scholarly journals Prevention of Pregnancy Complications in Antiphospholipid Syndrome

2020 ◽  
Vol 40 (02) ◽  
pp. 174-183
Author(s):  
Andreas Czwalinna ◽  
Frauke Bergmann
Keyword(s):  
Antiphospholipid Syndrome ◽  
Pregnancy Complications ◽  
Antiphospholipid Antibodies ◽  
Birth Rate ◽  
Clinical Symptoms ◽  
Adverse Pregnancy Outcome ◽  
Live Birth Rate ◽  
Obstetric Antiphospholipid Syndrome ◽  
Adverse Pregnancy ◽  
Definition Of

AbstractDespite a lot of research on antiphospholipid antibodies (aPL), standardization of test systems, and better definition of its clinical symptoms, the pathomechanism of this acquired autoimmune disease is not yet fully explained. Progress in treatment increased the live birth rate in 70 to 80% of women suffering from obstetric antiphospholipid syndrome (OAPS). However, still 20 to 30% will develop adverse pregnancy outcome. Lack of awareness of this disorder as the cause for pregnancy complications is very harmful to mothers and to their newborns. Complications can be avoided or minimized by proper treatment. The aim of this article is to increase the awareness of gynecologists and medical personal for OAPS.

scholarly journals POS0737 LOW PRECONCEPTIONAL COMPLEMENT LEVEL IS RELATED WITH ADVERSE OBSTETRIC OUTCOME IN A MULTICENTRIC COHORT OF PREGNANCY IN PATIENTS WITH APS AND APL POSITIVITY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 619.2-620
Author(s):  
D. Lini ◽  
C. Nalli ◽  
L. Andreoli ◽  
F. Crisafulli ◽  
M. Fredi ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Complement Activation ◽  
Pregnancy Complications ◽  
Antiphospholipid Antibodies ◽  
Pregnancy Loss ◽  
Adverse Pregnancy Outcome ◽  
Obstetric Outcome ◽  
Complement Level ◽  
Increased Risk ◽  
Adverse Pregnancy

Background:The role of complement in the antiphospholipid (aPL) related pathology has been widely studied in animal models. Antiphospholipid antibodies can induce fetal loss in experimental animals but mice deficient in specific complement components (C4, C3, C5) appear somehow protected. In addition, in pregnant mice injected with aPL, antibody deposition has been found at decidual level causing focal necrosis, apoptosis and neutrophil infiltrates and supporting aPL pathogenetic potential. On the other hand, human studies did find hypocomplementemia associated to pregnancy complications in patients with obstetric antiphospholipid syndrome (APS). These results, however, are not unanimously confirmed and, in addition, some studies only show increased levels of complement activation products (i.e. Bb) and not decreased levels of C3 and/or C4. A recently study focusing on complement level in early pregnancy and before pregnancy showed a significant correlation with pregnancy complications and loss in a large cohort of primary APS.Objectives:To investigate if the simple detection of low C3 and/or C4 could be considered a risk factor for adverse pregnancy outcome in APS and aPL carriers pregnancies.Methods:We performed a multicentric study including patients from 10 Italian and 1 Russian Centers. Data on pregnancies in women with primary APS (n=434) and asymptomatic carriers with persistently positive aPL but not fulfilling clinical criteria for APS (n=218) were retrospectively collected. Serum C3 and C4 levels were evaluated by nephelometry; hypocomplementemia was defined by local laboratory reference values. Statistical analysis was performed using GraphPad.Results:Preconceptional complement levels and gestational outcome were available for 107 (25%) pregnancies in APS out of 434 and for 196 (90%) pregnancies in aPL carriers women out of 218. In pregnancies with low preconceptional C3 and/or C4, a significantly higher prevalence of pregnancy losses was observed (p=0.019). A subgroup analysis focusing on triple aPL positive patients was also performed. Preconceptional low C3 and/or C4 levels were found to be associated with an increased rate of pregnancy loss (p = 0.027) in this subgroup also. Otherwise, adverse pregnancy outcomes in single or double aPL positive women were not related to preconception complement levels (p = 0.44) (Table 1). Of note, all the pregnancy losses in the triple positive group occurred in patients treated with low dose aspirin and low molecular weight heparin from the time of positive pregnancy test.Conclusion:Our findings confirm that decreased complement levels before pregnancy are associated with increased risk of adverse outcome. This has been seen only in in women with triple aPL positivity, indeed single or double positivity does not show this trend. Complement levels are cheap and easy to be measured therefore they could represent a useful aid to identify patients at increased risk of pregnancy loss. test positivity.References:[1]De Carolis S, et al. Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome. Lupus (2012) 21:776–8.[2]Kim MY, et al. Complement activation predicts adverse pregnancy outcome in patients with systemic lupus erythematosus and/or antiphospholipid antibodies. Ann Rheum Dis (2018) 77:549–55.[3]Fredi M, et al. Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies. Front Immunol. 2018 May 7;9:864.Triple aPL positivitySingle or double aPL positivityGestational outcomeLow C3/C4 (n=49)Normal C3/C4(n=17)pLow C3/C4 (n=57)Normal C3/C4(n=165)pTerm live birth (>37w)15 (31%)6 (35%)ns34 (60%)110 (67%)nsPreterm live birth (≤37w)22 (45%)11 (65%)ns15 (26%)38 (23%)nsPregnancy losses (abortion and miscarriages)12 (24%)0 (0%)0.0278 (14%) 17 (10%)nsDisclosure of Interests:None declared

