Successful management of recurrent spontaneous miscarriage by monthly high dose intravenous immunoglobulin at 10 weeks gestation or more

الملخص EN

Recurrent miscarriage, defined as three or more consecutive miscarriages, is a prevalent health problem that affects ≥ 1–2 % of couples.

Recurrent spontaneous Miscarriage (RSM) is a common complication of pregnancy for which there is no known cure.

Intravenous immunoglobulin (IVIG) has been studied in randomized controlled trials with conflicting results.

Therefore, a definitive trials was proposed.

IVIG has been used to improve the live birth rate in women with recurrent implantation failure at in vitro fertilization, unexplained recurrent pregnancy loss, and antiphospholipid syndrome.

Objective : To evaluate the efficacy of high-dose intravenous immunoglobulin in the management of pregnant women experiencing primary or secondary unexplained recurrent spontaneous pregnancy loss.

Patient and Methods : This study was carried out at department of obstetrics and gynecology in Kuwait General Hospital during the period from January 2010 till the end of June 2011.

It included 47 patients identified as having RSM ; 36 case could be followed and 11 cases dropped out.

Data from these 36 cases formed the basis of this analysis.

Patients were classified into three groups ; Group A : (10 patients, 27.8 %) admitted with Rhesus isoimmunisation in Nine of them (25.0 %) and one (2.8 %) patient with Idiopathic thrombocytopenic purpura (ITP).Twenty six Patients (72.2 %) with RSM were subdivided again into Group B with Primary IRSM in 10 patients (38.5 %) and Group C with Secondary RSM in 16 patients (61.5 %).

History of first trimester miscarriages was previously recorded in 76.9 % of cases.

Starting at the end of the 10th week of gestation, All pregnant ladies started to received a full high Dosage Regime of intravenous infusion of immune globulin (0.5 g / kg body weight) over 48 hours .

The patient received this infusion course every 28 days until pregnancy completed 36 weeks.

These cases were followed in our antenatal care clinics at our hospital till the end of their pregnancy.

Results : Antiphospholipid syndrome in was diagnosed in 11 cases, [42.3 %].

In 92.3 % of cases received their initial IVIG dose in the first trimester.

The pregnancies ended again in miscarriages in nine cases, (34.6 %).

Among the nine pregnancy losses occurring in women receiving IVIG, seven cases (73 %) ended in inevitable miscarriage and two cases (27 %) were intrauterine missed miscarriage after confirmation of positive fetal heart beat pulsations.

Seventeen cases [65.4 %] ; progressed to preterm / term deliveries of living babies.

This good pregnancy outcome achieved using IVIG was two times the rate of pregnancy loss which showed high statistical significance (P < 0.0010).

In patient with Rhesus Iso-immunization who received IVIG, 60.0 % of them also achieved healthy live births.

IVIG.

No significant adverse reactions occurred in patients treated with IVIG.

Conclusions : The use of IVIG in IRSM resulted in a favorable pregnancy outcome and has a positive role in IRSM and it should be offered to selected patients with IRSM.

A detailed analysis of all patients so far treated with IRSM will be completed in the near future.

This initial report contains only a small study population.