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Geburtshilfe Frauenheilkd 2000; 60(12): 604-608
DOI: 10.1055/s-2000-9547
Übersicht

Georg Thieme Verlag Stuttgart · New York

Neue Daten zur Ätiologie des habituellen Aborts: eine Übersicht

The Etiology of Habitual Abortion: A ReviewC. Tempfer1 , Christine Kurz2 , Elisabeth Vytiska-Binstorfer2
  • 1 Abteilung für Gynäkologie und Geburtshilfe, Universitätsklinik für Frauenheilkunde Wien
  • 2 Abteilung für Gynäkologische Endokrinologie und Sterilitätsbehandlung, Universitätsklinik für Frauenheilkunde Wien
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung

Neben anatomischen, hormonellen, infektiösen und genetischen Faktoren spielen immunologische Komponenten beim HA eine wesentliche Rolle. Diese Faktoren sollten daher bei der diagnostischen Abklärung betroffener Frauen berücksichtigt werden. Während der Schwangerschaft erlaubt ein subtiles Zusammenspiel einer Vielzahl von immunmodulatorischen Prozessen dem Embryo/Fetus, der Abstoßungsreaktion durch das mütterliche Immunsystem zu entgehen. Eine Defizienz in einem oder mehreren dieser Prozesse erhöht das Risiko für einen Spontanabort. Frauen mit HA zeigen sowohl im Bereich von Autoimmunkomponenten, z. B. dem Antiphospholipidsyndrom, als auch von Alloimmunkomponenten, z. B. der TH-1/TH-2-Ratio und der asymmetrischen Antikörper, charakteristische Mängel. Realistische therapeutische Optionen für Frauen mit HA, vor allem Therapieschemata mit Progesteron, Folsäure, Aspirin, Heparin und Kortison, sind einsetzbar und durch klinische Studien im Sinne einer Level II evidence (American College of Obstetricians and Gynecologists [ACOG] 1995) abgesichert.

Summary

Etiologic factors associated with habitual pregnancy loss include uterine anomalies, luteal phase defects, hyperprolactinemia, hyperandrogenemia, genital infections, and balanced chromosomal translocations. The diagnostic work-up should be planned accordingly. Normally the maternal immune system recognizes paternally-derived fetal and placental antigens and confronts the embryo/fetus with a host defense response. To avoid rejection of the semiallogenic embryo/fetus, the maternal immune system is suppressed. Imbalances in the complex immunologic interactions between mother and embryo/fetus increase the risk for spontaneous abortion. Women with habitual abortion can show characteristic deficiencies in autoimmune components (e.g., the antiphospholipid syndrome) or alloimmune components (e.g., TH-1/TH-2 ratio and asymmetrically glycosylated blocking antibodies). Treatment options based on level-II evidence include progesterone, folate, aspirin, heparin, and cortisone.

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Dr. Clemens Tempfer

Universitätsklinik für Frauenheilkunde Wien Klinische Abteilung für Gynäkologie und Geburtshilfe

Währinger Gürtel 18 - 20

1090 Wien

Österreich

Email: E-mail: clemens.tempfer@akh-wien.ac.at