Chronic histiocytic intervillositis (CHI) is a pregnancy disorder characterized by infiltration of maternal macrophages into the intervillous space of the human placenta, often with accompanying perivillous fibrin deposition. CHI is associated strongly with foetal growth restriction and increased risk of miscarriage and stillbirth. Although rare, affecting 6 in every 10 000 pregnancies beyond 12 weeks’ gestation, the rate of recurrence is high at 25%–100%. To date, diagnosis of CHI can only be made post‐delivery upon examination of the placenta due to a lack of diagnostic biomarkers, and criteria vary across publications. No treatment options have shown proven efficacy, and CHI remains a serious obstetric conundrum. Although its underlying aetiology is unclear, due to the presence of maternal macrophages and the reported increased incidence in women with autoimmune disease, CHI is hypothesized to be an inappropriate immune response to the semi‐allogeneic foetus. Given this lack of understanding, treatment approaches remain experimental with limited rationale. However, there is recent evidence that immunosuppression and antithrombotic therapies may be effective in preventing recurrence of associated adverse pregnancy outcomes. With similarities noted between the pathological features of CHI and acute rejection of solid organ transplants, further investigation of this hypothesis may provide a basis for tackling CHI and other immune‐related placental conditions. This review will explore parallels between CHI and allograft rejection and identify areas requiring further confirmation and exploitation of this comparison.

中文翻译：

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慢性组织细胞绒毛间炎：与同种异体移植排斥相当的免疫耐受崩溃？

慢性组织细胞绒毛间炎（CHI）是一种妊娠性疾病，其特征是母体巨噬细胞浸润到人胎盘的绒毛间隙，通常伴有绒毛周纤维蛋白沉积。CHI 与胎儿生长受限以及流产和死产风险增加密切相关。虽然这种情况很少见，每 10 000 例妊娠超过 12 周的妊娠中就有 6 例受累，但复发率高达 25%–100%。迄今为止，由于缺乏诊断生物标志物，CHI 的诊断只能在产后检查胎盘时做出，而且不同出版物的标准也有所不同。目前还没有任何治疗方案被证明有效，CHI 仍然是一个严重的产科难题。尽管其根本病因尚不清楚，但由于母体巨噬细胞的存在以及据报道患有自身免疫性疾病的女性发病率增加，CHI 被假设为对半同种异体胎儿的不适当的免疫反应。由于缺乏了解，治疗方法仍处于试验阶段，其合理性有限。然而，最近有证据表明免疫抑制和抗血栓治疗可能有效预防相关不良妊娠结局的复发。鉴于 CHI 的病理特征与实体器官移植的急性排斥之间存在相似性，对该假设的进一步研究可能为解决 CHI 和其他免疫相关胎盘疾病提供基础。本综述将探讨 CHI 和同种异体移植排斥之间的相似之处，并确定需要进一步确认和利用这一比较的领域。