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NUH Therapy for women who miscarry

11-Sep-2010 (Sat) The Straits Times

By Lee Hui Chieh

Mums-to-be with history of multiple miscarriages gain from method used on autoimmune diseases

Ms Chu with her husband Al Tan and their baby Trent. After three miscarriages, she finally delivered the healthy child about two months ago with NUH's help.

HOUSEWIFE Sue Chu, 34, had three miscarriages in three years before she finally delivered a healthy baby about two months ago.

The problem, her doctors at National University Hospital (NUH) found, had been high levels of a type of white blood cell which caused the miscarriages in the first trimester.

Now, NUH can help women like Ms Chu through a therapy normally used to treat autoimmune diseases such as arthritis.

Autoimmune diseases occur when the body's immune system goes awry and attacks the body, instead of disease-causing bacteria and viruses.

To tame the natural killer cells in her blood, Ms Chu was given intravenous doses of antibodies.

Normally, the natural killer cell attacks infections or foreign bodies. In a pregnant woman, it switches its role to help grow the placenta, an organ that attaches the foetus to the mother's womb.

But in women with high levels of the natural killer cell, the cell stays in 'attack mode' and prevents the foetus - half of which is made up of foreign cells from the father - from attaching to the womb.

It is not known why some women have high levels of this cell, or why it malfunctions when they are pregnant.

The intravenous immunoglobulin therapy lowers the cell levels and dampens its aggressiveness, explained Dr Sheila Vasoo, 40, a consultant with NUH's rheumatology division, who was part of the team that treated Ms Chu.

Previously, no treatment was available here to help women with this condition.

Ms Chu's gynaecologist, Associate Professor Mahesh Choolani, 47, senior consultant at NUH's obstetrics and gynaecology department, said: 'Before this, our only advice to them was to try again.'

NUH started using this method last year, after studies in countries in North America and Europe in the last five years found it helped some women who had suffered from recurrent miscarriages.

For example, in a 2005 study in the United States on 99 women who had had at least three miscarriages, 84 per cent of those given intravenous immunoglobulin before conceiving, and monthly during pregnancy, gave birth successfully.

Among those who declined the treatment, only 10 per cent had babies.

Ms Chu is the second woman successfully helped by NUH, which is now using the therapy on eight other pregnant women.

Thomson Medical Centre, the one other obstetrics centre which has used it once, said the patient still miscarried.

Singapore General Hospital and Mount Elizabeth Hospital do not offer the treatment, nor does Raffles Hospital, which said its effectiveness has not been proven in randomised, controlled trials.

A few patients can suffer from mild, temporary side effects such as rashes and muscle aches.

But Ms Chu and her husband of six years, technologist Al Tan, 34 - who had been trying for a baby since 2007 - jumped at the chance.

'When I had the first two miscarriages, we just thought that miscarriages were quite common. But after the third time, we thought, there's something wrong,' she said.

She saw Dr Anita Lim, 41, a consultant rheumatologist at NUH, who tested her and offered the therapy.

Mr Tan said: 'We accepted the diagnosis as there's a solution. We understood it to be a safe procedure.'

Ms Chu said: 'We love babies, and the difficulties made us more determined. I had to try, I couldn't just give up.'

All it took were two four-hourly infusions of antibodies, in the second and third month of her pregnancy, after which the placenta and foetus grew normally.

Ms Chu was given a check-up every week, far more often than the usual mother-to-be, said Prof Choolani. The treatment does not come cheap, though. Each infusion costs $2,000 to $2,500.

Cradling baby Trent in her arms, Ms Chu said: 'It's so worthwhile. I'm over the moon. We want to have at least one more child.'