Early Pregnancy Loss: Mechanisms and Treatment PDF
Preview Early Pregnancy Loss: Mechanisms and Treatment
Early Pregnancy Loss Mechanisms and Treatment Edited by R. W. Beard and F. Sharp Springer-Verlag London Berlin Heidelberg New York Paris Tokyo Professor Frank Sharp, MD, FRCOG Department of Obstetrics and Gynaecology, Northern General Hospital, Herries Road, Sheffield S5 7 AU Professor Richard W. Beard, MB, BChir(Cantab), MD, FRCOG Department of Obstetrics and Gynaecology, St Mary's Hospital, Praed Street, London W2 IPG ISBN-13: 978-1-4471-1660-8 e-ISBN-13 :978-1-4471-1658-5 DOl: 10.1007/978-1-4471-1658-5 British Library Cataloguing in Publication Data Royal College of Obstetricians and Gynaecologists, Study Group. (18th: 1987). Early pregnancy loss. I. Women. Miscarriages I. Title II. Beard, Richard W. (Richard William) III. Sharp, F. (Frank), /938- . 618.3'92 ISBN-13 :978-1-4471-1660-8 Library of Congress Cataloging-in-Publication Data Royal College of Obstetricians and Gynaecologists (Great Britain). Study Group (18: 1987) Early pregnancy loss. Includes bibliographies. I. Miscarriage-Congresses. I. Beard, Richard W. II. Sharp, F. (Frank) III. Title. [DLNM: I. Abortion~ongresses. 2. Fetal Death~ongresses. WQ 225 R8884 1987e] RG648.R67 1987 618.3'92 88-16070 ISBN-13 :978-1-4471-1660-8 The work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broad casting, reproduction by photocopying, machine or similar means, and storage in data banks. © The Royal College of Obstetricians and Gynaecologists 1988 Softcover reprint of the hardcover 1st edition 1988 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2128/3916-543210 Preface The first few months of any pregnancy are of supreme importance to the success of that pregnancy. This statement is so obvious as to be almost a platitude, yet it must be said that no aspect of pregnancy has been more neglected in the human than the first three months. Little is known of the morphological changes that occur at that time and our knowledge of the mechanisms that control this vital stage of pregnancy is almost non-existent. The explanation for this neglect of what is an obvious area for study is the difficulty of obtaining normal material. It is rare to have material to study from a healthy first trimester pregnancy and the study by Hertig and Rock!l) of early conception found by chance in hysterectomy speci mens must be unique. The information that we do have about early pregnancy is mostly gained from animal studies or single miscarriages in humans. Chromosomal defects are common but are not an explanation for the majority of recurrent miscarriages. Obstetricians have hypothesised many causes for this condition and have deve loped numerous metQods for treating it, but the studies have been poorly con trolled so that our understanding of the cause(s) has not advanced. Treatment of women with a history of recurrent miscarriage by paternal leuco cyte infusion (immunotherapy) may be yet another form of treatment that is hailed as a new advance only to be rejected when subject to rigorous testing. However, the encouraging results from many centres have had the effect of stimu lating new and intense interest in early pregnancy. The Study Group, the deliber ations of which are reported in this book, is the product of that interest. Scientists and clinicians have come together to examine the evidence to decide whether knowledge has been advanced. Whether this is so or not must be left to the reader to decide, but the editors, and all those who participated, present the data in the hope that a small flame will be lit to illuminate the gloom that has surrounded the subject of early