Immune Function and Recurrent Pregnancy Loss

Sacha Krieg; Lynn Westphal

doi:10.1055/s-0035-1554917

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2015; 33(04): 305-312
DOI: 10.1055/s-0035-1554917

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Immune Function and Recurrent Pregnancy Loss

Sacha Krieg

¹Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas

,

Lynn Westphal

²Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California

› Author Affiliations

Abstract

Recurrent pregnancy loss (RPL), defined as two or more consecutive miscarriages, is attributable to multiple causes. However, in 50% of cases no known cause is found. Although endometritis is a known cause of miscarriage, other inflammatory processes may play a role in idiopathic, recurrent loss. The fetoplacental unit evades rejection by the maternal immune system by poorly understood mechanisms. Despite this seemingly immune-privileged state for the fetus, human implantation requires inflammatory mediators for attachment and implantation. This review describes how the immune system must simultaneously permit and restrict trophoblastic invasion for healthy implantation and maintenance of pregnancy. Included in this review is a detailed description of the immune milieu in the decidua and abnormalities that are associated with RPL. Finally, autoimmune states associated with RPL and their treatment in an obstetrical setting are reviewed.

Keywords

recurrent pregnancy loss - inflammation - implantation - immune tolerance

Full Text

References

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