Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT)

Objective To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term

Induction versus expectant monitoring for intrauterine growth restriction at term: Randomised equivalence trial (DIGITAT)

Objective: To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term. Design: Multicentre randomised equivalence trial (the Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT)). Setting: Eight academic and 44 non-academic hospitals in the Netherlands between November 2004 and November 2008. Participants: Pregnant women who had a singleton pregnancy beyond 36+0 weeks' g

Major histocompatibility complex (MHC)-mediated immune regulation of decidual leukocytes at the fetal-maternal interface

Self and non-self recognition is the key mechanism by which the immune system determines whether or not to mount an immune response. During pregnancy the maternal immune system must tolerate the persistence of non-self semi-allogeneic fetal cells in the maternal tissue. Although many mechanisms have been shown to contribute to the prevention of a destructive maternal immune response to fetal cells, the immune acceptance of the allogeneic fetus in pregnancy largely remains an immunological paradox (Billingham et al., 1953). The aim of this review is to describe the expression of the polymorphic histocompatibility antigens at the fetal-maternal interface, their interaction with maternal leukocytes and their possible roles in immune regulation at the fetal-maternal interface during human pregnancy.Transplantation and autoimmunit

Egg donation pregnancy as an immunological model for solid organ transplantation

In egg donation (ED) pregnancies the fetus is allogeneic to the gestational carrier. During these ED pregnancies the mother has to cope with a higher degree of antigenic dissimilarity compared with spontaneously conceived pregnancies. At the fetal-maternal interface maternal cells and fetal cells come in close contact. Understanding the immune mechanisms at this fetal-maternal interface gives more insight into the question why the (semi-)allogeneic fetus is accepted and not rejected by the mother. The degree of antigenic dissimilarity in ED pregnancies is comparable with that in solid organ transplantations with HLA mismatched unrelated donors. Therefore, the immunologic interactions between mother and child in successful ED pregnancies may be relevant for the induction of immunological tolerance in solid organ transplantation.Transplantation and autoimmunit

Placental pathology in egg donor pregnancies

Objective: To determine placental pathology and immune response at the maternal-fetal interface in pregnancies conceived by IVF via egg donation compared with nondonor IVF pregnancies. Design: Retrospective case-control study. Setting: Academic medical center. Patient(S): The study population included 20 egg donor and 33 nondonor IVF pregnancies of >24 weeks' gestation. Intervention(s): None. Main Outcome Measure(s): Perinatal complications (gestational hypertension, abruption, preterm delivery, cesarean section), microscopic features indicating ail immune response and trophoblast damage, and characterization of inflammatory cells using immunohistochemistry. Result(S): There was ail increase in gestational hypertension and preterm delivery in egg donor pregnancies. Dense fibrinoid deposition in the basal plate with severe chronic deciduitis containing significantly increased numbers of T helper and natural killer cells were demonstrated in egg donor placentas. Trophoblast damage was also increased in the preterm egg donor group. Conclusion(S): There are significant histological and immunohistochemical differences between the placentas of egg donor and nondonor IVF pregnancies. The increased immune activity and fibrinoid deposition at the maternal-fetal interface of egg donor pregnancies Could represent a host versus graft rejection-like phenomenon. (Fertil Steril (R) 2010;93:397-404. (C)2010 by American Society for Reproductive Medicine.)Research into fetal development and medicin