Plasmapheresis for miscarriage and infertility
The problem of miscarriage is one of the most urgent problems of obstetrics. Its frequency is 15-20% of all pregnancies, and the frequency of infertility – in 5-11% of marriages [Kon'kov D.G. et al., 2008]. 30-40% of these abortions are "unexplained» [Kutteh W.H. et al., 1999].
Among the etiological factors observed anatomical abnormalities of female genitalia, chromosomal pathology, infectious disease, neuroendocrine pathology, antiphospholipid syndrome. We shall mention only those in the elimination of which can be used apheresis therapy, especially using plasmapheresis.
Virtually all of the above complications of pregnancy to some extent also threaten miscarriage or premature birth. This is also characteristic of preeclampsia and revitalization hidden genital infections, and Rh-conflict. In all these cases the pathogenesis of disorders is reduced to the accumulation in the body of a pregnant pathological products and apheresis therapy that promotes their excretion, and provides the best conditions for the continuation of pregnancy.
Often threatened abortion occurs due to inadequate treatment as in the case of ovarian hyperstimulation syndrome, and this situation could also be eliminated with plasmapheresis.
Cause late miscarriages may be intrauterine "bullish" infection with the development of chorioamnionitis and exudative effusion in the placenta and umbilical cord, and then in the fetus itself. In placental hemorrhage occur with edge placental abruption with acute disorders of utero-placental and feto-placental circulation. Infection of amniotic fluid leads to rising microbial colonization of the airways of lungs with the development of bronchiolitis and perifocal desquamation interstitial pneumonia. Among the pathogens note Staphylococcus aureus, Enterobacter, yeast Candida, Klebsiella, Pseudomonas aeruginosa and Corynebacterium [Glukhovets N.G., 1998].
However, the causes of miscarriage may be autoimmune mechanisms. Sex hormones play a different role in the pathogenesis of autoimmune diseases. In animal experiments established that estrogens provoke some autoimmune processes affecting steroid receptors in specific CD8+ T-lymphocytes, and CD5+ B-lymphocytes. However, autoantibodies are present in sera of patients without symptomatic autoimmune disease also. Abnormal levels of autoantibodies may be accompanied by not only obvious, but also preclinical or subclinical autoimmune disorders.