Efecto de los anticuerpos antifosfolipídicos en la formación y degradación de la malla de fibrina en pacientes con aborto recurrente / Effect of antiphospholipid antibodies on the formation and lysis of fibrin network in patients with recurrent miscarriage

En el presente trabajo se estudió el proceso de formación y disolución de la malla de fibrina y la generación de plasmina en un grupo de pacientes con aborto recurrente (AR) debido a la presencia de anticuerpos antifosfolipídicos (N= 10), mujeres con AR sin el síndrome antifosfolipídico (SAF) (N= 6) y se comparó con un grupo de mujeres sanas (N= 8). Del grupo de pacientes estudiadas con SAF, nueve fueron positivas para anticuerpos anticardiolipina (aCL), cinco para la anti-b2-glicoproteína I (anti-b2GPI), cuatro para ambos anticuerpos, una para anticuerpos antiprotrombina (aPT) y anticoagulante lúpico (AL). El proceso de formación de la fibrina y su disolución fue estudiado por turbidimetría y la generación de plasmina mediante sustrato cromogénico S2251. Las curvas de polimerización de la(s) paciente(s) con AR sin SAF y AL presentaron un incremento en la pendiente y turbidez final, comparado con las del grupo control de mujeres sanas. La velocidad de disolución del coágulo fue mayor en la paciente con AL (21 ± 0) 10-4 DDO/seg y en las AR sin SAF (19,6 ± 5,7) 10-4 DDO/seg, comparado con el grupo control (14,5 ± 2,8) 10-4 DDO/seg. La generación de plasmina estuvo incrementada solamente en las AR sin SAF (85 ± 24%) comparado con 52 ± 3% en el grupo control, p= 0,005. Los cambios observados en el proceso de polimerización y fibrinólisis de la(s) paciente(s) con AR sin SAF y AL pudieran estar relacionados con el incremento en los niveles de fibrinógeno, mientras que los de la generación de plasmina con la entidad mórbida.

The present work was intended to study the process of fibrin formation and lysis and plasmin generation in a group of patients with recurrent miscarriage (RM), due to the presence of antiphospholipid antibodies (N= 10); as well as in women with RM without the antiphospholipid syndrome (APS) (N= 6), compared with those of a group of healthy women (N= 8). In the group of patients with APS, nine were positive for antibodies against cardiolipin (aCL), five for anti-b2-glycoprotein I (anti-b2GPI), four for both antibodies, and one for antibodies against prothrombin (aPT) and lupus anticoagulant (LA). Fibrin formation and lysis was followed by turbidity and plasmin generation using chromogenic substrate S2251. The polymerization curves from RM patients without APS and the LA patient showed an increased slope and maximum turbidity compared to those of the control group. The speed of lysis was higher in the LA patient (21 ± 0) 10-4 DOD/seg and the RM patients without APS (19.6 ± 5.7) 10-4 DDO/seg, compared to that of the control group (14.5 ± 2.8) 10-4 DDO/seg. Plasmin generation increased only in RM patients without APS (85 ± 24%) against the control group (52 ± 3%), p= 0.005. The changes observed in the fibrin polymerization and lysis process of women with RM without APS and LA seem to be related to their higher fibrinogen levels, while the increased plasmin generation was related to the patients´ morbidity.