pregnancy for so long. We are grateful to the co-editors for their valuable assistance in editing the papers and discussions for their particular section, together with Diane Morgan, the Publications Officer and Beryl Stevens and staff of the Postgraduate Educa tion Department of the RCOG for their assistance in organising the Study Group and its publication. REFERENCE 1. Hertig AT, Rock J. A series of potentially abortive ova recovered from fertile women prior to the first missed menstrual period. Amer J Obstet Gynec 1949; 58: 968-993. London Professor Richard W. Beard May, 1988 Professor Frank Sharp Participants Professor A.E. Beer Department of Obstetrics/Gynecology and Microbiology and Immunology Professor E. Alberman University of Health Sciences Department of Clinical Epidemiology The Chicago Medical School The London Hospital Medical College 3333 Green Bay Road London El IBB North Chicago, IL 60064, U.S.A. Dr. S.c. Bell Dr. S. Alexander Department of Obstetrics and Universite Libre de Bruxelles Gynaecology Laboratoire d'Epidemiologie et de University of Leicester Medicine Sociale Clinical Sciences Building Campus Erasme CP 590/5 Leicester Royal Infirmary 808, route de Lennik P.O. Box 65 1070 Brussels, Belgium Leicester LE2 7LX Dr. W.O. Billington Dr. W.R. Allen Department of Pathology The Thoroughbred Breeders' University of Bristol Association The Medical School Equine Fertility Unit University Walk Animal Research Station Bristol BS8 ITO 307 Huntingdon Road Cambridge CB3 OJO Dr. J.M. Bulmer Department of Pathology Dr. D.F. Antczak University of Leeds James A. Baker Institute for Leeds LS2 9JT Animal Health New York State College of Dr. H.J.A. Carp Veterinary Medicine Department of Obstetrics and Cornell University Gynaecology Ithaca, NY 14853, U.S.A. Sheba Medical Centre Tel Hashomer, Israel Professor R.W. Beard Department of Obstetric and Dr. G. Chaouat Gynaecology Clinique Universitaire Baudelocque St. Mary's Hospital Medical School INSERM U262 Praed Street 123 Bd. de Port Royal London W2 1P G 75674 Paris Cedex 14, France Mr. M.G. Chapman Professor J. G. Grudzinskas Department of Obstetrics and Department of Obstetrics and Gynaecology Gynaecology Guy's Hospital Holland Wing St. Thomas Street The London Hospital Medical College London SEl 9RT London El 1BB Professor D.A. Clark Dr. E.N. Harris Department of Medicine Division of Rheumatology McMaster University Department of Medicine 1200 Main Street West University of Louisville Hamilton, Ontario L8N 3Z5 Louisville, Kentucky Canada U.S.A. Dr. M.R. Creasy Professor R. Harris Regional Cytogenetics Laboratory Department of Medical Genetics East Birmingham Hospital St. Mary's Hospital Bordesley Green East Hathersage Road Birmingham B9 5ST Manchester M13 OJH Dr. A. Croy Professor R.F. Harrison Department of Biomedical Sciences Department of Obstetrics and University of Guelph Gynaecology Ontario Veterinary College Maternity Unit Guelph, Ontario N1G 2Wl St James' Hospital Canada Dublin 8, Ireland Dr. S. Daya Department of Obstetrics and Dr. R.B. Heap Gynaecology AFRC Institute of Animal Physiology McMaster University and Genetics Research 1200 Main Street West Cambridge Research Station Hamilton, Ontario L8N 3Z5 Babraham Hall Canada Cambridge CB2 4AT Mr. D.K. Edmonds Mr. G. Hill Department of Obstetrics and Department of Obstetrics and Gynaecology Gynaecology Queen Charlotte's Maternity Hospital Pembury Hospital Goldhawk Road Pembury London W6 OXG Tunbridge Wells TN2 4QJ Professor T.J. Gill Department of Pathology Professor P. Howie School of Medicine Department of Obstetrics and University of Pittsburgh Gynaecology 716a Scaife Hall University of Dundee Pittsburgh, PA 