One of the reasons why immunological pregnancy loss has remained such a controversial and divisive subject is that investigators have not been able to reach consensus about how to treat affected patients. Some authorities argue that, since we have no proven treatment, why even bother with diagnosing these patients?
Indeed, it is correct that in certain situations we do not have a proven treatment. For example, no established treatment exists to normalize the increased miscarriage risk with autoimmune thyroid diseaseautoimmune thyroid disease . Some authorities have suggested that treatment with intravenous gamma globulin (IVIg) was effective in this situation; however, a majority of studies were unable to confirm this. However, in other clinical situations, for example in the presence of APA/RAFS, many studies, including some from CHR, have demonstrated that a variety of treatment approaches may be quite effective. These include aspirin, corticosteroids, heparin and, on occasion,intravenous gamma globulin.
As we noted above, we perceive CHR's treatment philosophy in this area as centrist. While some colleagues on one extreme propagate the aggressive use of high dosage medications including gamma globulin in practically all patients, and colleagues on the other extreme reject all treatments, we, based on our own data, and 20 years of experience with thousands of affected patients, have come to strongly believe in the individualization of patient care, based on the very specific immune conditions present in patients at any given time.
Physicians who really understand abnormal autoimmune function know that autoimmune function is never static. Patients with abnormal autoimmune function, whether they have overt clinical autoimmune disease or suffer from only sub-clinical autoimmunity, go through periods of exacerbations and remissions. Therefore, to treat every patient in the same way at all times does not make sense! Treatment at CHR is, therefore, adjusted to the actual immune status of the patient, as she goes through pregnancy. As a consequence, over 99% of our patients are off most medications by the time they reach approximately 20-23 weeks gestation. And because they do not have to take medications for the remainder of the pregnancy, the known, and frequent, complications from these medications are only very rarely seen.
Read more about Repeated Miscarriages
Any unwanted, spontaneous pregnancy loss prior to the 20th week of pregnancy...
Roughly 60% of all pregnancy losses are genetic in nature--in these cases, genetic abnormalities...
Last Updated: November 15, 2014