Serum leptin levels in women with immunological recurrent abortion

Recurrent abortion [RA] may be a consequence of aberrant expression of immunological factors during pregnancy. Although the relative importance of immunological factors in human reproduction remains controversial, substantial evidence suggests that autoantibodies contribute to reproductive failure. Production of such antibodies is under the control of cytokines; and leptin, besides its role in reproductive success, has a profound effect on directing the cytokine profile toward Th[1] [cellular] pattern. Therefore, the present study was performed to assess serum leptin levels in women with immunological recurrent abortion. In this prospective study, 250 women who attended Avicenna Infertility Clinic with RA were screened for known causes of abortion from July to December 2008 in Tehran, Iran. Eighty-one patients with normal karyotypes and hormonal profile with normal ovaries and uterus and no signs of infection were categorized as patients with immunological [IRA, n = 39] or unexplained [URA, n = 42] recurrent abortion based on presence or absence of autoantibodies. After blood sampling, levels of anti-nuclear antibody [ANA], anti-double stranded DNA antibody [anti-dsDNA], lupus anti-coagulant antibody [LACAb], anti-phospholipid antibody [APA], anti-cardiolipin antibody [ACA], anti-thyroglobulin antibody [TgAb], anti-thyroperoxidase antibody [TPOAb] and anti-thrombin III antibody [ATIIIAb] were measured by enzyme-linked immunosorbent assay [ELISA] or chemiluminescent enzyme immunoassay [CLEIA]. In IRA group, 9 [23.1%], 24 [61.5%], 25[64.1%] and 1 [2.6%] women were above the normal cut-off point for ANA, TgAbs, TPOAbs and AT-III Abs, respectively. IRA patients had normal values of LACAbs, APA and ACA. With normal level of fasting blood sugar [FBS], IRA and URA groups had similar serum leptin levels [23.7 +/- 13.2 ng/ml vs. 22.7 +/- 12.5 ng/ml, respectively]. Serum leptin concentrations showed a positive correlation with weight and BMI in both groups. This study suggests that serum leptin levels are higher in IRA and URA patients than normal women. The findings of this study suggest the need for a more comprehensive study and comparison of leptin levels in IRA and URA patients to women with no history of miscarriages

Abortamento de causa aloimune: diagnóstico e tratamento / Alloimmune abortion: diagnosis and treatment

Abortamento espontâneo recorrente (AER) é definido, usualmente, como a perda de três ou mais gestações, até a 20ª semana de gravidez, e afeta aproximadamente 5 % dos casais. Em boa parte dos casos, a causa é desconhecida e muitas hipóteses foram levantadas, dentre elas, a imunológica. Diversos trabalhos vêm tentando mostrar a fisiopatologia da causa aloimune e seu possível diagnóstico e tratamento. Apesar de não haver, até hoje, a liberação por parte de instituições de saúde, como a Food and Drug Administration (FDA) e a Agência Nacional de Vigilância Sanitária (Anvisa), os tratamentos são oferecidos em diversas clínicas ao redor do mundo. Por meio do levantamento dos últimos artigos acerca do assunto, foi possível observar que um método diagnóstico específico que detecte a perda gestacional precoce imune mediada e um método confiável que determine quais mulheres se beneficiariam da manipulação do sistema imune materno são urgentes. Para estabelecer definitivamente ou avaliar a eficácia de qualquer suposto tratamento para o AER, são necessários novos estudos randomizados, com adequado número de amostra.

Recurrent spontaneous abortion (RSA) is usually defined as three or more consecutive pregnancy losses prior to the 20th week of gestation, and affects approximately 5 % of the couples. The etiology of recurrent spontaneous abortion is often unclear and may be multifactorial. However, the majority of cases of RSA remain unexplained and some studies have been attempting to associate it with autoimmune and alloimmune antibodies. Although until today there is no release by health institutions such as Food and Drug Administration (FDA) and Agência Nacional de Vigilância Sanitária (Anvisa), these treatments are offered at various clinics around the world. Through the survey of recent articles on this subject, it was possible to see that a specific diagnostic method to detect the early pregnancy loss imune mediated as well as a reliable method to determine which women would benefit from the manipulaton of the maternal immune system are more than necessary. To definitively establish or evaluate the effectiveness of any treatment for RSA, further randomized studies with adequate number of sample are needed.

Gestational prognostic factors in women with recurrent spontaneous abortion / Fatores de prognóstico gestacional em mulheres com aborto espontâneo recorrente

CONTEXT AND OBJECTIVE: Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses before 20 weeks and is associated with several etiological factors related to genetics, anatomy, hormones, infections and immunology, for example. Many cases of RSA remain unclear. New factors or their associations may influence gestational results. The aim was to identify possible single or associated causes of RSA that could predict gestational prognosis for women undergoing investigation and treatment. DESIGN AND SETTING: Case-control study, at the Recurrent Abortion Outpatient Clinic, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp). METHODS: Two hundred and forty-six medical records of women with RSA seen at the Recurrent Abortion Outpatient Clinic, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp), between 1994 and 2003, were evaluated. Data on age, obstetric history, possible etiological factors, treatment and pregnancy outcomes were evaluated. Statistical analysis was performed using odds ratios (OR), logistic regression analysis and decision trees. RESULTS: Two hundred and twenty-nine women were included in the study. The most frequently found etiological factors were immunological, particularly alloimmune factors (93.9 percent). Women with a single alloimmune factor had better gestational results (77.7 percent deliveries) than those with other associated factors. Autoimmune factors were associated with a higher abortion rate (OR: 4.30; 95 percent confidence interval, CI: 1.36-13.63). No association was found between the number of abortions prior to treatment and pregnancy results. Women aged 40 or over presented the highest rate of spontaneous abortion (OR: 5.83; 95 percent CI: 1.12-30.40). CONCLUSION: Age over 40 years old, immunological factors and two or more concomitant factors were associated with poor gestational outcomes among the women studied.

