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Immune relationship between mother and fetus

During pregnancy, the mother’s immune system is tolerant to the antigenic structures of the fetus, so that it does not reject. This is due to the presence of a placental barrier, with a low density of histocompatibility antigens on trophoblast cells, as well as the suppressive orientation of immune reactions in the mother - fetus system. The female body, placenta and fetus synthesize a number of protein factors (alpha-fetoprotein, uromodulin, trophoblast proteins) and non-protein compounds (estrogens, progesterone, prostaglandins E1 and E2), which suppress rejection reactions.

The immunological relationships established between the mother and the baby during pregnancy, due to the fact that the syncytiotrophoblast and the basal decidual membrane are in direct contact, and also due to the fact that the fetal cells constantly enter the bloodstream of the mother, protect the fetus and its formations from maternal immune mechanisms triggered by antigens of the fetus of paternal origin. But under certain conditions, immunological mechanisms can cause severe complications leading to impaired development or even death of the fetus.

During pregnancy, both maternal responses directed against fetoplacental antigens (host versus graft reaction) and fetal responses directed against maternal antigens (transplant versus host transplant) should be included simultaneously during pregnancy. The basis of the symptoms on the part of the mother’s body during the development of Rh immunization is not immune mechanisms, but such factors as massive inflows from the fetoplacental complex of gonadotropins or toxic substances, reflexes emanating from the uterus, impaired feto-placental metabolism, etc.

Pregnancy complications in which the leading or supporting role belongs to impaired immune interaction between the mother and the fetus:

? Hematological complications - disorders caused by immunization with antigens of blood cells, in particular, red blood cells.

The maternal body responds to any fetal red blood cell antigens that are not found in its own red blood cells, producing specific antibodies that subsequently pass into the fetal body and cause the destruction of the fetal red blood cells and other cytotoxic effects in relation to cells that share antigens with the red blood cells of the fetus. The clinical expression of these processes is the hemolytic disease of the fetus and newborn.

The immunogenicity of erythrocyte fetal antigens is different. The most frequent and severe disorders result from iso-immunization with the Rh factor (in particular, agglutininogen D) and AB0 antigens (the first blood group in the mother and the second or third blood group in the fetus). Very rarely isoimmunization is associated with other systems of red blood cell antigens.

The fetal leukocytes also penetrate the placenta and, being carriers of antigens, stimulate the synthesis of anti-leukocyte antibodies by the mother's body. These antibodies can adversely affect the fetus in subsequent pregnancies.

Fetal platelets that cross the placenta into the mother’s bloodstream are immunogenic to the mother’s body and stimulate the synthesis of antiplatelet antibodies. However, these antibodies, despite the fact that they penetrate the bloodstream of the fetus, do not affect the platelets of the fetus. Isoimmune fetal thrombocytopenia is a very rare occurrence, although cases of severe bleeding are described, even with a fatal outcome.

? Immunological miscarriage. Some spontaneous miscarriages, in particular repeated ones, are the result of the action of immunological factors, and in these cases the miscarriage can be compared with the phenomenon of transplant rejection. This is confirmed by a high rate of detection of antitrophoblast antibodies in the mother's blood at the time of abortion.
The role of these antibodies in the pathogenesis of miscarriages is confirmed by the abortive effect of antiplacental serum in various animal species.

The occurrence of an immune conflict between the mother and the fetus can cause a miscarriage, since the antigen-antibody reaction is accompanied by the release of a significant amount of histamine and, possibly, other biologically active substances that cause vasomotor changes and changes in the permeability of the placenta, which is expressed, in particular, by a change in the secretion of estrogen. Despite the fact that in women with repeated miscarriages, the level of histamine is often low, they note a positive therapeutic effect from the use of antihistamines in case of miscarriage.

The cause of immunological abortion may be of an embryonic or maternal nature. The development of the fetal egg is impaired if the trophoblast does not protect it from the immunological aggression of the mother. In some cases, a miscarriage appears to be the result of an abnormal reaction of the mother to a feto-placental allograft. In addition, chromosomal abnormalities in the embryo are a common cause of miscarriage, and the immune mechanisms can be activated again.

? Late toxicosis of pregnant women. In pregnant women with immune incompatibility between the mother and the fetus, the development of a characteristic triad of symptoms (proteinuria, edema, arterial hypertension) is observed according to the Rh factor system. Evidence of the participation of individual immune mechanisms in late toxicosis is some pathological data.

In toxicosis, anti-placental antibodies contribute to the defeat of organs that cross-react with placental antigens, in particular, the kidneys (mainly the glomerular basement membrane).

? Underdevelopment disease is an experimental syndrome created by introducing immunocompetent allogeneic cells of an adult donor to an unripe fetus or newborn, different from the donor by antigens of the main tissue compatibility complex.

