Womb natural killer cell discovery could lead to screening for miscarriage risk

eLife (2017). DOI: 10.7554/eLife.31274

For the first time the functions of natural killer cells in the womb have been identified.

Researchers at the University of Warwick and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust have discovered the role that they play in preparing the womb for pregnancy.

Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.

The new study Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium which is published in eLife shows two functions of the cells not previously known.

Top miscarriage research priorities identified by women and health professionals

First study of its kind reveals what the public and health professionals want future miscarriage research to focus on.

More research is needed to improve psychological and emotional support for women and their partners affected by miscarriage, reveals a survey published in BMJ Open.

Other top priorities include research into preventative treatment, relevance of pre-existing medical conditions, importance of lifestyle factors and genetic and chromosomal causes, investigation after different numbers of miscarriage and male causal factors.

Thromboprophylaxis after miscarriage

Answer to the question What thromboprophylaxis is recommended after first trimester miscarriage? posted to the RCOG query bank.

Multi-Resolution Cell Orientation Congruence Descriptors for Epithelium Segmentation in Endometrial Histology Images

Medical Image Analysis. Available online 22 January 2017

It has been recently shown that recurrent miscarriage can be caused by abnormally high ratio of number of uterine natural killer (UNK) cells to the number of stromal cells in human female uterus lining. Due to high workload, the counting of UNK and stromal cells needs to be automated using computer algorithms. However, stromal cells are very similar in appearance to epithelial cells which must be excluded in the counting process. To exclude the epithelial cells from the counting process it is necessary to identify epithelial regions. There are two types of epithelial layers that can be encountered in the endometrium: luminal epithelium and glandular epithelium. To the best of our knowledge, there is no existing method that addresses the segmentation of both types of epithelium simultaneously in endometrial histology images. In this paper, we propose a multi-resolution Cell Orientation Congruence (COCo) descriptor which exploits the fact that neighbouring epithelial cells exhibit similarity in terms of their orientations. Our experimental results show that the proposed descriptors yield accurate results in simultaneously segmenting both luminal and glandular epithelium.

UHCW Research: Nasir M. Rajpoot

An altered endometrial CD8 tissue resident memory T cell population in recurrent miscarriage

Scientific Reports 7, Article number: 41335 (2017) doi:10.1038/srep41335

When trying to conceive 1% of couples have recurrent miscarriages, defined as three or more consecutive pregnancy losses. This is not accounted for by the known incidence of chromosomal aneuploidy in miscarriage, and it has been suggested that there is an immunological aetiology. The endometrial mucosa is populated by a variety of immune cells which in addition to providing host pathogen immunity must facilitate pregnancy. Here we characterise the endometrial CD8-T cell population during the embryonic window of implantation and find that the majority of cells are tissue resident memory T cells with high levels of CD69 and CD103 expression, proteins that prevent cells egress. We demonstrate that unexplained recurrent miscarriage is associated with significantly decreased expression of the T-cell co-receptor CD8 and tissue residency marker CD69. These cells differ from those found in control women, with less expression of CD127 indicating a lack of homeostatic cell control through IL-7 signalling. Nevertheless this population is resident in the endometrium of women who have RM, more than three months after the last miscarriage, indicating that the memory CD8-T cell population is altered in RM patients. This is the first evidence of a differing pre-pregnancy phenotype in endometrial immune cells in RM.

UHCW Research:, J. Brosens and S. Quenby

Maternity report shows trends in hospital deliveries

Hospital Maternity Activity, 2015-16, presents the number of delivery episodes during the last financial year, broken down by categories including, but not limited to:

• Method of delivery
• Age and ethnicity of the woman
• How deprived the area is where the woman lives
• Type of anaesthetic used before or during the delivery
• Length of hospital stay
• Delivery and birth complications, where appropriate
• Miscarriage and ectopic pregnancies that resulted in an NHS hospital stay.

Success after failure: the role of endometrial stem cells in recurrent miscarriage

Reproduction November 1, 2016 152 R159-R166


Endometrial stem-like cells, including mesenchymal stem cells (MSCs) and epithelial progenitor cells, are essential for cyclic regeneration of the endometrium following menstrual shedding. Emerging evidence indicates that endometrial MSCs (eMSCs) constitute a dynamic population of cells that enables the endometrium to adapt in response to a failed pregnancy. Recurrent miscarriage is associated with relative depletion of endometrial eMSCs, which not only curtails the intrinsic ability of the endometrium to adapt to reproductive failure but also compromises endometrial decidualization, an obligatory transformation process for embryo implantation. These novel findings should pave the way for more effective screening of women at risk of pregnancy failure before conception.


UHCW Research: J. J. Brossens, Emma S. Lucas and Sascha Ott

Caring for patients with pregnancy loss

The Miscarriage Association hears from thousands of women – and some men – who have been though pregnancy loss. Some are going through it when they get in touch – from home, from A&E, from the Early Pregnancy Unit waiting room.  They talk to us about their feelings and their fears. They ask questions – often about the terminology they have heard or the procedures they may face.

They also talk about the care they received from the variety of health professionals they have met along the way. And it is very clear that the kind of care that they receive can make a significant difference to how they cope with their experience of pregnancy loss.

Along with that, women and their partners tell us how much the human aspects of care matter. Kindness, understanding, clear information and sensitive language are just some of the ways that health professionals can help them cope with their experience.

Of course most health professionals work hard to provide good and sensitive care. What’s more, many of them will have been through pregnancy loss themselves and know how important this is.
Limited training budgets, staff time and cover mean that it is increasingly difficult for staff to access training, whether on or off site. The Miscarriage Association’s new online learning resources aim to fill some of those gaps.

Cervical cerclage and twin pregnancy

Answer to the question, What is the evidence for cervical cerclage in a twin pregnancy with a previous history of second trimester loss?, posted to the RCOG Query Bank.