CONTEXTO E OBJETIVO: A perda espontânea de três ou mais gestações subseqüentes é chamada de aborto espontâneo recorrente (AER). É relacionado com alterações genéticas, anatômicas, hormonais, infecciosas, imunológicas e outras. Muitos casos de AER continuam como de causa desconhecida. Novos fatores ou associações podem influenciar o resultado gestacional. O objetivo do estudo foi identificar as possíveis causas do AER, isoladas ou associadas, que poderiam predizer o prognóstico gestacional em mulheres submetidas a um protocolo de investigação e tratamento. TIPO DE ESTUDO E LOCAL: Estudo de caso-controle, no ambulatório de Perdas Gestacionais do Centro de Atenção Integral a Saúde da Mulher da Universidade Estadual de Campinas. MÉTODOS: Foram revisados 246 prontuários médicos de mulheres com três ou mais perdas espontâneas sucessivas atendidas no Ambulatório de Perdas Gestacionais do CAISM/Unicamp entre 1994 e 2003. Foram avaliados dados relativos à idade, antecedentes obstétricos, possíveis etiologias para a recorrência do aborto, tratamentos realizados e resultados gestacionais. A análise estatística envolveu razão de chances (RC), análise por regressão logística e arvores de decisão. RESULTADOS: 229 mulheres foram incluídas no estudo. O fator imunológico, principalmente o aloimune, foi o mais encontrado (93,9 por cento). Mulheres com fator aloimune isolado obtiveram melhores resultados gestacionais (77.7 por cento de partos) do que aquelas com a associação de outros fatores. A presença do fator autoimune aumentou a chance de aborto (RC 4.30 95 por cento intervalo de confiança, IC 1.36 - 13.63). Não foi encontrada associação entre o número de abortos prévios ao tratamento e o resultado gestacional. Mulheres com 40 anos ou mais apresentaram a mais alta taxa de aborto espontâneo (OR 5.83 95 por cento CI 1.12-30.40). CONCLUSÃO: Idade acima de 40 anos, a presença de fatores imunológicos e a associação de dois ou mais fatores conferiram o pior prognóstico gestacional às mulheres avaliadas.

Anticardiolipin antibody in women with recurrent spontaneous miscarriage

To determine the association between the presence of anticardiolipin antibody [ACA] and history of recurrent spontaneous miscarriage. Also, to evaluate the association between raised ACA and activated partial thromboplastin time [APTT]. This is a case-control study which was carried out in Basrah Hospital for Maternity and Children, Basrah, Iraq during January to September 2004 on 91 women with recurrent spontaneous miscarriage, matched with 109 women with no history of pregnancy wastage. Sera were collected from these 200 women and analyzed for ACA by enzyme linked immunosorbent assay [ELISA]. In women with pregnancies that ended with a loss, 17.6% were positive of ACA, compared with none among the control group. Women with 4 or more miscarriages had almost higher percentages of ACA [26.3% and 22.2%] than women with only 3 miscarriages [13%] but with no statistical significance. Prolonged APTT was detected among 18.8% of patients having positive ACA while only 1.6% of patients who were negative for this antibody. A significant association was observed between recurrent spontaneous miscarriage and the presence of ACA. Also, there was a significant relationship between positive ACA and prolonged APTT

Evaluation of anticardiolipin antibodies and antiphosphatidylserine antibodies in women with recurrent abortion.

