Spontaneous Abortions in the Second Trimester of Pregnancy: Research and Analysis of Factors Associated at Laquintinie Hospital in Douala

Introduction: Spontaneous abortion of the second trimester is an interruption of pregnancy with complete expulsion or not of the product of conception between 15 and 28 weeks of pregnancy without any maneuvers. The objective of our study was to determine the factors associated with second trimester spontaneous abortions at Laquintinie Hospital in Douala. Methodology for this purpose: We conducted a case-control study from January to May 2019 on pregnant women who may or may not have had spontaneous second trimester abortions. Results: In total we recorded 1609 pregnancies and recruited 184 patients, including 46 cases and 138 controls;which gave a frequency of spontaneous abortion in the second trimester of pregnancy of 2.85%. A correlative analysis showed that spontaneous abortions in the second trimester were associated with housewife status (OR = 2.89;CI = 1.21 - 6.79;p = 0.010), gestation > 5 (OR = 4.09;CI = 1.02 - 17.66;p = 0.040), multiparity (OR = 3.81;CI = 1.59 - 9.16;p = 0.002), history of endouterine maneuvers (OR = 5.64;CI = 2.43 - 13 .03;p = 0.000), malaria in pregnancy (OR = 3.99;CI = 1.1 - 14.76;p = 0.030), incompleteness on the second trimester ultrasound (OR = 2.37;CI = 1.18 - 4.70;p = 0.010), jolts when traveling (OR = 46.04;CI = 17.29 - 123.66;p = 0.000), long car journeys (OR = 7.05;CI = 1.99 - 27.77;p = 0.000). After logistic regression eliminating the confounding factors, only the following were associated with abortions: Multiparity (OR = 13.90;CI = 2.96 - 65.18;p = 0.000), endo uterine maneuvers (OR = 3.69;CI = 1. 01 - 13.44;p = 0.047), jolts when traveling (OR = 72.63;CI = 19.47 - 270.96;p = 0.000), long car journeys (OR = 15.41;CI = 2.7 - 85, 95;p = 0.000). Conclusion: Our study reveals that a set of factors contribute to the occurrence of spontaneous abortions in the second trimester of pregnancy in our context.

Populational change of CD4^(+)CD25^(+)Treg cells is responsible for the synergistic effect of the combination of RAMP2 with baicalin in treating recurrent spontaneous abortion mouse models

Background: The absence of a safe and effective therapy for recurrent spontaneous abortion due to a maternofetal failure in immunological tolerance remains an intractable clinical obstacle for surgeons. Recently, traditional Chinese medicine has become a feasible alternative for certain diseases, including recurrent spontaneous abortion. However, because of the complex composition of the traditional Chinese medicine formula, its action mechanism remains unclear. Methods: We selected two isolated active ingredients (RAMP and baicalin) from the traditional Chinese medicine formula and used an abortion-prone CBA/J × DBA/2 model to simulate human RSA and compared the changes in fetal resorption rate, Treg cell percentage, and relevant cytokines before and after combination therapy. In addition, The mechanisms were preliminarily discussed using in vitro differentiation models. Results: In CBA/J × DBA/2 abortion-prone mice, the combination therapy resulted in a lower embryo resorption rate compared to that obtained with individual delivery of either RAMP or baicalin, thereby playing an embryo-protective role through the increase in Treg cells for the maintenance of maternal-fetal immune tolerance. In in vitro primary cell differentiation experiments, the concentration of Treg cells significantly increased from 11% to 17.9% after the combination therapy compared to that of the single administration group. Conclusion: the synergistic effects of RAMP and baicalin were responsible for Treg differentiation. The present study provides a solid basis for improving the applicability of traditional Chinese herbs in the treatment of recurrent spontaneous abortion.

Relationship between the Abnormal Expression of FasL on Human First Trimester Trophoblast and Spontaneous Abortion

In order to study the molecular immune-pathological mechanism of spontaneous abortion (SA), immunohistochemistry techniques were used to detect the FasL expression of first trimester trophoblast in the SA patients and normal controls. High precise color-image measure system for immuno-histochemistry (HPIS) was used to determine the quantity of FasL expression. The results showed that the scale and intensity of FasL expression on the trophoblasts in SA group were significantly lower than in the control group. It is indicated that abnormal expression of FasL on trophoblasts, which damages the immunological tolerance between mother and fetus, may be one of the important mechanisms of development of SA. To induce the expression of FasL or to regulate the immunological tolerance will be a new way to treat SA.

Correlation of Abortus Imminence Cases in the First Trimester with Biochemical Markers

Objective: In this study, we compared the biochemical markers of imminent abortion, missed abortion, and healthy pregnant women in the first trimester to see if there were any differences. Materials and Methods: The study method is prospective. Pregnant women who applied to the obstetrics clinic of Istanbul Training and Research Hospital between 01.04.22 and 31.10.22 were diagnosed with abortion imminens or missed abortion between 6 weeks and 12 weeks or had normal pregnancy follow-up, had no chronic diseases, and did not take magnesium and calcium supplements were included in the study. 20 pregnant women with missed abortion, 20 pregnant women with abortion imminens diagnosis and 20 normal pregnant women who met the criteria were included in the study. Magnesium (Mg), calcium (Ca), copper (Cu), zinc (Zn) and hemogram (CBC) levels were checked in pregnant women included in the study. Results: The Mg, Cu, Zn, and CBC values of the study participants’ women did not differ in a statistically significant way. When compared to pregnant women who had a normal pregnancy process, the difference in Ca value was found to be statistically substantially smaller in pregnant women who were diagnosed with abortion imminens and missed abortion. The findings of our study suggest that serum Ca levels be measured prior to conception or at the initial visit. Conclusion: Serum Ca levels were found to be significantly lower in the missed abortion group than in the abortus imminens and normal pregnant groups in our study (p 0.05).

The Effect of Lymphocyte Immunotherapy on CD80^+ Cells at the Fetomaternal Interface and Cyesis Result of Mice Model of Spontaneous Abortion

Objectives To explore the relationship between CD80 expression on lymphocytes at the fetomaternal interface and the fertility characteristics in CBA/J×DBA/2 mice as a model of recurrent spontaneous abortion (RSA) and to investigate the effects of lymphocyte immunotherapy (LIT) on the level of CD80 expression. Materials & Methods The characteristics of fertility in CBA/J×DBA/2 mice were observed in a 120 day period and compared with four normal fertile groups. In another 15 pairs of CBA/J×DBA/2 breedings, resorption rate on day 13 of pregnancy were calculated and the proportion of CD80 + cells at the fetomaternal interface were determined by using two color flow cytometric analysis, mainly stained with CD80 FITC and CD45 PE. In order to determine the identity of CD80 + cells, the expression levels of CD3(T cell marker), DX5(NK cell marker), and MHC II(antigen presenting cell marker) were detected in this cell population. Furthermore, the resorption rate and the proportion of CD80 + cells among CBA/J×DBA/2 breedings with and without immunotherapy were also determined and compared with normal fertile controls. Results The characteristics of abortion in CBA/J×DBA/2 mice were recurrent abortion on about day 10 of gestation. The resorption rate in CBA/J×DBA/2 mice was significantly higher than that in BALB/c×DBA/2 mice (30.8%±16.6% vs. 7.7%±6.7%, P<0.01). Accordingly, the proportion of CD80 + cells evaluated at the fetomaternal interface in CBA/J×DBA/2 mice was also significantly higher (11.7% ±5.8% vs. 3.9%±1.8%, P<0.01). Resorption rate of CBA/J×DBA/2 mice underwent of LIT was significantly lower than that without LIT, and this decreased rate was correlated with decreased proportion of CD80 + cells. Conclusion In CBA/J×DBA/2 mice model, the characteristics of abortion seem to be peri implantation embryo resorption. A correlation between early embryonic waste and higher CD80 proportion at the fetomaternal interface suggests that CD80 + cells may be an important determinant in recurrent peri implantation abortion.

