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