The cells introduced into the recipient cause fetal death and expulsion of the fetus. At the same time, a new complex of changes is found in the newborn, such as: underdevelopment, diarrhea, damage to the skin and coat, initial hypertrophy, and then complete involution of the lymphoid system, foci of necrosis in the liver, spleen, and thymus. An underdevelopment disease with its various variants is a typical example of a transplant reaction against a host when cells capable of an immune response are introduced into an alien organism that is unable to defend itself from such aggression.

Under normal conditions, the underdevelopment disease does not develop, probably due to the ability of the fetus to term the birth to destroy, without sensitizing, a small number of maternal lymphocytes penetrating the placental barrier (in pregnant women with leukemia, newborns do not suffer from leukemia). The fetus destroys the mother’s lymphocytes. However, according to research results, in some cases, the development of the disease in children cannot be ruled out.

The role of immune mechanisms in the pathogenesis of individual pregnancy complications has not yet been clarified. And if in some pathological conditions, such as iso-immunization of the mother to red blood cell antigens, the participation of immune mechanisms is well established, then this can not be said about miscarriage and late toxicosis, where we can talk mainly about hypotheses. Clarification of the role of violations of the immune relationship between the mother and the fetus in the pathogenesis of various pregnancy complications will become possible only after a detailed clarification of the mechanisms protecting the feto-placental transplant.
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Immune relationship between mother and fetus

  1. Abstract. Immunity of the child's body. Immune relationship of mother and fetus., 2009
    Introduction 1. Immunity
  2. Protection mechanisms on the part of the fetus (formation of the immune system of the fetus)
    During embryogenesis (3-8 weeks), the laying, growth and development of all organs of the fetus, including cells of the immune system, occurs. At 5 weeks of gestation, the thymus gland forms, which will become the central organ of the immune system. At the same time, the liver, spleen, and lymph clusters are formed along the vessels. From one stem hematopoietic polypotent cell from the 3rd week of development to
  3. ISOSEROLOGICAL INCOMPATIBILITY OF BLOOD OF MOTHER AND FRUIT
    The basis of the isoserological incompatibility of the blood of the mother and the fetus is the heterogeneity of antigenic factors of red blood cells in them, more often in the Rhesus system, less often in the ABO system. Due to the penetration of fetal blood factors with antigenic properties into the bloodstream of a mother who does not have them, in her body alloimmune antibodies are produced that penetrate the placenta to the fetus,
  4. DISEASES ARISING FROM INCOMPATIBILITY OF MOTHER AND FRUIT ON BLOOD ANTIGENS
    This is an independent group of hereditary diseases caused by incompatibility of the mother and fetus by blood antigens. Schematically, the incompatibility process can be represented as follows. Suppose a woman has Rh-negative blood. The fetus has Rh-positive blood. He inherited from his father one of the allelic genes that determines the presence of the Rh factor. During the period
  5. Group incompatibility of maternal and fetal blood
    Incompatibility occurs if the mother has 0 (1) blood type and the fetus has A (P) or B (W). However, group incompatibility does not proceed as hard as Rh incompatibility. This is because antibodies A and antibodies B belong to class M immunoglobulins and do not cross the placenta, while anti-Rhesus antibodies belong to class G immunoglobulins, have a small molecule and are easily
  6. INFLUENCE OF HARMFUL FACTORS ON THE MOTHER AND FRUIT ORGANISM
    The mother-fetus system is exposed to a variety of environmental factors during pregnancy. Under the influence of these factors, the course of physiological relationships between the maternal organism and the fetus changes, as a result of which, in some cases, various forms of pathology arise. Among the many environmental factors that can cause various forms
  7. INJURY OF MOTHER AND FRUIT.
    During pregnancy, an increase in uterine extensibility occurs. This is due to an increase in the number of blood and lymph vessels, as well as an increase in the level of hyaluronidase. In childbirth, trauma to the soft birth canal always occurs; small tears of the uterus form. Classification of birth injury. 1) uterine rupture 2) perineal rupture (three degrees)
  8. ISOSEROLOGICAL INCOMPATIBILITY OF BLOOD OF MOTHER AND FRUIT
    ISOSEROLOGICAL INCOMPATIBILITY OF BLOOD OF MOTHER AND
  9. The relationship of the cardiovascular system of the mother and fetus
    A special place is occupied by the pathology of pregnancy, leading to a violation of the utero-placental and placental-fetal circulation and pathology of the umbilical cord (H. Plat et al., 1984; P.S. Gurevich, 1989). As you know, during pregnancy a new vascular bed develops - uterine-placental circulation. The blood flow in the uterus changes, and if the non-pregnant uterus is supplied with two uterine arteries, the outgoing
  10. . Anatomical and topographic relationship of the fetus and the birth canal of the mother during childbirth
    The relationship between the fetus and the birth canal of the mother is determined by four indicators: position, position, presentation, and articulation of the fetus. Under the position of the fetus understand the relationship of his back to the walls of the abdomen of the mother. Distinguish between upper (correct), lower and side (incorrect) positions. The position of the fetus is the ratio of the longitudinal axis of his body to the longitudinal axis of the mother. The correct position is
  11. Problem 42. ISOSEROLOGICAL INCOMPATIBILITY OF THE BLOOD OF THE MOTHER AND THE FRUIT BY RESUSCENT FACTOR
    Pregnant K., 25 years old, turned to the antenatal clinic on March 30 about pregnancy. From the anamnesis. Menarche from 13 years old, established immediately, regular, 5 days, 23 days later. Last menstruation December 24-28, Sexual life from 19 years. The first and second pregnancies ended in childbirth, the children died antenatally from the hemolytic disease of the fetus. This pregnancy is the third, desired, in
  12. ISOSEROLOGIC INCOMPATIBILITY OF BLOOD OF MOTHER AND FRUIT BY RESUS FACTOR
    ISOSEROLOGICAL INCOMPATIBILITY OF BLOOD OF MOTHER AND FRUIT
  13. Rhesus blood system and its importance in the development of isoserological incompatibility of mother and fetal blood
    Isoserological incompatibility of the blood of the mother and the fetus most often occurs as a result of the Rh conflict, when the mother’s blood is Rh-negative and the fetal blood is Rh-positive. The Rh factor system (Rh) consists of various antigens RhD, RhC, RhE. There are varieties of Hr c, d, e, which have six main types (alleles) of Rh factor antigens. They have
  14. CELLULAR AND HUMORAL BASES OF THE IMMUNE RESPONSE. PATHOLOGY OF THE IMMUNE SYSTEM. PATHOLOGICAL CONDITIONS OF THE IMMUNE SYSTEM. Hypersensitivity Reactions
    The immune system has developed in humans as a defense mechanism against microbial infections. It provides two forms of immunity: specific and non-specific. A specific immune response protects the body from a specific pathogen. It takes effect when a non-specific immune response is exhausted.
  15. INCORRECT POSITION OF THE FRUIT OF THE OPERATION CORRECTING THE POSITION OF THE FRUIT. OBSTETRIC TURNS REMOVING THE FRUIT FOR THE PELVIC END
    ANOMALIES OF THE FETAL POSITION The position of the fetus is called correct when the axis (length) of the fetus coincides with the axis of the uterus. If the axis of the fetus crosses the axis of the uterus at any angle, an incorrect position of the fetus occurs, in which the course of labor becomes dangerous for the mother and the fetus. Incorrect positions include the transverse and oblique position of the fetus. The transverse position of the fetus is called such
  16. INCORRECT POSITION OF THE FRUIT OF THE OPERATION CORRECTING THE POSITION OF THE FRUIT. OBSTETRIC TURNS REMOVING THE FRUIT FOR THE PELVIC END
    ANOMALIES OF THE FETAL POSITION The position of the fetus is called correct when the axis (length) of the fetus coincides with the axis of the uterus. If the axis of the fetus crosses the axis of the uterus at any angle, an incorrect position of the fetus occurs, in which the course of labor becomes dangerous for the mother and the fetus. Incorrect positions include the transverse and oblique position of the fetus. The transverse position of the fetus is called such
  17. Immune Thrombocytopenia Consumption - Immune Thrombocytopenic Purpura (ITP)
    ITP is a group of diseases united by the principle of a single pathogenesis of thrombocytopenia. With this pathology, the platelet life is reduced to several hours, which is due to the action of antibodies or other immune mechanisms of their destruction. Autoimmune and hapten forms of ITP are distinguished. Autoimmune forms are: symptomatic (with systemic diseases
  18. Pathology of the immune system. Hypersensitivity reactions. Autoimmunization and autoimmune diseases. Amyloidosis. Systemic lupus erythematosus. Scleroderma. Immune Deficiency Syndrome (AIDS).
    1. Forms of immunity 1. focal 3. specific 2. diffuse 4. non-specific 2. Mechanical protection is provided by 1. skin 4. peripheral nerves 2. blood 5. vascular mucosa 3. vascular endothelium 3. Humoral non-specific components of the immune response 1. sweat 4. mesangiocytes 2. macrophages 5. lacrimal fluid 3. neutrophils 4. To establish compliance: ORGAN APPROPRIATE
  19. Mother-to-Mother Support Groups
    If several nursing mothers live next door to each other, they may become interested in creating a group for mutual support. Such mother-to-mother support groups can have the greatest effect in helping mothers continue breastfeeding after the first weeks after giving birth. Perhaps they can provide even more effective assistance than
  20. Childbirth during prolapse of small parts of the fetus, large fetus, fetal hydrocephalus
    Presentation and prolapse of the pedicle. Complications are extremely rare with head presentation, for example, with a premature and macerated fetus, as well as with twins, if there is a sharp bending of the body of the fetus with an unbent leg. If it is not possible to straighten the leg with a viable fetus, a cesarean section is indicated. The birth is large and giant. Childbirth with malformations and
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