Stukalova O. Differential approach to diagnostic and complex therapy of pregnancy loss.

The thesis is devoted to the problem of diagnosis and therapy of recurrent spontaneous abortion (RSA) caused by immunological disorders. Based on the statistical analysis of clinical cases it was found out that the risk of pregnancy loss following two, three or four consecutive miscarriages is 27%, 38% and 60% respectively. The roles of different etiological factors of RSA were studied on the basis of microbiological, immunological, endocrinological and ultrasonic investigations. It was determined that the main causes of RSA are TORCH infections. For selection of women with RSA of immunological origin can be used the Index of Sharing (IS) which quantifies HLA-sharing between partners. The IS measurement is calculated according to the lymphocyte proliferation level in mixed lymphocyte culture (MLC). The threat of pregnancy loss up to 12 weeks of gestation is characterized by an increase in the cytotoxic activity of peripheral blood lymphocytes, increased concentration of cytokines such as IFN-g and TNFin MLC and a decrease in the level of IL-4 which suggests a functional prevalence of Тh2. A decreased IS level of minus 3% or less is an indication for immunization by partner's lymphocytes. It has been found that such immunization shifts the balance between Th1 and Th2 towards Th2 prevalence. Partner lymphocyte immunotherapy increases the rate of live births and decreases the rate of spontaneous abortions in women with RSA. It also contributes towards a normal course of pregnancy, decreases low birth weight babies and subsequent neonatal morbidity.