15261 Ninewells Hospital U.S.A. Dundee DDl 9SY Professor D.M. Jenkins Professor J.F. Mowbray Department of Obstetrics and Department of Experimental Pathology Gynaecology St. Mary's Hospital Medical School Erinville Hospital Praed Street Western Road London W2 1P G Cork, Ireland Dr. W. Page Faulk Professor P.M. Johnson Department of Experimental Pathology University Department of Immunology Methodist Center for Reproduction Royal Liverpool Hospital and Transplantation Immunology P.O. Box 147 1701 North Senate Blvd. Liverpool L69 3BX Indianapolis, IN 46202 U.S.A. Professor T.G. Kennedy Department of Obstetrics and Mr. G.D. Pinker Gynaecology (President RCOG) University of Western Ontario Department of Obstetrics and 339 Windermere Road Gynaecology London, Ontario N6A 5A5 St. Mary's Hospital Medical School Canada Praed Street Professor J. Klein London W2 I PG Max Planck-Institut fUr Biologie Abteilung Immungenetik Dr. C.W.G. Redman Corrensstrasse 42 Nuffield Department of Obstetrics D-7400 Tiibingen I and Gynaecology F.R.G. John Radcliffe Hospital Headington Dr. Y.W. Loke Oxford OX3 9DU Cambridge University Department of Pathology Miss L. Regan Cellular Pathology Division Department of Obstetrics and Tennis Court Road Gynaecology Cambridge CB2 IQP The Rosie Maternity Hospital Robinson Way Mr. M. Michel Cambridge CB2 2SW Department of Obstetrics and Gynaecology Dr. C. Renard St. Mary's Hospital Medical School Institut Nationale de Recherche Praed Street Agronomique London W2 I PG Laboratoire de Radiobiologic, Appliquee Dr. W.J. Modle 78350 Jouy-en-Josas Senior Medical Officer Versailles, France Department of Health and Social Security Dr. M.F. Reznikoff-Etievant Room D1017, Alexander Fleming CNTS Foundation House Etablissement Cabanel Elephant and Castle 6, rue Alexandre Cabanel London SEI 6BY 75739 Paris, Cedex 15, France Dr. L. Rhodes Dr. S. Stray-Pederson Department of Clinical Sciences Department of Obstetrics and Cornell University Gynaecology New York State College of National Hospital Veterinary Medicine University of Oslo Ithaca, NY 14853 Oslo, 0514, Norway U.S.A. Professor G. Stirrat Professor W.B. Robertson Department of Obstetrics and The Royal College of Pathologists Gynaecology 2 Carlton House Terrace Bristol Maternity Hospital London SW1Y 5AF Southwell Street Bristol BS2 8EG Dr. D.1. Rushton The Birmingham Maternity Hospital Professor A.E. Szulman Queen Elizabeth Medical Centre Department of Pathology Edgbaston Magee Womens' Hospital Birmingham B15 2TG Forbes Avenue and Halket Street Pittsburgh, PA 15213 Professor J.S. Scott U.S.A. Department of Obstetrics and Gynaecology Dr. C. Taylor University of Leeds Department of Haematology Clarendon Wing Pembury Hospital Belmont Grove Pembury Leeds LS2 9NS Tunbridge Wells TN2 4QJ Dr. A.E. Semprini Dr. M. Unander Obstetric and Gynaecology Clinic Department of Obstetrics and Ospedale San Paolo Gynaecology Via A. di Rudini 8 Sahlgren's Hospital 20142 Milan, Italy S-413 45 Gothenburg, Sweden Dr. B. Stray-Pederson Department of Obstetrics and Ms. J. Underwood Gynaecology Department of Experimental Pathology Aker Hospital St. Mary's Hospital Medical School University of Oslo Praed Street Oslo 0514, Norway London W2 1P G Additional Dr. F. Figueroa Max-Planck-Institut fUr Biologie Contributors Abteilung Immungenetik Correnstrasse 42 0-7400 Tiibingen Dr. P.R. Apps F.R.G. Pembury Hospital Pembury Tunbridge Wells TN2 4QJ Dr. Walter Gottlieb Obstetrics and Gynaecology Professor S. Campbell Hopital Erasme Department of Obstetrics and 808, route de Lennik Gynaecology 1070 Brussels, Belgium King's College Hospital Medical School Denmark Hill Dr. Hong-Nerng Ho London SE5 9RS