Expression of the Inducible Nitric Oxide Synthase Isoform in Chorionic Villi in the Early Spontaneous Abortion

To investigate the relationship between inducible nitric oxide synthase (iNOS) and the early spontaneous abortion. , in situ hybridization and immunohistochemistry were used to detect the expression of iNOS in trophoblasts in the early pregnancy with and without spontaneous abortion (group Ⅰ and group Ⅱ). By light microscopy and computer color magic image analysis system (CMIAS), light density (D) and the positive cell number per statistic square (N/S) in situ hybridiza- tion were used to analyze the positive cell index, while total positive cells (N) and the positive unit (Pu) were used in immunohistochemistry. By in situ hybridization, D and N/S in trophoblasts were 0.35±0. 028, 0. 07±0. 011 respectively in group Ⅰ and 0. 18±0.016,0. 015±0. 003 in group Ⅱ . In terms of immunohistochemical staining, N and Pu were 0. 058±0.007, 11. 94±2. 01 in group Ⅰand 0.013±0.009, 1.08±0. 35 in group Ⅱ in trophoblasts. Significant differences existed between two groups. It is concluded that the higher nitric oxide produced by the higher expression of iNOS in tro- phoblasts might play an important role in the early spontaneous abortion.

Role of Oral Misoprostol in First Trimester Abortion: A Prospective Study at CMH, Dhaka, Bangladesh

Background: Misoprostol has been used for medical abortion. We conducted this prospective study to see the efficacy of oral misoprostol in our tertiary Hospital. Objective: Objective of this study was to assess the efficiency, safety and compliance of misoprostol in first trimester abortion. Materials and Methods: This prospective study was undertaken in obstetrics and gynecology dept of CMH Dhaka, Bangladesh from July 2014 up to Dec 2014. A total 50 patients of incomplete abortion (54%), missed abortion (30%), anembryonic pregnancy (14%) and inevitable abortion (2%) of s of gestation were the targeted population. Study population was diagnosed from history, physical examination and ultrasonogram had received 600 microgram misoprostol orally. If the pregnancy was not completely evacuated at this time another dose of misoprostol was given. All women returned for follow-up care 7 days later. If the pregnancy was not completely evacuated at this time, women underwent immediate surgical evacuation. Efficacy was defined as the percent of women discharged from the study without need for surgical intervention. Results: 30 patients had complete evacuation after 1st dose, 12 cases needed 2nd dose and only 2 cases needed 3rd dose. Remaining 6 cases needed surgical evacuation. Efficacy was satisfactory (85%) and analysis revealed statistically significant (p 0.05). Conclusion: Management of first trimester abortion with oral misoprostol is highly effective and highly acceptable.

Methods of Abortion in First and Second Trimester

Background: Medical and surgical methods are available for abortions in both the first and second trimester. Aim: To review the evidence base and current recommendations for available methods of abortions in first and second trimesters. Methods: Extensive literature search and review of available guidelines?were?done. Results: In the first trimester, medical methods are recommended below 7 weeks gestation while vacuum aspiration is an appropriate method between 7 to 12 weeks gestation. In the second trimester, the three methods of abortion available are dilatation and evacuation, intrauterine instillation of abortifacients and administration of systemic abortifacients. Conclusion: The choice of techniques depends on many factors including uterine volume, operator experience, patient preference, medical history and indication for abortion.

Research advances of Chinese and Western medicine in the treatment of unexplained recurrent spontaneous abortion

Recurrent spontaneous abortion is a common disease in gynecology,and it seriously affects women's reproductive health and brings heavy burden and pain to society and families.The cause of recurrent spontaneous abortion is complicated,in addition to the well-defined genetic,anatomical,infection and endocrine factors,and there are still some unknown causes,which is called as unexplained recurrent spontaneous abortion,accounting for 40%of recurrent abortion.At present,there are a lot of researches on the treatment methods of the patients with the unexplained recurrent spontaneous abortion,which also shows that the treatment of traditional Chinese and Western medicine all have certain clinical application effect.Western medicine clinical methods mainly includes immunotherapy,immunosuppressive therapy,anticoagulation therapy,progesterone therapy,etc.Based on the experience of the professor and combined with many years of clinical practice,the author believes that the pathogenesis of this disease in traditional Chinese medicine is mainly due to impaired impulse and deficiency of Spleen,lack of qi and blood,can not nourishing the fetus;deficiency of Kidney Qi,blood flow was delayed,and blood stasis and could not raise the fetus.Clinical treatment is based on invigorating the kidney,tonifying spleen and nourishing blood,promoting blood circulation to remove blood stasis and dredging collaterals.Oral Chinese medicine combined with external acupuncture and moxibustion has achieved excellent effects in improving pregnancy rate.This article reviews the domestic and foreign methods of treating unexplained recurrent miscarriage in order to provide clinical reference.In the future,the combination of Chinese and Western medicine should become the main therapy to increase pregnancy rate.

The Expressions of P53, MDM2 in Trophoblasts of Spontaneous Abortion Mouse Model and the Relevant Researches

Objective: To explore the mRNA expression of the related genes of p53, MDM2, vascular endothelial growth factor (VEGF) and hypoxia inducible transcription factors-1 a (HIF-la) in villous samples of spontaneous abortion mouse models and normal pregnancy models, and to discuss the effect of p53, MDM2 on the growth of villous trophoblast cells. Methods: The abortion-prone CBAXDBA/2 matings were established as the model of spontaneous abortion and the non-abortion-prone CBAXBALB/c matings as the model of normal pregnancy. Applied q Real-time PCR method to detect the mRNA expression levels of p53, MDM2, VEGF and HIF-la in villous samples of spontaneous abortion mouse models and normal pregnancy models. Results: The relationship of the mRNA expression level of p53, MDM2, VEGF and HIF-la in vinous samples of spontaneous abortion mouse models: in the villous samples of spontaneous abortion mouse models, the expression of p53 was positively correlated with the expression of MDM2, HIF-la (r = 0.35;r = 0.63), and the relationship was significant (P = 0.01;P < 0.001);but negatively correlated to the expression of VEGF (r = ?0.30), and the relationship was significant (P = 0.03). The expression of MDM2 was positively correlated with the expression of HIF-la (r = 0.28), and the relationship was significant (P = 0.04);and negatively correlated with the expression of VEGF (r = ?0.08), but the relationship was not significant (P = 0.57). The expression of HIF-la was negatively correlated with the expression of VEGF (r = ?0.37), and the relationship was significant (P = 0.007). The relationship of the mRNA expression level of p53,MDM2, VEGF and HIF-1 a in vinous samples of normal pregnancy models: in the vinous samples of normal pregnancy models, the expression of p53 was positively correlated with the expression of MDM2, VEGF and HIF-la (r = 0. 31;r = 0. 48;r = 0. 67), and the relationship was significant (P = 0.03;P = 0.003;P < 0.001). The expression of MDM2 was positively correlated with the expression of VEGF (r = 0. 23), but the relationship was not significant (P = 0.11);and negatively correlated with the expression of HIF-la (r = ?0.03), but the relationship was not significant (P = 0.84). The expression of HIF-la was positively correlated with the expression of VEGF (r = 0. 35), and the relationship was significant (P = 0.01). Conclusion: angiogenesis reduces in villous samples of spontaneous abortion mouse model, P53 and MDM2 involve in angiogenesis in villous samples, unlikely p53, and MDM2 have effects on normal early pregnancy villous angiogenesis and when the cell DNA damages or hypoxia exacerbates, it can induce high expression of p53, MDM2, inhibit angiogenesis in villous samples in early pregnancy. P53, MDM2 generegulate villous trophoblast cell growth by adjusting expression of HIF-1a and VEGF gene, finally influences pregnancy.