scholarly journals Does Adjusted Global Antiphospholipid Syndrome Score (aGAPSS) Predict the Obstetric Outcome in Antiphospholipid Antibody Carriers? A Single-Center Study

2021 ◽  
Author(s):  
Sara Del Barrio-Longarela ◽  
Víctor M. Martínez-Taboada ◽  
Pedro Blanco-Olavarri ◽  
Ana Merino ◽  
Leyre Riancho-Zarrabeitia ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Antiphospholipid Syndrome ◽  
Adverse Pregnancy Outcome ◽  
Clinical Manifestations ◽  
Live Birth Rate ◽  
Response To Treatment ◽  
Antiphospholipid Antibody ◽  
Single Center Study ◽  
Patients At Risk ◽  
Adverse Pregnancy

AbstractThe adjusted Global Antiphospholipid Syndrome (APS) Score (aGAPSS) is a tool proposed to quantify the risk for antiphospholipid antibody (aPL)-related clinical manifestations. However, aGAPSS has been validated mainly for thrombotic events and studies on APS-related obstetric manifestations are scarce. Furthermore, the majority of them included patients with positive aPL and different autoimmune diseases. Here, we assess the utility of aGAPSS to predict the response to treatment in aPL carriers without other autoimmune disorders. One-hundred and thirty-seven women with aPL ever pregnant were included. Sixty-five meet the APS classification criteria, 61 had APS-related obstetric manifestations, and 11 were asymptomatic carriers. The patients’ aGAPSS risk was grouped as low (< 6, N = 73), medium (6–11, N = 40), and high risk (≥ 12, N = 24). Since vascular risk factors included in the aGAPSS were infrequent in this population (< 10%), the aGAPSS score was mainly determined by the aPL profile. Overall, the live birth rate was 75%, and 37.2% of the patients had at least one adverse pregnancy outcome (APO). When considering patients according to the aGAPSS (high, medium, and low risk), no significant differences were found for pregnancy loss (29.2%, 25%, and 21.9%) or APO (33.3%, 47.5%, and 32.9%). In the present study, including aPL carriers without other autoimmune diseases, aGAPSS is not a valuable tool to identify patients at risk for obstetric complications despite treatment. In these patients with gestational desire, in addition to the aPL profile, other pregnancy-specific factors, such as age or previous obstetric history, should be considered.

Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies

2018 ◽  
Vol 151 (6) ◽  
pp. 215-222 ◽  
Author(s):  
Jaume Alijotas-Reig ◽  
Enrique Esteve-Valverde ◽  
Raquel Ferrer-Oliveras ◽  
Elisa LLurba ◽  
Amelia Ruffatti ◽  
...  
Keyword(s):  
Comparative Study ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Obstetric Morbidity ◽  
Obstetric Antiphospholipid Syndrome

Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia

2011 ◽  
Vol 105 (02) ◽  
pp. 295-301 ◽  
Author(s):  
Jantien Visser ◽  
Veli-Matti Ulander ◽  
Frans Helmerhorst ◽  
Katja Lampinen ◽  
Laure Morin-Papunen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Live Birth ◽  
Pregnancy Complications ◽  
Birth Rate ◽  
Neonatal Outcome ◽  
Recurrent Miscarriage ◽  
Fetal Loss ◽  
Live Birth Rate ◽  
First Trimester ◽  
Significant Difference

SummaryRecurrent miscarriage affects 1–2% of women. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment. A randomised double-blind (for aspirin) multicentre trial was performed among 207 women with three or more consecutive first trimester (<13 weeks) miscarriages, two or more second trimester (13–24 weeks) miscarriages or one third trimester fetal loss combined with one first trimester miscarriage. Women were analysed for thrombophilia. After complete work-up, women were randomly allocated before seven weeks’ gestation to either enoxaparin 40 mg and placebo (n=68), enoxaparin 40 mg and aspirin 100 mg (n=63) or aspirin 100 mg (n=76). The primary outcome was live-birth rate. Secondary outcomes were pregnancy complications, neonatal outcome and adverse effects. The 0.92–1.48] was found for enoxaparin and placebo and 65% [RR 1.08, 95% CI 0.83–1.39] for enoxaparin and aspirin when compared to aspirin alone (61%, reference group). In the whole study group the live birth rate was 65% (95% CI 58.66–71.74) for women with three or more miscarriages (n=204). No difference in pregnancy complications, neonatal outcome or adverse effects was observed. No significant difference in live birth rate was found with enoxaparin treatment versus aspirin or a combination of both versus aspirin in women with recurrent miscarriage.

