Immunology of pregnancy Flashcards
What is the immunological paradox?
Maternal tolerance of foetal semi-allograft without rejection
Give 3 maternal physiological adaptions to pregnancy
Cardiovascular Resp Renal Repro Endo GI Immune Metabolic
What type of implantation is human?
Interstitial
Name 2 parts of primary decidualization
Uterine stromal enlargement
uNK cells proliferate
What type of placentation is involved?
Haemochorial
What can cytotrophoblasts differentiate into?
Syncytiotrophoblasts
Extra-villus trophoblasts
Describe the 4 steps of invasion
1 - apposition
2- interstitial implantation
3 - interstitial invasion
4 - spiral artery remodelled and endovascular invasion
What combination of HLA-C:KIR is good and why?
HLA-C1:KIR-B
Promotes EVT invasion
uNK cells activated
What combination of HLA-C:KIR is bad and why?
HLA-C2:KIR-A
Inhibits uNK cells
Poor EVT invasion
Pre-eclampsia link?
What are 4 placenta mediated/failed endovascular invasion diseases?
Pre-eclampsia Prematurity Placental abruption Recurrent miscarriage Growth restriction Placenta creta
What are the 3 types of placenta creta and where do they invade?
Acreta - superficial myometrium
Increta - deep myometrium
Percreta - through myometrium/uterine serosa
Which Ig can cross the placenta?
IgG
What are the 2 steps that occur in rhesus disease?
1) Sensitisation
2) Rapid response
Explain rhesus disease sensitisation
Mum is Rh-ve
First pregnancy
Mixing of blood with trauma (eg delivery)
Maternal immune response makes memory IgM against Rh+ve
Explain rhesus disease rapid response
Subsequent pregnancy if exposed to blood
Rapid immune response due to IgM to Rh+ve antigen
Memory B cells release IgGs that cross placenta
Attack RBCs
What are the implications of rhesus disease?
Anaemia, death
Which Ig is involved in breast milk?
IgA
What is the management for rhesus disease?
Anti-D