Advances of Genetic Testing Technology in Etiology Diagnosis of Recurrent Spontaneous Abortion

Recurrent spontaneous abortion (RSA) is a complex and heterogeneous disorder with multiple etiologies. Genetic factors are thought to play an important role in the etiology of RSA. With recent advances in genetic testing technologies, there has been an increasing interest in using these tools to diagnose the etiology of RSA. This review discusses the different types of genetic testing methods, such as karyotyping, chromosomal microarray analysis, next-generation sequencing, and their applications in the diagnosis of the etiology RSA. The use of genetic testing in the diagnosis of RSA has the potential to improve the accuracy of diagnosis and the understanding of the underlying mechanisms of the disorder, which could lead to better management and treatment of affected individuals.

Meta-Analysis of Bushen Huoxue Method in the Treatment of Recurrent Spontaneous Abortion Due to Prethrombotic State

Objective:To evaluate the effectiveness and safety of Bushen Huoxue prescription in the treatment of recurrent spontaneous abortion(RSA)due to prethrombotic state(PTS).Methods:Databases such as CNKI,WanFang,VIP,CBM,PubMed,Embase,and Cochrane Library were searched for randomized controlled trials on Bushen Huoxue prescription in treating RSA due to PTS from inception to March 2021;meta-analysis was performed by RevMan Version 5.3.0 following quality evaluation.Results:Seven trials were included,with 496 patients;the meta-analysis indicated that Bushen Huoxue prescription has advantages on the improvement of total clinical effective rate[RR=1.22,95%CI(1.10,1.35),Z=3.80(P=0.0001)],embryo survival rate at pregnancy of 12 weeks[RR=1.25,95%CI(1.10,1.41),Z=3.53(P=0.0004)],D-dimer levels[SMD=-1.59,95%CI(-2.20,-0.97),Z=5.07(P<0.00001)],and fibrinogen levels[MD=-1.00,95%CI(-1.29,-0.70),Z=6.61(P<0.00001)],but the statistical heterogeneity was significant;in terms of incidence of adverse reactions,there was no statistical difference between Bushen Huoxue prescription and western medicine.Conclusion:Compared with western medicine alone,Bushen Huoxue prescription alone or in combination with western medicine showed significant advantages in improving the overall clinical efficiency,embryonic survival rate at 12 weeks of pregnancy,and reducing D-dimer values as well as fibrinogen levels,without any significant difference in the incidence of adverse effects;however,the number of included studies is small and there are drawbacks,such as small sample size and low quality;therefore,high-quality clinical studies with large sample size and rigorous trial designs are needed in the future to provide a reliable basis for the effectiveness and safety of TCM in reducing the incidence of RSA due to prethrombotic state.

Improving Sexual and Contraceptive Behaviours of Unmarried Female Youth with First Trimester Induced Abortion in Sichuan,China

Objectives To understand the changes on sexual and contraceptive behaviours of unmarried induced abortion（IA） youth by intervention in Sichuan, China; and to find a way to improve sexual and contraceptive behaviours of unmarried IA youth. Methods Intervention epidemiological surveys （baseline and evaluation） plus qualitative interview were used. During July 2002 and July 2003, 2 484 unmarried female volunteers who aged 15-29 years and come to clinics seeking abortion were recruited by cluster random sampling from the four selected regions of Sichuan, 48 volunteers were interviewed for 8 focusgroup discussions （FGDs） and 16 in-depth interviews equally for each survey. Information, education anol communication（IEC） materials, education sessions, trainings and counseling were given to subjects and service providers during the project implementation. Questionnaires for surveys and guidelines for qualitative interviews were used. Results Comparison of the after with the before intervention. 1） the proportion of respondents having knowledge about sexuality was increased by 13%. Among them, the proportion of respondents got part and most of the knowledge was increased by 43%. Maximum number of sex partners the respondents have decreased from 9 to 4. Respondents＇partnerships have gradually changed from more acquaintances/school mates/boyfriends to fianés mainly; 2） respondents＇ contraceptive use rate was increased by 20%. Among them, the condom use rate increased rapidly to 80%. Purposes of condom use were changed from only for contraception to for prevention of HIV/AIDS/STDs and pregnancy. And most of respondents stabilised their method use - condoms. Most of respondents suggested condoms was the method most suitable for unmarried IA youth, this proportion was increased by 44%; 3） proportion of respondents knowing more about consequences of induced abortion was increased by 24%; and 4） proportions of respondents having depression and anxiety symptoms were decreased by 66% and by 61%, respectively. Conclusion The intervention including IEC materials, education, training and counseling was effective in improving sexual and contraceptive behaviours of unmarried IA youth.

