Introduction
Recurrent pregnancy loss (RPL) is defined as two or more consecutive
pregnancy losses prior to 20 – 24 weeks gestation. It affects about 1
– 2 % of pregnancies and is often associated with serious
psychological complications. During the last few decades, many factors
including age, inheritable and aquired genetic and/or anatomical
abnormalities, infections, and endocrine dysfunctions have been
identified to play a crucial role in this field. However, the true cause
remains unclear in most cases. Until now, there is no specific or even
generally accepted treatment in such cases.1,2 In
general, pharmacological treatment is only recommended for
anti-phospholipid syndrome, and factor V mutation.3-5Dependent on clinicians and patients, this treatment may also be
employed in the presence of other congenital thrombophilias, i.e.
prothrombin mutation, deficiencies in anti-thrombin, protein C, and
protein S.1,6,7
Based on the fact that pregnancy reflects an immunological miracle
combining immune defense/response on the one hand and immune tolerance
on the other hand, it is not surprising that immune imbalance during
pregnancy may result in complications. In fact, several studies have
shown that RPL could be related to immune abnormalities in roughly 50 %
of affected women.8-12 Current studies have focused on
the role of decidual macrophages. These cells mature during early stages
of pregnancy and persist during the entire gestation
period.13 In the first trimester, about 40 % of all
cells in the decidua are leukocytes and 20 – 30 % of these cells are
macrophages, which have the plasticity to alter their function in
response to various environmental signals. They are also sensitive to
small changes in the microenvironment13-15, they
represent the most crucial immune cells for pregnancies due to their
involvement in regulation of implantation, placentation, fetal
development, and most importantly vascular remodelling at the
maternal-fetal interface. These properties make those cells attractive
as a therapeutic target in immune related diseases.
Polyclonal Anti-D is successfully used to prevent alloimmunization in
Rh(D) negative pregnant women as well as in treatment of patients with
autoimmune thrombocytopenia (ITP). Until now, the mechanisms by which
these antibodies are operating in vivo are poorly understood. In
addition to Fc mediated phagocytosis of IgG coated RBCs, Anti-D has
exciting immunomodulatory effects, which could not completely be
explained yet.16,17
In this retrospective study, Anti-D has been shown to increase the rates
of successful pregnancies in Rh(D) positive women who remained abortive
despite treatment with LMWH and/or aspirin.