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- Skamris Matthiesen, Leif, 1954-
(författare)
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Immune Changes in Pregnancy : A Survey of some Immunological Variables in Normal and Complicated Pregnancies
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The maternal systemic immune response during pregnancy is only fragmentarily understood. An adequate immune response to the gestational product is of vital importance for a successful pregnancy. Research in the field of reproductive immunology could clarify whether there is a difference between the immune responses in women with normal pregnancies and women with complicated pregnancies.The present thesis is a survey of selected immunological variables in non-pregnant women and in women with uncomplicated and complicated pregnancies. This was done by studying Jymphocyte populations, the proliferative capacity of lymphocytes as stimulated with mitogcns and immunomodulating drugs, the presence of iL-4 and JFN-g secreting cells, and the presence of certain autoantibodies in a low-risk pregnant population.Normal pregnancies were characterised by decreased levels of B cells (CD19+),_ NK cells (CD56+), expression of the IL-2 Receptor on lymphocytcs (CD25+) as well as HLA-DR+ on T cells (CD3+) and increased level of inactivated CD4+CD45RA+ T cells. Increased levels of NK cells, expression ofHLA-DR on T cells and antigen activated CD4+CD45R0+ T cells was found in preeclamptic patients compared with normal pregnancies. Thus, the immunosuppression that was found in normal pregnancies was not seen in pregnancies complicated by prccclampsia.Addition ofmitogens to cell cultures in either autologous or AB serum culture media demonstrated the existence of serum and cell mediated suppressor activity. The lymphoprolifcrative response to mitogens was reduced during nmmal pregnancies, possibly mediated by PGE2 and the presence ofT lymphocytes with suppressor function. The lymphoproliferative response in pregnancies complicated with severe precclampsia was further reduced as compared with normal pregnancies.Circulating IFN-g and IL-4 secreting cells increased during nonnal pregnancies. By the use of a mixed lymphocyte culture test it was found that paternal lymphocytes as stimulator-cells generated an elevated IL-4 secretion from maternal responder cells. These results indicate that the maternal immune response is shifted towards humoral immunity (TH2) by the recognition of the paternal allo-antigens, possibly to avoid maternal allo-reactivity against the fetus. The present findings also indicate that cell-mediated immunity (THl) to antigens were allowed to occur.The prevalence of anticardiolipin antibodies (aCL, IgG, ELISA), antinuclear antibodies (ANA, Indirect immunofluorescence) and rheumatoid factor (RF, agglutination test) in a low-risk pregnant population was low. However, there was an association, albeit weak, between ANA and women with preeclampsia.In summary, the maternal systemic immune response is characterised by suppression and non-aggression in nmmal human pregnancies. In women with pregnancy complications, such as preeclampsia, this suppression and inactivation is only partially achieved.
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- Uustal Fornell, Eva K., et al.
(författare)
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Clinical consequences of anal sphincter rupture during vaginal delivery
- 1996
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Ingår i: Journal of the American College of Surgeons. - 1072-7515 .- 1879-1190. ; 183:6, s. 553-558
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to meet women with anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth.STUDY DESIGN:Fifty-one consecutive women with primarily sutured anal sphincter rupture and 31 women without anal sphincter rupture were prospectively studied after vaginal delivery. All were assessed clinically at 3 days, 6 weeks, and 6 months after delivery. After 6 months, all women underwent anorectal manometry and answered a questionnaire about incontinence, social function, and general health.RESULTS:The overall incidence of sphincter rupture was 2.4 percent. Significantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture. The resting pressures did not differ between groups. Approximately 40 percent of the women in both groups had noted some fecal incontinence by 6 months postpartum. Symptoms were significantly more severe in patients with sphincter rupture.CONCLUSIONS:Anal sphincter rupture was 2.4 times as common as reported in Swedish birth statistics. The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.
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