Research of Active Immunotherapy on Unexplained Recurrent Spontaneous Abortion(URSA)

Objective To investigate the effect of active immunotherapy on unexplained recurrent spontaneous abortion （URSA ） during the process of gestation and delivery period. Methods We collected the data of the women with URSA and their offsprings. The women were treated by immunization with paternal lymphocytes and then had a successful pregnancy. The fore mentioned group of women were compared with those who had a normal pregnancy and then delivered in the same period. Results The incidences of premature rupture of membranes, adherent placenta, and residual cauls in the group of URSA patients were statistically higher than those in the normal group. Correspondingly, gestational age at delivery and birth weight of the newborns of the group of URSA patients were lower, but there were no significant differences between the two groups. Conclusion These results indicate that paternal lymphocyte immunotherapy is effective on the maintenance of pregnancy in women with URSA, and has no deleterious effects on the fetus or newborns. However, in case of the higher incidence of premature rupture of membranes, adherent placenta, and residual cauls, more attention should be paid to the treated patients to avoid intrauterine growth retardation and postpartum hemorrhage.

A Simple Procedure for Termination of Pregnancy in the Late First Trimester with Mifeprostone and Misoprostol

Purpose: To assess the efficacy of medical methods for termination of pregnancy at 9 - 12 weeks of gestation. Methods: Between December 2008 and December 2010, the 116 consecutive women received 200 mg oral mifepristone and after 24 - 36 hours they applied 800 μg vaginal misoprostol to medically terminate pregnancy. If the products of conception did not pass, three further doses of 400 μg misoprostol were given vaginally at three hours intervals to medically terminate pregnancy. Results: Of the 116 patients undergoing the procedure 104 (90%) aborted completely. Half of the patients aborted within 6 hours. After medical termination, five per cent of the women were treated because of infection, and five per cent needed a revisit to hospital because of excessive bleeding. Two women received a blood transfusion. Previous live births or previous inducted abortion is presented in the study results. Conclusions: Medical abortion at 9 - 12 weeks’ gestation is a safe alternative to surgery.

Investigation of FOXP3 (rs3761548) polymorphism with the risk of preeclampsia and recurrent spontaneous abortion: A systemic review and meta-analysis

Objective:To investigate the association between forkhead box P3(FOXP3)(rs3761548)polymorphism and the risk of preeclampsia and recurrent spontaneous abortion.Methods:Literature on the association of FOXP3 gene polymorphisms and susceptibility to preeclampsia and unexplained recurrent spontaneous abortion was retrieved by searching databases such as PubMed,Science Direct,Google Scholar and Embase from 2000 to 2021.The association measure was analyzed using an odds ratio(OR)and 95%confidence interval(CI).All the statistical analyses were executed using RevMan 5.4 software.Results:In the present meta-analysis,11 articles were analyzed.The pooled results showed no association between FOXP3 gene polymorphism(rs3761548)and preeclampsia risk in allelic,recessive,dominant and over dominant contrast models.FOXP3 gene polymorphism(rs3761548)showed an association with recurrent abortion in allelic,recessive and dominant models(OR 1.85,CI 1.59-2.14;OR 2.02,95%CI 1.56-2.62;OR 2.69,95%CI 1.50-4.83,respectively),while no association in the over dominant contrast model(OR 1.35,CI 0.87-2.10).Conclusions:In the present study,FOXP3 gene(rs3761548)polymorphism is associated with risk of recurrent spontaneous abortion but not preeclampsia.However,larger sample size and multiracial studies are needed in the future to confirm the findings.

