Advertisement
Mini-symposium: Recurrent abortion| Volume 9, ISSUE 1, P2-6, March 1999

Current concepts in the pathogenesis of recurrent miscarriage

  • M. Tulppala
    Correspondence
    Correspondence to: Maija Tulppala MD, Infertility Clinic, The Family Federation of Finland, Kalevankatu 16,00100 Helsinki, Finland.
    Affiliations
    Department of Obstetrics and Gynaecology, University Central Hospital of Helsinki, Finland
    Search for articles by this author
  • O. Ylikorkala
    Affiliations
    Department of Obstetrics and Gynaecology, University Central Hospital of Helsinki, Finland
    Search for articles by this author
DOI:https://doi.org/10.1016/S0957-5847(99)90065-3
Current concepts in the pathogenesis of recurrent miscarriage
Previous ArticleRecurrent abortion
Next ArticleAntiphospholipid antibodies and the investigation of recurrent miscarriage
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Between 10 and 15% of clinically-recognized pregnancies abort spontaneously, usually during the first trimester. Thus, miscarriage is the most common complication of pregnancy. Recurrent spontaneous abortion (RSA), defined as the loss of three or more consecutive pregnancies, affects approximately 2% of women of childbearing age. In most cases, RSA is associated with random occurrence of chromosomally abnormal conceptions. Parental structural chromosomal rearrangements, congenital and acquired anatomic faults, endocrine disorders and silent infection of the genital tract each make a contribution to the etiology of RSA. In approximately one-half of the patients a putative cause can be identified, but whether it really is a cause of RSA often remains elusive. Although little is known about the exact mechanisms involved in the maternal-fetal immunological interaction, recent evidence indicates that in the pathogenesis of RSA, decidual natural killer cells play a vital role. One of the most promising areas for future research is, therefore, to elucidate the complex immunological mechanisms underlying pregnancy failure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Obstetrics, Gynaecology and Reproductive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Stirrat G.M.
        Recurrent miscarriage I: definition and epidemiology.
        Lancet. 1990; 336: 673-675
        • Hatasaka H.H.
        Recurrent miscarriage: epidemiologic factors, definitions, and incidence.
        Clin Obstet Gynecol. 1994; 37: 625-634
        • Medawar P.B.
        Some immunological and endocrinological problems raised by evolution of viviparity in vertebrates.
        in: In society for experimental biology, evolution symposia No 11. Academic Press, New York1953: 320-338
        • Scott J.R.
        • Branch D.W.
        Potential alloimmune factors and immunotherapy in recurrent miscarriage.
        Clin Obstet Gynecol. 1994; 37: 761-767
        • Lea R.G.
        • Calder A.A.
        The immunology of pregnancy.
        Current Opinion in infectious diseases. 1997; 10: 171-176
        • Loke Y.W.
        • King A.
        Immunology of human implantation; an evolutionary perspective.
        Hum Reprod. 1996; 11: 283-286
        • van der Ven K.
        • Ober C.
        HLA-G polymorphisms in African-Americans.
        J Immunol. 1994; 153: 5628-5633
        • Starkey P.M.
        The decidua and factors controlling placentation.
        in: Redman C.W.G. Sargent I.L. Starkey P.M. The human placenta. Blackwell Scientific Publications, Oxford1993: 362-413
        • Lachapelle M.
        • Miron P.
        • Hemmings R.
        • Endometrial T.
        • et al.
        B and NK cells in patients with recurrent spontaneous abortion.
        J Immunol. 1996; 156: 4027-4034
        • Hill J.A.
        • Polgar K.
        • Anderson D.J.
        T-helper 1-type immunity to trophoblast in women with recurrent spontaneous abortion.
        JAMA. 1995; 273: 1933-1936
        • Stirrat G.M.
        Recurrent miscarriage II: clinical associations, causes, and management.
        Lancet. 1990; 336: 728-733
        • Stern J.J.
        • Dorfmann A.D.
        • Gutierrez-Najar A.J.
        • et al.
        Frequency of abnormal karyotypes among abortuses from women with and without a history of recurrent spontaneous abortion.
        Fertil Steril. 1996; 65: 250-253
        • Rai R.
        • Clifford K.
        • Regan L.
        The modern preventive treatment of recurrent miscarriage.
        Br J Obstet Gynaecol. 1996; 103: 106-110
        • Patton P.E.
        Anatomic uterine defects.
        Clin Obstet Gynecol. 1994; 37: 705-721
        • Acien P.
        Incidence of Müllerian defects in fertile and infertile women.
        Hum Reprod. 1997; 12: 1372-1376
        • Byrne J.L.B.
        • Ward K.
        Genetic factors in recurrent abortion.
        Clin Obstet Gycecol. 1994; 37: 693-704
        • Nielsen S.
        • Hahlin M.
        Expectant management of first-trimester spontaneous abortion.
        Lancet. 1995; 345: 84-86
        • Coulam C.B.
        • Stern J.J.
        Endocrine factors associated with recurrent spontaneous abortion.
        Clin Obstet Gynecol. 1994; 37: 730-744
        • Kelly R.W.
        Pregnancy maintenance and parturition: the role of prostaglandins in manipulating the immune and inflammatory response.
        Endocrin Rev. 1994; 15: 684-706
        • Tulppala M.
        • Björses U.-M.
        • Stenman U.-H.
        • et al.
        Luteal phase defect in habitual abortion: progesterone in saliva.
        Fertil Steril. 1991; 56: 41-44
        • Baird D.D.
        • Weinberg C.R.
        • Wilcox A.J.
        • et al.
        Hormonal profiles of natural conception cycles ending in early, unrecognized pregnancy loss.
        J Clin Endocrinol Metab. 1991; 72: 793-800
        • Tulppala M.
        • Julkunen M.
        • Tiitinen A.
        • et al.
        Habitual abortion is accompanied by low serum levels of placental protein 14 in the luteal phase of the fertile cycle.
        Fertil Steril. 1995; 63: 792-795
        • Dalton C.F.
        • Laird S.M.
        • Serle E.
        • et al.
        The measurement of CA125 and placental protein 14 in uterine flushings in women with recurrent miscarriage; correlation to endometrial morphology.
        Hum Reprod. 1995; 10: 2680-2684
        • Tulppala M.
        • Huhtaniemi I.
        • Ylikorkala O.
        Genetic variant of luteinising hormone occurring frequently in women with a history of recurrent miscarriage and with relative overweight: no relation to luteal function and miscarriage rate.
        Hum Reprod 7. 1998; 13: 2699-2702
        • Regan L.
        • Owen E.J.
        • Jacobs H.S.
        Hypersecretion of luteinising hormone, infertility, and miscarriage.
        Lancet. 1990; 336: 1141-1144
        • Tulppala M.
        • Marttune M.
        • Söderström-Anttila V.
        • et al.
        Low-dose aspirin in prevention of miscarriage in women with autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production.
        Hum Reprod. 1997; 12: 1567-1572
        • Tulppala M.
        • Ailus K.
        • Palosuo T.
        • et al.
        Antibodies to low-density lipoprotein and to cardiolipin in nonpregnant and pregnant women with habitual abortion.
        Fertil Steril. 1995; 64: 947-950
        • Hay P.E.
        • Lamont R.F.
        • Taylor-Robinson D.
        • et al.
        Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage.
        Br Med J. 1994; 308: 295-298

      Article info

      Identification

      DOI: https://doi.org/10.1016/S0957-5847(99)90065-3

      Copyright

      © 1999 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX