Mitsui Junichiro, Ota Kuniaki, Takayanagi Yuko, Nako Yurie, Tajima Makiko, Fukui Atsushi, Kawai Kiyotaka
Graduate School of Medical and Dental Sciences, Comprehensive Reproductive Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
Kameda IVF Clinic Makuhari, Reproductive Medicine, Chiba 261-0023, Japan.
J Clin Med. 2023 Feb 4;12(4):1250. doi: 10.3390/jcm12041250.
About 60% of cases of recurrent pregnancy loss have unexplained etiology. Immunotherapy for unexplained recurrent pregnancy loss is still unestablished. A 36-year-old woman, not obese, had a stillbirth at 22 gestational weeks and a spontaneous abortion at 8 weeks. She had been examined for recurrent pregnancy loss at previous clinics with no significant findings. When she visited our clinic, a hematologic test showed a Th1/Th2 ratio imbalance. Ultrasonography, hysteroscopy, and semen analysis showed no abnormalities. She successfully conceived by embryo transfer in hormone replacement therapy cycle. However, she had a miscarriage at 19 weeks. The baby had no deformities, but a chromosomal test was not performed, according to the parents' will. The placenta pathologically suggested hemoperfusion problems. Her and her husband's chromosomal tests showed normal karyotypes. Other examinations revealed a repeated Th1/Th2 ratio imbalance and a high resistance index of uterine radial artery blood flow. She was administered low-dose aspirin, intravenous immunoglobulin, and unfractionated heparin after the second embryo was transferred. Her baby was healthily born by cesarean section at 40 weeks. Intravenous immunoglobulin therapy can be a choice for recurrent miscarriage without risk factors because it has clinically beneficial influences on the patient's immunological aberration.
约60%的复发性流产病例病因不明。不明原因复发性流产的免疫治疗仍未确立。一名36岁非肥胖女性，孕22周时发生死产，孕8周时自然流产。她曾在之前的诊所接受复发性流产检查，未发现明显异常。她来我院就诊时，血液学检查显示Th1/Th2比值失衡。超声检查、宫腔镜检查和精液分析均未发现异常。她在激素替代治疗周期中通过胚胎移植成功受孕。然而，她在孕19周时流产。婴儿无畸形，但根据父母意愿未进行染色体检查。胎盘病理提示存在血液灌注问题。她和丈夫的染色体检查显示核型正常。其他检查显示Th1/Th2比值反复失衡，子宫桡动脉血流阻力指数升高。在第二次胚胎移植后，她接受了小剂量阿司匹林、静脉注射免疫球蛋白和普通肝素治疗。她的婴儿在40周时通过剖宫产健康出生。静脉注射免疫球蛋白治疗对无危险因素的复发性流产患者可作为一种选择，因为它对患者的免疫异常具有临床有益影响。