BACKGROUND: Antiphospholipid syndrome (APS) is a major reproductive complication in women, which is characterized by recurrent fetal loss, thrombosis, and thrombocytopenia in association with anticardiolipin antibodies (aCL). AIMS: To analyze the prevalence of aCL and antiphosphatidylserine antibodies (aPS) in relation to pregnancy failures in women with the history of recurrent spontaneous abortion. SETTINGS AND DESIGN: A sequential study of 155 patients, who had three or more recurrent spontaneous abortions, was carried out. METHODS AND MATERIALS: Women with unexplained recurrent pregnancy loss in first trimester were selected for this study. Anticardiolipin antibodies IgG and aPS IgG were detected in the serum by the enzyme linked immunosorbent assay method. STATISTICAL ANALYSIS: Percentage calculation was carried out. Two-tailed t-test was performed to know the significance of aCL and aPS total population. RESULT: The levels of aCL IgG and aPS IgG were detected as 40% (62) and 19% (18), respectively in women with history of recurrent abortion. CONCLUSION: Anticardiolipin antibody is found to be the most important factor for recurrent abortion. In addition, women with negative aCL are having positive for another antiphospholipid antibodies like aPS, which may involve in recurrent abortion.

Anticardiolipin and anti beta 2 glycoprotein 1 in Omani patients with anti phospholipid syndrome

Anti-cardiolipin [ACA] and anti-beta 2 glycoprotein I [beta 2GP1] antibodies are thought to be involved in the development of arterial or venous thrombosis, thrombocytopenia and recurrent fetal loss. We examined the presence of these autoantibodies in Omani patients with autoimmune and non-autoimmune disorders. Sera from 30 patients with systemic lupus erythematosus [SLE; 30], 44 with a history of recurrent abortion and 36 with thrombosis/thromboytopeania were tested for ACA and anti-beta 2GP1 antibodies. In addition, sera from 30 healthy subjects were also tested for these antibodies. ACA were detected in 23% with SLE, 27% suffering from recurrent abortion and 36% of patients with thrombosis/thrombocytopenia while anti-beta 2GP1 antibodies were detected in 16.6%, 18% and 22% of same patients, respectively. Our data demonstrate a high prevalence of ACA and anti-beta 2GP1 antibodies of either combined or separate pattern among the Omani patient groups studied

Anticorps antiphospholipides et grossesse

The presence of antiphospholipid antibodies is associated with a clinical syndrome characterised by thrombocytopenia, arterial and venous thromboses and recurrent fetal loss. Among theses antibodies currently detectable in laboratory are the lupus anticoagulant and anticardiolipin antibody. The antigens for these antibodies are phospholipid-binding-proteins [prothrombin and beta 2 glycoprotein. I]. The exact mechanism of action of antiphospholipid antibodies remains controversal. The pathogenesis of pregnancy loss seems related to the increased incidence of placental infraction. In spite of the improvement in our knowledge on the pathogenic mechanisms of the antiphospholipid syndrome, the standard therapy is still based on anti-platelet or anticoagulant drugs, both for vascular and obstetrical problems. Larger prospective clinical studies are needed to validate therapeutic implications

Antiphospholipid antibodies--our experience.

Antiphospholipid antibodies (APA) have aroused multispeciality interests. In our study of 200 cases worked up for APA, we have used a few simple coagulation tests to detect lupus anticoagulant (LA) and ELISA to detect anticardiolipin antibodies. The positivity rate for LA among cases with recurrent pregnancy loss was 4.16% and for aCL 20.8%. The positivity rate for LA in patients with venous thrombosis was 6.2%, in arterial thrombosis was 7.14% and in SLE patients was 58.3%. In conclusion APAs are to be looked for in cases of recurrent pregnancy loss, thrombosis in people < 45 years of age without risk factors and SLE patients to assess the thrombotic risk and to decide on anti coagulant therapy for further management.

The antiphospholipid syndrome.

The antiphospholipid syndrome encompasses a wide spectrum of presentations cutting across all subspecialties of medicine. It is characterized by recurrent thrombotic events involving both the arterial and venous systems. Large arteries and veins as well as the microcirculation are involved. Recurrent strokes, myocardial infarction, pulmonary embolism, gangrene of the digits, etc. cause much morbidity and mortality in affected patients. It is recognized as an important cause of recurrent pregnancy loss. The risk in pregnancy extends to a propensity towards pre-eclampsia, abruptio placentae and intrauterine growth retardation. It often manifests as asymptomatic thrombocytopenia and sometimes as a life-threatening form called catastrophic anti-phospholipid syndrome. The management of thrombotic events rests on high grade anticoagulation (INR 3-4) as lower values of INR than this often fail to prevent recurrence. Aspirin is generally added in case of arterial thrombosis. A combination of heparin and aspirin at least in the first trimester and sometimes throughout pregnancy is used to prevent foetal loss.

