Introduction
Chronic histiocytic intervillositis (CHI) is a rare placental disorder
that affects approximately 1 in 600 pregnancies.1 It
is diagnosed when at least 5% of the intervillous space is occupied by
maternal CD68+ immune cells (histiocytes) and is often accompanied by
massive perivillous fibrin deposition.2 CHI is
strongly associated with miscarriage (24%), stillbirth (29%), fetal
growth restriction (72%) and preterm birth (68%).2It carries a high risk of recurrence in subsequent
pregnancies.1,2
The aetiology of CHI is unclear, but its association with maternal
autoimmunity and its histological similarity to rejected solid organ
allografts suggest a maternal immune “rejection” of the
placenta.3
While maternal immunosuppression reduces the histological severity of
CHI and can improve live birth rate,4 some patients
have refractory disease in which every successive pregnancy is affected.
In these women, gestational surrogacy offers an alternative route to
parenthood. However, there is only one published case of successful
surrogate pregnancy in this context.5
We report the outcomes of 17 surrogate pregnancies in which the embryos
came from 13 women with recurrent adverse pregnancy outcomes due to CHI
(n=54).