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A United States Army Medical Department

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continuing Education program,

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the 24 th annual Armed Forces seminar on

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obstetrics and Gynecology.

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The Association of anti HL

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antibody and obstetrical

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complications

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with Robert E Harris,

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Lieutenant Colonel MC US,

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Air Force,

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OBGYN Department,

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Wilford Hall US Air Force Medical Center,

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Texas.

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Their constituents of cells are

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extremely important to us the day I would like to present to

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you the association that we have found a

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maternal lymphocytotoxic antibodies with obstetrical

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complications and fetal sex.

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Next line,

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the HL A or the human leucocyte antigen is

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becoming increasingly more important to the understanding

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of the immunology of obstetrics and

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pregnancy.

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One postulate for the lack of rejection of

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the normal fetuses has been a

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masking these paternal antigens on

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fetal cells thus rendering them more

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tolerant to the mother.

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Next line,

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the HL A antigens are determined by several

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closely linked genetic low side that

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are inherited on one pair of chromosomes.

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Thus,

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usually there exists an incompatibility between the

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mother and the paternal h antigens

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of the fetus.

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Next line,

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the hlan engines are present early in

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ontogeny.

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They have been demonstrated in spleen

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lung,

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liver and kidney and 3 to 5.5

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month human fetuses.

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Next slide please.

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And 20 to 50% of pregnant women have

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lymphocytotoxic antibodies against the paternal

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HL A antigens.

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This percent is known to increase with parity.

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Next line

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in our prospective study,

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we obtained Sarah from 20 patients at the

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time of spontaneous abortion and 180

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patients at the initial obstetrical clinic visit

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and 129 patients were followed 6 to 7

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months.

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A form was initiated and then was completed

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after delivery.

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Sarah was obtained at 28 and 30 weeks,

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36 weeks,

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chest station and at delivery.

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Next line s was typed

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for cytotoxic activity against

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lymphocytes.

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And a given serum was considered positive for

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cytotoxic activity.

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When it reacted with 10% or more of a

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panel of 30 lymphocytes from normal

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population Neel at

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delivery,

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the infant's cord blood and the blood from the

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patient's husband whenever he was available

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were obtained for L A.

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Next slide of the there were

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23 abortions,

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20 that spontaneously aborted that we obtained

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samples from and three of the 180 patients

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and none of these abortions.

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Did we detect any lymphocytotoxic antibody?

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However,

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28 of 129 or 22% of the

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patients developed lymphocytotoxic antibody

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during the chest station of those patients that were followed for the

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6 to 7 month period.

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Next slide please.

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In the results we analyzed this

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according to two groups,

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those patients who had cytotoxic antibodies

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and those who did not have cytotoxic antibodies.

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As you can see,

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the age of the patients was pretty much the same with less

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than 20 years being represented.

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66% of those patients who did

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have antibodies presence and absent.

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Those patients had 66 62% of those

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were under 20 years.

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As would be expected in the multi paris group,

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71% of the multi paris

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patients fell into those patients who did

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have cytotoxic antibodies.

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And 52% were among the

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group that had no antibodies present.

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The overall complication rate in obstetrics

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was somewhat surprising to us.

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And there were 50% of those patients who did have

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lymphocytotoxic antibodies did have an

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obstetrical complication during the course of her

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pregnancy.

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As compared to 29% of those

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patients that did not have antibodies.

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There was really no difference in the median infant weight

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of the two groups in the median being

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3375 g as compared to

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3402 g.

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Next line,

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the is a little difficult for you to see.

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But the striking thing we found was that 12% of these

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patients had preeclampsia as

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compared to only 5% of those

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patients who did not have lymphocytotoxic

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antibodies and fetal stress was present and

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16% of those patients as compared to

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six and fetal stress was manifested

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by fetal brady cardia and meconium

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staining.

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There was one unexplained fetal death

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among the group with antibodies and in

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the injury growth retardation,

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there was one infant for 4% and we

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had no injury growth retarded infants.

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Among the other 101 patients who did not

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have any antibodies.

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In a previous report.

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In a retrospective analysis,

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it had been stated that those mothers who had

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lymphocytotoxic antibodies had a higher instance of

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congenitally defective infants.

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In our prospective analysis,

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we had no congenitally anomalous infants or fetuses

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delivered to those mothers who had

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antibodies.

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And there were two for 2% in the

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101 patients who did not have any antibodies

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present.

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Next line,

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please.

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HL A typing was done on the cord blood.

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It has been reported that it is difficult to type these

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infants cord blood.

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As far as the HL A in our

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group,

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only eight of the 28 infants were typable for

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these eight.

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The lymphocytotoxic antibody was specific for the

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paternal HL A antigen on the fetal cells.

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For nine of the 13 husbands syrup that were

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obtained.

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Maternal antibodies were demonstrated then to be directed

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against the paternal HL A antigen system.

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Next line.

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And one thing that was of interest to us that we did not

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anticipate was that there has been experimental

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evidence that maternal fetal

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disparity for his ability antigens favors a

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fetal survival particularly for male

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offspring.

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And this has been done with mice and rats.

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And recently just this summer,

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one of the person from England,

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his phd thesis came up with the evidence in

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humans that this was a true also in

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humans.

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When we analyzed our data.

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Next slide,

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we were struck with the fact of an infant male to

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female ratio.

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And those mothers who had maternal lymphocytotoxic

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antibodies was 4 to 3,

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the ratio of males to females and those mothers who had

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absent antibodies was 2 to 5.

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Next,

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in conclusion,

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we cannot say anything about the fetal sex at this

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point except that it is interesting.

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We feel that there is more data that is needed in a further

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prospective study.

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If this data is confirmed,

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it may indicate that the HL A system

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may be a prospective analysis that we can do on

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obstetrical patients,

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determine those patients at high risk in certain

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categories and also to try to prevent some of the

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problems that we have.

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Thank you very much.

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This program was produced through the mobile

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facilities of the television branch,

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Health Sciences,

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media division,

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Academy of Health Sciences,

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United States Army,

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Fort Sam Houston,

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Texas.