Diseases associated with the different patterns of antinuclear antibodies detected by immunofluorescence

immunofluorescent antinuclear antibody [ANA] patterns are variable and may indicate specificity towards certain diagnosis. to explore the spectrum of diseases associated with the common different ANA patterns seen at King Abdulaziz University Hospital [KAUH]. ANA tests were performed by indirect immunofluorescent assay [IIFA] in the clinical immunology laboratory. Cases with positive ANA cases were selected sequentially. Their IIFA patterns and patient files were reviewed. 211 positive ANA cases were studied. The ages ranged between 3-70 years [mean age 31.4 +/- 15] females predominated [83%]. Rheumatological disorders were the predominant illnesses; they were diagnosed in 148 cases [70.1%]. These included systemic lupus erythematosus [SLE] 71 [33.6%], rheumatoid arthritis 18 [8.5%], others 26 [12.3%], and undiagnosed 33 [15.6%]. Other autoimmune disorders followed with 34 [16.1%]. There were also 23 [10.9%] cases with recurrent abortion and 6 [2.8%] with miscellaneous illnesses. The different ANA patterns on IIFA were: homogeneous 107 [50.7%], speckled 68 [32.2%], nuclear 18 [8.5%], peripheral 7 [3.3%], centromere 1 [0.5%], and mixed 10 [4.7%]. A highly significant association was detected between the peripheral ANA pattern and SLE cases [P<0.01]. autoimmune disorders, particularly rheumatological, were the commonest diseases associated with positive ANA test. The predominant ANA pattern was the homogeneous, followed by the speckled which is compatible with reports in the literature. ANA staining pattern have limited value in the clinical assessment of autoimmune diseases; however, ANA has very high sensitivity for SLE especially in cases with peripheral ANA pattern

Increase of NK cells in decidua of women with recurrent spontaneous abortion

Various immunological mechanisms are known to be involved in maintenance of pregnancy but mechanisms underlying the failure of pregnancy in spontaneous abortion are poorly understood. Leukocytes consist a substantial percentage of endometrial stroma cells and classic natural killer cells have been proposed as immunological factor in spontaneous abortion. This study was performed to clarify the immunological role of classic NK cells in women with recurrent spontaneous abortion in the first trimester and of unknown etiology. This cell population was studied in 30 samples of decidua tissue of women with spontaneous abortion [test group] and compared with 30 samples of decidua of women undergoing elective pregnancy termination [control group]. Paraffin embedded sections were prepared from endometrial tissue samples of both groups and were dyed with specific monoclonal antibody against CD57 marker by using avidin-biotin-peroxides technique. NK cells positive for CD57 were then evaluated and counted under light microscopy with 400 magnification. Z-test was used to statistically compare NK population between test and control groups. Result showed that NK cells were scattered through stroma cells in both normal and abotion group. There was few NK cells observed in normal decidua tissue, where as this cell population was significantly increased in women with spontaneous abortion [P<0.003]. It seems that NK cells play key role in recurrent spontaneous abortion during the first trimester of pregnancy. Probably classic NK cells are activated by local cytokines and attack trophoblast cells of placenta and are thus involved in induction of spontaneous abortion

Avaliaçäo de testes imunológicos em pacientes com aborto recorrente / Evaluation of immunologic tests in recurrent abortion

INTRODUÇÃO: O aborto recorrente é um grande enigma, pois apesar de várias causas que lhe säo atribuidas poucas tem um real valor. O papel do fator imunológico tem sido pesquisado amplamente. OBJETIVO: Avaliar alguns testes imunológicos em pacientes com aborto recorrente. TIPO DE ESTUDO: prospectivo LOCAL: Setor de Reproduçäo Humana do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeiräo Preto. PARTICIPANTES: Num estudo piloto foram selecionados nove casais com duas perdas fetais ou mais sem causa aparente e nove casais voluntários com pelo menos dois filhos, sem história de aborto e com idade inferior a 40 anos VARIAVEIS ESTUDADAS: A freqüência de compartilhamento de antígenos HLA e de anticorpos linfocitotóxicos contra antígenos paternos foram avaliados por métodos sorológicos, a variaçäo de fenótipos celulares (CD4, CD8, CD19, CD16, CD56 e HLA-DR) por citometria de fluxo, a atividade "natural killer" (NK) pela liberaçäo de 51Cr e a dosagem de progesterona por radioimunoensaio. RESULTADOS: Näo houve diferença de compartilhamento entre casais com aborto recorrente tanto em relaçäo à classe I quanto II e näo se detectou o aparecimento de anticorpos citotóxicos no grupo investigado. Houve um número absoluto maior de células CD8+(587 vs 448 linfócitos/mmü, p=0,01) e das CD19+(215 vs 182 linfócitos/mmü, p=0,05) nas pacientes. A atividade NK näo foi estatisticamente diferente entre os dois grupos estudados, mas houve uma tendência à reduçäo da atividade NK entre pacientes com aborto recorrente. Näo houve correlaçäo da atividade NK com um número de células CD16+ e CD56+ nem com dosagem de progesterona nos dois grupos estudados. CONCLUSÃO: Estes dados sugerem que o compartilhamento de antígenos HLA, o aparecimento de anticorpos linfocitotóxicos e elevaçäo da atividade NK podem näo ser importantes para a ocorrência de abortos repetidos. o aumento de células CD8+ e CD19+ circulantes pode ocorrer independente de qualquer terapêutica e a citotoxicidade contra antígenos fetais pode ser mediada por células T e näo por células NK.

