Intravenous Human Immunoglobulin for Treatment of Unexplained Recurrent Spontaneous Abortion

Shin, J S; Park, M I; Hwang, J H; Chung, S R; Moon, H; Lee, J A; Hwang, Y Y

Abstract

Intravenous human immunoglobulin (IVIG) has been proposed in patients with unexplained recurrent spontaneous abortion (RSA). Twenty-one women with a history of recurrent spontaneous abortion were treated with IVIG. Among them, 2 patients miscarried and were treated with immunoglobulin again during their next pregnancy (N=23). At the time of diagnosis of pregnancy, patients were treated with 0.5 g/Kg dose of IVIG. Therapy was repeated every 3 weeks at a dose of 0.5 g/Kg until 13 week`s gestation. Of these patients, Blocking Effect Index (BEI) was peformed before and after treatment, respectively. The results were as follows ; 1. Of 23 pregnancies participating in the study, treated with IVIG. Pregnancy outcomes included 17 deliveries and 4 abortions. Two patients were not followed up. The success rate was 81.0% (17/21). But among 4 patients who miscarried, 2 patients were resulted as abnormal pregnancies (chromosomal abnormality & partial hydatdiform mole, respectively), and treated with immunoglobulin during their next pregnancy and gave birth successfully. Therefore, the overall success rate was 89.5% (17/19). 2. Seven out of 17 babies were born vaginally (41.2%), while ten (58.8%) were delivered by cesarean section. Fifteen were born at term, while 2 (11.8%) were preterm (36th and 37th gestatonal weeks, respectively). 3. Twenty-three cases received IVIG once, 21 cases twice and 11 cases three times. The rate of BEI in patients who were not treated with IVIG was -3.23+/-31.42% (N=23)(range: -53.6~75%). The rate of seroconversion of BEI in patients who were treated with IVIG was 21.81+/-30.31% (N=20)(range: -42.2~75%). The converted BEI rate after second infusion of IVIG was 14.34+/-14.24 (N=5)(range: -10~26.5%) in 5 out of in 20 patients who showed poor results and needed a recheck. There was no adverse effect of IVIG. Immunotherapy with human IVIG is effective in unexplained recurrent spontaneous abortion and the rate of seroconversion of BEI was increased. However, the immunomodulating effect of IVIG`s related to its possible mechanism to prevent abortion remains unestablished.