Extraintestinal infection of Listeria monocytogenes and susceptibility to spontaneous abortion during pregnancy:A systematic review and meta-analysis

BACKGROUND Listeria monocytogenes(L.monocytogenes)is one of the most important zoonotic bacteria that is transmitted to humans through infected animal products and is the cause of human listeriosis.Pregnant women and immunocompromised patients are more susceptible to the bacterium than healthy people.Recent studies have reported extensive evidence on the role of L.monocytogenes infection and the risk of spontaneous abortion.AIM To evaluate the possible connection with L.monocytogenes in the risk of spontaneous abortion in pregnancy.METHODS We conducted a systematic literature review using several databases to search the relevant case-control studies on the association between L.monocytogenes infection and spontaneous abortion.Finally,the impact of infection with L.monocytogenes and risk of spontaneous abortion was assessed via odds ratio at corresponding 95%confidence intervals.RESULTS In the present study,we evaluated the data of 4059 pregnant women who had a spontaneous abortion,and interestingly their colonization rate of L.monocytogenes was about 20.5%.CONCLUSION Therefore,based on statistical analysis,we found that there is a significant relationship between the infection with L.monocytogenes and spontaneous abortion.

Recurrent Spontaneous Abortion of Immune Origin and HLA Sensitization Immunotherapy

Introduction: Spontaneous abortion is defined as pregnancy loss before the twentieth week and Recurrent Spontaneous Abortion (RSA) is defined as at least three spontaneous and successive pregnancy losses in the same period. Among the different types of immunological causes, this study refers specifically to the alloimmune cause. Women with RSA of alloimmune cause share a greater number of Human Leukocyte Antigen (HLA) with their husbands, leading to the inhibition of the production of anti-paternal asymmetric blocking antibodies, which would protect embryonic cells. Objectives: To evaluate the effect of immunotherapy with paternal HLA-sensitizing mononuclear cells in cases of RSA through the positivity of the cross-match test and its efficacy in pregnancy success. Patients and Methods: Written consent was obtained, 12 couples with a history of RSA presenting negative cross-match were included in the study. Blood samples were collected from the couple for cross-matching and the separation of paternal mononuclear cells. Immunotherapy was performed with paternal mononuclear cells intradermally in the wives’ arms on day (D) 0, D15 and D30. After the third dose, a second evaluation of the cross- match tests was performed. Results and Discussion: The age of the wives ranged from 28 to 41 years, with a mean of 34.5 years. The twelve couples had a negative cross-match test (100%). Eleven couples (96.6%) tested positive in the cross- match test after immunotherapy. Of these, 10 (90.9%) had successful pregnancies. Immunotherapy with paternal mononuclear cells showed an excellent ability to sensitize the maternal immune system, with positive cross-match, resulting in a successful pregnancy.

Up-regulated Expression of Tim-3/Gal-9 at Maternal-fetal Interface in Pregnant Woman with Recurrent Spontaneous Abortion

The relationship between T cell immunoglobulin domain and mucin domain protein 3（Tim-3）/Galectin（Gal）-9 pathway and recurrent spontaneous abortion（RSA） was studied. Thirty-one pregnant women with RSA and 27 normal early gravidas were investigated to detect the levels of Tim-3 and Gal-9 in villi and deciduas by Western blotting. Meanwhile, the concentration of interleukin（IL）-4 and IL-12 in peripheral blood plasma was determined by ELISA in 25 healthy fertile non-pregnant controls, the normal early gravidas and pregnant women with RSA mentioned above, respectively. It was found that the relative expression levels of Tim-3 and Gal-9 in villi and deciduas were significantly increased in pregnant women with RSA as compared with those in the normal early gravidas. The concentration of IL-4 in peripheral blood plasma of pregnant women with RSA was lower than that of the normal early gravidas（P〈0.05） and healthy fertile non-pregnant controls（P〈0.05）, but that of IL-2 in pregnant women with RSA was significantly higher than that of the normal early gravidas（P〈0.05） and healthy fertile non-pregnant controls（P〈0.05）. It was suggested that the overexpression of Tim-3/Gal-9 pathway may be related to the pathogenesis of RSA.