2) H Yamada, et al (Hokkaido Univ, Sapporo, Japan)
    Massive Immunoglobulin treatment in Women with four or More Recurrent Spontaneous Primary Abortions of Unexplained Aetiology.
    Hum Reprod.13:2620-2623,
       
    Conclusion: Administration of intravenous immunoglobulin (IVIG) at intervals during early-pregnancy and mid-pregnancy as a treatment for unexplained recurrent miscarriage has been performed by several groups. In the majority of randomized controlled trials, such as the first one, the viable birth rate has not been found to be significantly greater with IVIG than when saline solution or albumin is infused in the control group. IVIG is expensive. Therefore, until its use has been shown to be significantly better than placebo, clinicians should not advise women to receive IVIG for the treatment of unexplained recurrent miscarriage.
         

  • Pregnancy Complications in Women with Recurrent Miscarriage Associated with Antiphospholipid Antibodies Treated with Low Dose Aspirin and Heparin.
    M Backos, et al (St Mary’s, London), Br. J Obstet Gynaecol 106:102-107, 1999.
      
    The late pregnancy and perinatal course in 150 women treated with low dose aspirin and low-dose heparin because of recurrent miscarriage associated with antiphospholipid antibodies was prospectively examined.
      
    There were 107 live births (71%) and 41 miscarriages (27%), most of which occurred in the first trimester.
      
    Conclusion : A high birth rate was observed among women with recurrent miscarriage and antiphospholipid antibodies who underwent combined treatment with aspirin and heparin. Successful pregnancies were susceptible to a increased risk of complications during all trimesters. These high-risk pregnancies should have close antenatal surveillance, and deliveries should occur in a unit with specialist obstetric and neonatal intensive care facilities.
        
    About 15% of women with recurrent miscarriage have antiphospholipid antibodies. The current therapy for these women is administration of 75mg aspirin daily as soon as human chorionic gonadotropin is detectable in the urine, and 5000 IU of subcutaneous heparin every 12 hours beginning when fetal heart activity is first observed sonographically. With this therapy the viable pregnancy rate is about 70%, significantly greater than the 40% rate when therapy consists of aspirin alone. 
      
    The results of this study of a large group of women treated with aspirin and heparin during their pregnancies found there was little effect on bone density, and no women developed thrombocytopenia. However, because there is a high incidence of pregnancy-induced hypertension, antepartum hemorrhage, and premature and low birth weight infants, pregnant women with antiphospholipid syndrome need to be monitored closely and frequently during their gestation.
        

 

 

By |2022-07-20T16:42:10+00:00July 20, 2022|Uncategorized|Comments Off on Abortion

About the Author: