Fetal survival and development is supported by the maternal immune system. Questions regarding those mechanisms have risen from development of transplantation medicine and observation of graft rejection. Initial theories of anatomic division, fetal immune immaturity and maternal immune system inertia were found incorrect. Rejection of fetal "semi-allograft" by maternal immune system could result in pregnancy loss. Two pregnancy losses of any etiology are considered recurrent and effort should be made to name the probable cause. Immune causes of pregnancy loss are probably multifactorial, thus difficult to research and implement findings in clinical practice. Although a full understating of pregnancy loss is not established, new therapies are being developed. This review summarizes the role of lymphocytes in pregnancy development, presents data from studies on recurrent pregnancy loss patients, evidence of new therapies and ESHRE guidelines regarding immunologic investigations.
lymphocytes role fetal development pregnancy, recurrent pregnancy loss immune causes mechanisms, maternal immune system fetal semi-allograft tolerance, NK cells T cells recurrent miscarriage, immunologic investigations recurrent pregnancy loss ESHRE guidelines, immune-mediated pregnancy loss multifactorial etiology, maternal immunology implantation fetal survival, lymphocyte subsets habitual abortion review, immunotherapy recurrent pregnancy loss evidence, transplantation immunology graft rejection pregnancy analogy
PMID 30860279 30860279 DOI 10.5603/GP.2019.0019 10.5603/GP.2019.0019
Cite this article
Modzelewski, J., Kajdy, A., & Rabijewski, M. (2019). The role of lymphocytes in fetal development and recurrent pregnancy loss. Ginekologia polska, 90(2), 109-113. https://doi.org/10.5603/GP.2019.0019
Modzelewski J, Kajdy A, Rabijewski M. The role of lymphocytes in fetal development and recurrent pregnancy loss. Ginekol Pol. 2019;90(2):109-113. doi:10.5603/GP.2019.0019
Modzelewski, J., et al. "The role of lymphocytes in fetal development and recurrent pregnancy loss." Ginekologia polska, vol. 90, no. 2, 2019, pp. 109-113.
Congenital uterine anomalies are the result of abnormal development of the Müllerian ducts and occur in approximately 5% of the general female population. These malformations often remain asymptomatic and undiagnosed until complications arise, especially during reproductive years. Accurate diagnosis and classification are crucial for counseling, reproductive planning, and appropriate surgical management. Recent advances in three-dimensional (3D) imaging and printing technology have enhanced diagnostic and therapeutic strategies in complex gynecologic cases. This report aims to present a rare postpartum complication associated with a congenital uterine anomaly, characterize the histopathological and radiological features of the case, and assess the role of printed three-dimensional (3D) anatomical modeling in supporting accurate post hoc classification and surgical decision-making. A 25-year-old primiparous woman with a congenital uterine malformation underwent cesarean section at 28 weeks of gestation due to premature rupture of membranes and regular uterine contractions. One month postpartum, the patient presented with vaginal discharge and reported a palpable resistance in the vagina. Pelvic examination revealed a lobulated, dark pink, nonbleeding, firm mass measuring approximately 15 × 10 cm protruding into the vagina, along with an intact vaginal septum located 2-3 cm from the introitus. Ultrasound demonstrated an irregular mass in the right uterine cavity with indistinct margins suggestive of a necrotic fibroid. The patient underwent surgery involving removal of the vaginal mass and resection of the vaginal septum. Histopathological examination revealed fascicularly arranged, shadowed spindle cells consistent with necrotic smooth muscle tissue of myometrial origin, indicative of degenerative tissue of the uterine septum. Subsequently, a patient-specific 3D printed uterine model was generated using imaging and surgical data to facilitate detailed postoperative anatomical assessment. Postoperative assessment using the 3D printed model enabled a precise classification of the malformation as a "double septate uterus with cervix and septate vagina" (ESHRE/ESGE classification U2bC2V1) with an intracavitary FIGO type 2 submucosal leiomyoma. The 3D model provided a tangible visualization of the uterine architecture, improving anatomical understanding, facilitating retrospective diagnosis, and supporting interdisciplinary evaluation. This case demonstrates the diagnostic and educational utility of 3D printing in the management of rare Müllerian anomalies. Integration of patient-specific 3D models into clinical practice may improve diagnostic precision and surgical planning, particularly in complex gynecological malformations.