Microquimerismo y actividad bloqueante en mujeres con abortos espontáneos recurrentes (RSA) después de la aloinmunización con linfocitos del esposo / Microchimerism and blocking activity in women with recurrent spontaneous abortions after the allo immunization with their partner's leucocytes

Se han detectado células fetales en la circulación materna de seres humanos 4 semanas post-concepción (Thomas y colab. 1994). Se podría hipotetizar que el tráfico celular temprano a través de la placenta es importante y tal vez necesario para la inducción de tolerancia fetal. La localización de células fetales CD34+ en los órganos maternos linfoides puede ayudar a mantener la tolerancia fetal de una manera análoga al trasplante de órganos alogeneicos (Bianchi y colab. 1996). El reciente hallazgo de que células del dador circulan en el receptor de trasplante hasta 29 años post-trasplante, ha hecho pensar que éstas células quiméricas (Microquimerismo) pueden tener un rol en la inducción y perpetuación de la tolerancia. La terapia de aloinmunización con linfocitos del esposo podría ser efectiva para prevenir los abortos recurrentes de causa desconocida. Algunos investigadores establecieron que después de la aloinmunización se observa la presencia de factores bloqueantes (FB) en el suero de mujeres con embarazos exitosos en ensayos "in vitro" de cultivo mixto linfocitario (MLC). Nosotros hemos investigado la producción de FB en MLC antes y después de la aloinmunización y su posible relación con el desarrollo de microquimerismo (M). Antes del tratamiento estudiamos 14 parejas con 3 o más abortos quienes eran evaluadas clínicamente para descartar causas anatómicas, genéticas, estructurales, endócrinas, infecciosas y/o autoinmunes. El estudio de M fue hecho con la técnica llamada nested PCR-SSP para los alelos HLA-DR antes del tratamiento y después de 30 días de la última inmunización. Antes del tratamiento, solo 1 paciente tenía M positivo y ninguna tenía FB positivos con índice de inhibición (I.I) >50, solo 8 pacientes realizaron el tratamiento. Las pacientes recibieron entre 3 y 9 aloinmunizaciones (x=4.7). Después del tratamiento todas las pacientes tenían M positivo e I.I>50, 6 meses después de la última inmunización 4 pacientes tienen M positivo eII>50. En conclusión: la hipótesis propone que la aloinmunización establece un estado de microquimerismo que sería el estímulo alogénico necesario para la activación de células T y la inducción o mantenimiento de la tolerancia hacia el feto durante el embarazo

Status of toxoplasma antibodies in recurrent fetal loss in U.A.E. women.

A retrospective analysis to determine the status of toxoplasma (IgG & IgM) antibodies in UAE women with recurrent fetal loss was done using immunofluorescence assay. Two thousand three hundred and fourty three patients with one or more fetal loss were studied over a period of five years. In patients with fetal loss, the range of toxoplasma IgG seropositivity varied from 24.2-30.6%. There were 3 patients with IgM positive. Only in a single patient one of her two abortions could be attributed to acute toxoplasmosis. Habitual fetal loss cannot be attributed to chronic toxoplasmosis. Also, 67.2% of the women of child bearing age group in U.A.E were found to be seronegative, highlighting the need for routine antenatal screening to detect primary acute toxoplasmosis.