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

2019 ◽  
Vol 29 (6) ◽  
pp. 1021-1031 ◽  
Author(s):  
Anastasios Tranoulis ◽  
Dimitra Georgiou ◽  
Ahmad Sayasneh ◽  
John Tidy
Keyword(s):  
General Population ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Obstetric Outcomes ◽  
Gestational Trophoblastic Neoplasia ◽  
Stillbirth Rate ◽  
Multi Agent ◽  
Adverse Pregnancy

IntroductionGestational trophoblastic neoplasia represents a rare placental malignancy spectrum that is treated with single- or multi-agent chemotherapy. This disease often impacts women of childbearing age, making post-chemotherapy fertility and obstetrical outcomes an important consideration. We aimed to ascertain the pregnancy rates and obstetric outcomes in women with gestational trophoblastic neoplasia after undergoing treatment with chemotherapy.MethodsA systematic literature review was conducted to identify studies that reported post-chemotherapy fertility and obstetric outcomes among women with gestational trophoblastic neoplasia. We performed a single-proportion meta-analysis for the outcomes of conception/pregnancy rate, term live birth rate, first and second trimester spontaneous abortions rate, stillbirth rate, premature delivery rate, and fetal/neonatal malformation rate.ResultsA total of 27 studies were included in the analysis. The median age ranged between 25.5 and 33.1 years. The pregnancy rate among women with a desire to conceive, comprising a total of 1329 women and 1192 pregnancies, was 86.7% (95% CI 80.8% to 91.6%). The term live birth rate in 6752 pregnancies was 75.84% (95% CI 73.4% to 78.2%). The adverse pregnancy outcomes were seemingly comparable to those of the general population apart from a minor increase in the stillbirth rate. The pooled proportion for the outcome of malformation rate was 1.76% (95% CI 1.3% to 2.2%). The repeat mole rate in 6384 pregnancies was 1.28% (95% CI 0.95% to 1.66%). Subsequent sub-group analysis indicated that neither multi-agent chemotherapy nor conception within 12 months post-chemotherapy increased the adverse obstetric events risk or fetal malformations.ConclusionsNearly 90% of patients desiring future fertility after chemotherapy for gestational trophoblastic disease were able to conceive. In addition, adverse pregnancy outcomes were similar to that in the general population. Multi-agent chemotherapy does not seemingly increase the malformation rate.

Correlations between TORCH infections and antiphospholipid antibodies in spontaneous abortion

2020 ◽  
Vol 19 (4) ◽  
pp. 92-98
Author(s):  
E.N. Kravchenko ◽  
◽  
L.V. Kuklina ◽  
G.V. Krivchik ◽  
O.Yu. Tsygankova ◽  
...  
Keyword(s):  
Spontaneous Abortion ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Clinical Symptoms ◽  
Annexin V ◽  
Reciprocal Relation ◽  
Strong Positive Correlation ◽  
Positive Correlation ◽  
Torch Infection ◽  
Torch Infections

Objective. To study correlations between TORCH infections and antiphospholipid antibodies in spontaneous abortion. Patients and methods. We analysed 137 medical records of women with histories of abortion, who were divided into two groups according to the presence/absence of plasmapheresis in their treatment regimens at the stage of pregravid preparation with subsequent ranking to two subgroups according to the presence/absence of an active TORCH infection. Results. A moderate positive correlation was found between the levels of TORCH infection markers and IgМ against cardiolipin, IgМ against annexin V, IgМ against phospholipids. The maximal values of a strong positive correlation was noted in the pairs «TORCH – anticardiolipin IgG» as one of the most specific markers of antiphospholipid syndrome (APS) and «TORCH – antiphospholipid IgG» as the less specific antibodies, whose concentrations significantly increase in case of a TORCH infection, irrespective of the presence of APS. The presence of antibodies against a TORCH infection and correlations between them have shown a reciprocal relation between the markers of a TORCH infection and anticardiolipin IgG, anti-b2-glycoprotein-1 IgG, and TORCH – antiphospholipid IgG. Conclusion. TORCH infections are associated with higher titers of antiphospholipid antibodies, which in certain cases might lead to the appearance of the clinical symptoms of antiphospholipid syndrome. Key words: antiphospholipid antibodies, antiphospholipid syndrome, miscarriage, plasmapheresis, TORCH infection

scholarly journals 748: Antiphospholipid antibodies characteristics and adverse pregnancy outcome

2017 ◽  
Vol 216 (1) ◽  
pp. S434-S435
Author(s):  
Eran Hadar ◽  
Hadas Zafrir-Danieli ◽  
Dorit Blickstein ◽  
Rony Chen ◽  
Arnon Wiznitzer ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Antiphospholipid Antibodies ◽  
Adverse Pregnancy Outcome ◽  
Adverse Pregnancy
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