Department of Obstetrics and Gynaecology National Taiwan University Hospital Mr. M.A. Crepeau 1 Chang-Te Street Department of Biomedical Sciences Taipei, Taiwan 10016 University of Guelph Republic of China Ontario Veterinary College Guelph, Ontario NIG 2Wl Dr. J. Huchet Canada Centre d'Hemobiologie Perinatale (CHP) Dr. M. Debruyere Hopital St. Antoine Universite Catholique de Louvain Paris, France Cliniques Saint Luc Avenue Hippocrate, 10 Dr. A. Kanbour 1200 Brussels, Belgium University of Pittsburgh School of Medicine Professeur E. Dupont Department of Pathology Departement d'Immunologie 716a Scaife Hall Hopital Erasme Pittsburgh, PA 15261 808, route de Lennik U.S.A. 1070 Brussels, Belgium Dr. M. Kasahara Department of Microbiology and Mrs. I. Durieux Immunology Unite CHP/INTS University of Miami School of Medicine 23 rue Crozatier Miami, FL 33101 75012 Paris, France U.S.A. Dr. H.W. Kunz Dr. M.F. Robards University of Pittsburgh Pembury Hospital School of Medicinc Pembury Departmcnt of Pathology Tunbridgc Wells TN2 4Ql 716a Scaife Hall Pittsburgh, PA 15261 Professor C. Salmon U.S.A. Institut National de Transfusion Sanguine (INTS) Dr. D. Latinne Paris. France Universite Catholique dc Louvain C1iniques Saint Luc Avenue Hippocratc, 10 Dr. I. Stabile 1200 Brussels, Belgium Academic Unit of Obstetrics and Gynaecology Dr. N.A. Maclachlan The London Hospital Medical Collcgc Pcmbury Hospital London E 1 18B Pcmbury Tunbridge Wells TN2 4Ql Dr. K. Thomas Dr. T.A. Macpherson Universite Catholique de Louvain University of Pittsburgh Departement d'Obstetrique School of Medicine Avenue Hippocrate, 10 Department of Pathology 1200 Brussels, Belgium 716a Scaife Hall Pittsburgh, PA 15261 Dr. V. Vincek U.S.A. Max-Planck-Institut fUr Biologie Abteilung Immungenetik Dr. 1.A. Mcintyre Corrensstrasse 42 Methodist Center for Reproduction D-74oo Tiibingen and Transplantation Immunology F.R.G. Methodist Hospital of Indiana Indianapolis, IN 46202 Dr. T.G. Wegmann U.S.A. Medical Research Council of Canada Dr. D.N. Misra Immunology Group Univcrsity of Pittsburgh University of Alberta Edmonton, Alberta School of Medicine Departmcnt of Pathology Canada 716a Scaife Hall Dr. 1.K. Wilson Pittsburgh, PA 15261 Pembury Hospital U.S.A. Pembury Profcssor A. Ncttcr Tunbridge Wells TN2 4Ql H6pital Saint Louis Paris, Francc Dr. S. Yamashiro Department of Biomedical Sciences Miss A. Ritson University of Guelph Department of Pathology Ontario Veterinary College University of Leeds Guelph, Ontario NIG 2W1 Leeds LS2 9JT Canada Contents Page SECTION 1 - THE CLINICAL PROBLEM Clinical associations of recurrent miscarriage 3 Professor R.W. Beard The epidemiology of repeated abortion 9 Professor E. Alberman Discussion 19 A prospective study of spontaneous abortion 23 Miss L. Regan Discussion 39 Clinical and immunological significance of anti-phospholipid antibodies 43 Dr. E.N. Harris Discussion 61 SECTION 2 - EXPERIMENTAL MODELS OF EARLY PREGNANCY FAILURE Anatomical and immunological aspects of fetal death in the Mus musculus/ Mus caroli model of pregnancy failure 69 Mr. M.A. Crepeau, Dr. S. Yamashiro, Dr. B.A. Croy Discussion 85 Genetic aspects of the CBA x DBA/2 and BlO x BlO.A models of murine pregnancy failure and its prevention by lymphocyte immunisation 89 Dr. G. Chaouat, Professor D.A. Clark, Dr. T.G. Wegmann Discussion 103 Effects of feto-maternal major histocompatibility differences on litter size in pigs 105 Dr. C. Renard Discussion 119 A non-genetic development defect in trophoblast formation in the horse: immunological aspects of a model of early abortion 123 Dr. D.F. Antczak, Dr. W.R. Allen Discussion 141
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