Diejomaoh Michael F, Bello Zainab, Al Jassar Waleed, Jirous Jiri, Karunakaran Kavitha, Mohammed Asiya T
Department of Obstetrics and Gynaecology, Faculty of Medicine, Kuwait University, Safat, Kuwait ; Maternity Hospital, Shuwaikh, Kuwait.
Maternity Hospital, Shuwaikh, Kuwait.
Int Med Case Rep J. 2015 Dec 11;8:337-44. doi: 10.2147/IMCRJ.S93159. eCollection 2015.
Recurrent spontaneous miscarriage (RSM) has a multifactorial etiology, mainly due to karyotype abnormalities including balanced translocation, anatomical uterine disorders, and immunological factors, although in 50%-60% the etiology is unexplained. The treatment of RSM remains challenging, and the role of intravenous immunoglobulin (IVIG) in RSM is controversial.
Mrs HM, 37 years old, obstetric summary: P0+1+13+1, a known case of hypothyroidism/polycystic ovary syndrome, married to an unrelated 47-year-old man, presented to our RSM clinic in early January 2014 for investigation and treatment. She has had multiple failed in vitro fertilization trials and 13 first-trimester missed miscarriages terminating at 6-7 weeks, all without IVIG therapy. Her tenth pregnancy was spontaneous, managed in London, UK, with multiple supportive therapy and courses of IVIG starting from the third to the 30th week of pregnancy. The pregnancy ended at 36 weeks of gestation with a cesarean section and a live girl baby was delivered. Mrs HM had balanced translocation, 46XX t (7:11) (p10:q10). Preimplantation genetic diagnosis/intracytoplasmic sperm injection/in vitro fertilization was performed with embryo transfer on May 29, 2014, and resulted in a successful pregnancy. She was commenced immediately on metformin, luteal support, and IVIG therapy, started at 6 weeks of gestation and at monthly intervals until 30 weeks of gestation, and also received additional therapy. The pregnancy was monitored with ultrasound, progressed uneventfully until admission at 35 weeks of gestation, with mildly elevated liver enzymes and suspected fetal growth restriction. She was managed conservatively, and in the light of nonreassuring fetal status, a live female infant weighing 2.29 kg was delivered by emergency cesarean section on January 14, 2015, with an Apgar score of 8 and 9 and mild respiratory distress, and was admitted to the Special Care Baby Unit for intensive therapy. The mother and baby made satisfactory progress and were discharged on January 24, 2015.
Two consecutive successful pregnancies in Mrs HM with multiple causes of RSM treated with other medications and IVIG strongly suggest that IVIG has a positive role in RSM.
复发性自然流产（RSM）病因多因素，主要是染色体核型异常，包括平衡易位、子宫解剖结构异常和免疫因素，不过50%-60%的病因不明。RSM的治疗仍具挑战性，静脉注射免疫球蛋白（IVIG）在RSM中的作用存在争议。
HM夫人，37岁，产科情况总结：0次足月产+1次早产+13次孕早期稽留流产，已知患有甲状腺功能减退/多囊卵巢综合征，丈夫为47岁非近亲男性，2014年1月初到我们的RSM门诊进行检查和治疗。她多次体外受精失败，13次孕早期稽留流产均发生在6-7周，均未接受IVIG治疗。她的第10次妊娠为自然妊娠，在英国伦敦进行管理，从妊娠第3周到第30周接受多种支持治疗及IVIG疗程。妊娠于孕36周剖宫产结束，产下一名活女婴。HM夫人有平衡易位，核型为46XX t(7;11)(p10;q10)。2014年5月29日进行了植入前基因诊断/卵胞浆内单精子注射/体外受精并进行胚胎移植，成功妊娠。她立即开始服用二甲双胍、进行黄体支持并接受IVIG治疗，从妊娠6周开始，每月一次，直至妊娠30周，还接受了其他治疗。通过超声监测妊娠情况，妊娠进展顺利，直至孕35周入院，当时肝功能酶轻度升高，怀疑有胎儿生长受限。对她进行了保守治疗，鉴于胎儿情况不乐观，2015年1月14日通过急诊剖宫产产下一名体重2.29 kg的活女婴，阿氏评分8分和9分，有轻度呼吸窘迫，被送入特殊护理婴儿病房进行强化治疗。母婴情况进展良好，于2015年1月24日出院。
HM夫人有多种RSM病因，经其他药物和IVIG治疗后连续两次成功妊娠，强烈提示IVIG在RSM中具有积极作用。