Perimenopause/MenopauseDHEA SupplementationHormonal TreatmentDehydroepiandrosterone
Open Access
Dehydroepiandrosterone (DHEA) concentration decreases with age, therefore, DHEA has been considered a hormone that reduces the symptoms associated with aging, so the usefulness of DHEA in premenopausal and postmenopausal women, and the options of hormone therapy have received a large amount of attention. The effectiveness of DHEA in the premenopausal women remains unclear, while in postmenopausal women with coexisting estrogens deficiency is controversial. Despite many years of study, the use of DHEA is still controversial, especially regarding its effectiveness. The aim of present article was to evaluate DHEA specific effects on metabolic parameters, bone mineral density, insulin resistance as well as the therapeutic potential of DHEA in preand postmenopausal women using measures of sexual activity, cognition and well-being. The summary of this article is the position statement of expert group of the Polish Menopause and Andropause Society regarding the efficacy and safety of DHEA supplementation in women. We concluded, that currently available clinical trials and meta-analyses indicate that DHEA supplementation is effective in women with adrenal insufficiency and chronically treated with exogenous glucocorticoids, postmenopausal women with low bone mineral density and/or osteoporosis, premenopausal women with sexual disorders and low libido, and in women with vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause. Currently available clinical trials also suggest that DHEA supplementation is probably effective in postmenopausal women with hypoactive sexual disorders, infertile women with diminished ovarian reserve, women suffering from depression and anxiety, and women with obesity and insulin resistance. No serious adverse effects have been reported.
InfertilityOocyte RetrievalProcedural SafetyIVF Procedural Risks
Open Access
The most common complication during oocyte retrieval is vaginal bleeding, which is largely controlled by buffer application. In conclusion, the oocyte retrieval process can be considered a safe procedure.
PregnancyPremature Rupture of MembranesC-Reactive Protein in PregnancyChorioamnionitis Detection
The purpose of our study was to analyze the efficacy of serum C-reactive protein (CRP), white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) serial evaluations in the prediction of chorioamnionitis in cases of premature rupture of membranes (PROM). A group of 80 patients with PROM before 35 weeks' gestation were evaluated prospectively and managed expectantly. We applied the expectant management with the permanent use of tocolysis, antibiotics, steroids, amnioinfusions of artificial amniotic fluid and intravaginal chemotherapeutics. Patients were monitored with frequent vital signs, fetal heart rate evaluation and everyday CRP, WBC and ESR. All afterbirths were examined to establish the presence of histologic chorioamnionitis (gold standard of intrauterine infection). S: 59 (73.7%) patients had significant chorioamnionitis on histopathology and only 15 of them had clinical chorioamnionitis. Serum CRP serial determinations (definition 1) > 1.2 mg/dl; 2) > 2.0 mg/dl; 3) > 1.2 mg/dl and increasing in two consecutive days) were found the most reliable with a sensitivity 1) 91.5%; 2) 85%; 3) 88%, specificity 57%; 76%; 86%, positive predictive value 86%; 90%; 94.5%, negative predictive value 70.5%; 64%; 72% and accuracy 82.5%; 82.5%; 87.5% respectively. The efficacy of WBC (abnormal > 12500/mm3; > 15000/mm3; > 12500/mm3 and increasing in two consecutive days) and ESR (abnormal > 60 mm/h; > 60 mm/h and increasing in two consecutive days) serial evaluations was significantly lower. Moreover, in cases of chorioamnionitis CRP increased above the upper limit of normal 3 days earlier than WBC or ESR. S: CRP was found the most reliable indicator of histologic chorioamnionitis and indicated the presence of intrauterine infection earlier than WBC or ESR.