Naslov
Imunotherapy and infertility.

Autori
Duic, Zeljko ; Singer, Zvonimir ; Podobnik, Mario ; Radic, Vanja ; Ciglar, Srecko ; Leder Miljenko ; Zmijanac, Jasenka ; Humar, Ines ; Marusic, Zrinka.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Journal of Perinatal Medicine. 2005 ; 33(Suppl 1):177. / - , 2005, 177-177

Skup
7thWorld Congress of Perinatal medicine,

Mjesto i datum
Zagreb, Hrvatska, 21.09.2005. - 24.09.2005

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
recurrenr abortion, IVIG treatment

Sažetak
Objective: The aim of this study was to present the results of the treatment and eventually beneficial evidence for therapeutic effect IVIG/didrogesteron in women who had suffered at least three recurrent miscarriages. Success was defined as pregnancy beyond gestational week 24 and/or de¬livery. Study design: In the period of 1992 to 2003 forty primary aborters enrolled in study to receive infusion humane intra¬venous immunoglobuline (IVIG) or didrogesteron at doses 30 mg per day starting as soon as pregnancy test was positive. IVIG was produced at the Institute of Immunology in Za¬greb, Croatia. In this study, partners with histocompatbility in HLA-D loci were included. Tissue typing was carried out at the Tissue Typing Center, University Hospital Rebro, Zagreb. Before treatment at our hospital all the patients with the possibility of the chromosomal aberrations, genopaties, anatomic, microbiological, endocrinological, environmental factors or autoimmunization as a cause of abortion were excluded. Treatment (IVIG/didrogesteron, bed rest) started after confirmation of pregnancy on the fifth week of pregnancy. First infu¬sion contained 30 grams of IVIG. Fur¬ther five/six doses of 20 grams were infused every third week. Total dose of IVIG was 130/150 grams per case. All pregnancies, except one, were treated at our hospital, but five women gave birth out of our hospital. Didrogesteron, one of synthetic progestational agent in daily doses of 30 mg was taken orally until 12th week of pregnancy. Results: In IVIG group the average age of women was 31, 8 years (range 24-40). Seventeen out of twenty (85% (17/20) pregnant women delivered 19 babies (one triplets). One pre-term at 28 weeks born baby died 3 hour after birth. Three abortions occurred after the first or sec¬ond infusion. Due to obstetrics reasons ten deliveries terminated by caesarean section (58, 82%). Three pregnancies (17, 64%) terminated before 37 gestation weeks. Two babies were born small for gestational age. Three patients developed hypertension disorders in pregnancy. Three women had pre-term labor pain and were treated with infusion of ritodrin. Due to cervical incompetence in 5 cases in second trimester of pregnancy cervical cerclage were performed (29, 41%). Only six patients in IVIG group had side effects at the time of the first infusion and they were: head¬ache, nausea, chills, and elevated body temperature under 38 C, hot flushing, and chill. Side effects disappeared after reducing the speed of infusion. In control group (bed rest, didrogesteron) the average age of women was 27, 9 years (range 22- 36). Out of twenty, 18 pregnant women gave birth 19 babies (one twins). Success rate was 90% (18/20). Twins were born at 26 weeks pre-term, and died several hours later. Three women had pre-term delivery (16, 66%), in one of them caesarean section was performed in 34th weeks of gestation due to worsening universal fetal hydrops. Baby was died 12 hours after delivery due to hydrops unknown etiology. Due to pre-term uterine contractions we were treated five pregnant women with infusion of ritodrin. Due to cervical incompetence in 6 cases in second trimester of pregnancy cervical cerclage was performed (33, 33%). Due to obstetrics reasons 5 deliveries were terminated by caesarean section (27, 77%). The average weight of the newborns was 2863, 2g (range 400g-3650g) in the IVIG group and 2925, 8g (range 480g-4350g) in didrogesteron group. The average gestational ages were 38, 11 weeks (range 29-41) in the IVIG group and 36, 16 weeks (range 26-41 weeks) in control groups. No congenital malformations were observed in the newborns. Conclusions: We did not find significant differences in the pregnancy course or perinatal outcome between two treatment groups of patients (IVIG/didrogesteron) may be due to imunomodulatory effects of progesterone or good selections criteria for couples including in study.We also want to stress that IVIG treatment is expensive and experimental.IVIG treatment for the management of recurrent spontaneous pregnancy loss is indicated in patients with probably immunological causes of habitual abortion with history of four and more recurrent abortions.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti, Kliničke medicinske znanosti

POVEZANOST RADA