Unexplained intrauterine fetal death is accompanied by activation of complement : Journal of Perinatal Medicine

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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland


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Unexplained intrauterine fetal death is accompanied by activation of complement

Karina Richani1 / Roberto Romero2 / Eleazar Soto3 / Jimmy Espinoza4 / Jyh Kae Nien5 / Tinnakorn Chaiworapongsa6 / Jerrie Refuerzo7 / Sean Blackwell8 / Samuel S. Edwin9 / Joaquin Santolaya-Forgas10 / Moshe Mazor11

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Corresponding author: Roberto Romero, MD Chief, Perinatology Research Branch, NICHD, NIH, DHHS, Hutzel Women's Hospital, 3990 John R, 4th Floor, Detroit, MI 48201, USA,

Citation Information: Journal of Perinatal Medicine. Volume 33, Issue 4, Pages 296–305, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2005.052, August 2005

Publication History

Received:
April 4, 2005
Accepted:
May 16, 2005
Published Online:
2005-08-10

Abstract

Objective: Activation of the complement system has recently been implicated in the mechanisms of fetal loss in the antiphospholipid syndrome. It is, however, possible that complement activation is also involved in other causes of fetal death in the second and third trimesters of pregnancy. We therefore conducted a study to determine whether fetal death is associated with changes in the maternal plasma concentrations of complement split products or anaphylatoxins (C3a, C4a and C5a).

Study design: A cross-sectional study was designed to include normal pregnant women (n=60) and patients with fetal death (n=60). Patients with fetal death were classified according to the cause of fetal demise into: a) unexplained (n=44); b) associated with preeclampsia (n=8); and c) associated with chromosomal abnormalities or major congenital fetal anomalies (n=8). The plasma concentrations of C3a, C4a and C5a were measured using sensitive and specific ELISAs. Non-parametric statistics were used for analysis. A P value of <0.05 was considered significant.

Results: 1) The median plasma concentration of C5a was higher in patients with fetal death than in normal pregnant women [median 16 ng/mL (range 4.5–402.5) vs. median 11.6 ng/mL (range 1.2–87.1), respectively; P<0.001]; 2) patients with an unexplained fetal death and those associated with preeclampsia had a higher median plasma C5a concentration than normal pregnant women (P=0.002 and P<0.001, respectively); 3) no differences were observed in the maternal plasma concentrations of C3a and C4a among the study groups.

Conclusions: Unexplained fetal death is associated with evidence of complement activation.

Keywords: Pregnancy; intrauterine fetal death; anaphylatoxins; complement system; C3a; C4a; C5a; pre-eclampsia

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