Criteria for Antiphospholipid Syndrome: Early Pregnancy Loss, Fetal Loss, or Recurrent Pregnancy Loss?

SummaryInherited and acquired thrombophilia are associated with recurrent pregnancy loss. Recently, an increased risk for thromboembolic disease was described for patients with elevated coagulation factor VIII, but it is unknown whether there is also an association to early pregnancy loss. We therefore evaluated the relation between recurrent early pregnancy loss and levels of coagulation factor VIII. We enrolled 49 unrelated Caucasian women with a history of 2 6 early pregnancy losses and 48 healthy controls, who had delivered at least one term infant and had never experienced pregnancy loss. We determined factor V Leiden-, G20210A prothrombin-, MTHFR C677Tand A1298Cgene mutations, levels of antithrombin, protein C, protein S, factor VIII, C-reactive protein and antiphospholipid antibodies. There was a significantly higher rate of pregnancy losses in women with Antiphospholipid Syndrome (p = 0.043). Furthermore, plasma levels of coagulation factor VIII were significantly higher in cases than in controls (130.5 IU/dl ± 25.4 vs 119.5 IU/dl ± 24.1; p = 0.032) and appeared independent of Creactive protein (R = 0.146, p = 0.323 in cases; R = 0.028, p = 0.850 in controls). The relative risk for recurrent pregnancy loss in women with factor VIII levels above 151 IU/dl (90th percentile of controls) was 2.5 (0.7 – 8.9, 95 percent confidence interval), for levels above 156 IU/dl (95th percentile of controls) 3.9 (0.8 – 20.0, 95 percent confidence interval). Elevated maternal plasma levels of coagulation factor VIII tend to be associated with an increased risk for recurrent early pregnancy loss.

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Ultrasonographically documented early pregnancy loss in an Asian elephant (Elephas maximus)

Reproduction Fertility and Development ◽

10.1071/rd09305 ◽

2010 ◽

Vol 22 (7) ◽

pp. 1159 ◽

Cited By ~ 7

Author(s):

Imke Lueders ◽

Barbara Drews ◽

Cheryl Niemuller ◽

Charlie Gray ◽

Peter Rich ◽

...

Keyword(s):

Early Pregnancy ◽

Pregnancy Loss ◽

Fetal Loss ◽

Normal Pregnancy ◽

Uterine Horn ◽

Asian Elephant ◽

Early Pregnancy Loss ◽

Early Pregnancy Failure ◽

Embryonic Life ◽

Embryonic Death

Early embryonic resorption or fetal loss is known to occur occasionally in captive elephants; however, this has mostly been reported anecdotally. The present study documents the case of a 24-year-old, multiparous Asian elephant cow that suffered embryonic death and resorption at around 18 weeks of gestation. From ovulation onwards, this female was sonographically examined 58 times. Blood was collected twice weekly for progestagen determination via enzyme immunoassay. On Day 42 after ovulation, a small quantity of fluid was detected in the uterine horn, which typically indicates the presence of a developing conceptus. Repeated inspections followed what appeared to be a normal pregnancy until Day 116. However, on Day 124, signs of embryonic life were absent. Progestagen concentrations started declining two weeks later, reaching baseline levels one month after embryonic death. Retrospectively, ultrasound examination revealed several abnormalities in the uterine horn. Besides an existing leiomyoma, multiple small cystic structures had formed in the endometrium at the implantation site and later in the placenta. These pathological findings were considered as possible contributors to the early pregnancy failure. PCR for endotheliotropic elephant herpes virus (EEHV) (which had occurred previously in the herd) as well as serology for other infectious organisms known to cause abortion in domestic animals did not yield any positive results. Although no definitive reason was found for this pregnancy to abort, this ultrasonographically and endocrinologically documented study of an early pregnancy loss provides important insights into the resorption process in Asian elephants.

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Successful Pregnancy Outcome in a Patient with Antiphospholipid Syndrome : A Case Report

BIRDEM Medical Journal ◽

10.3329/birdem.v3i1.17126 ◽

2013 ◽

Vol 3 (1) ◽

pp. 44-46

Author(s):

Hasna Fahmima Haque ◽

Muhammad Abdur Rahim ◽

Mohammad Gaffar Amin ◽

Shahana Zaman ◽

Pratik Dewan ◽

...

Keyword(s):

Pregnancy Outcome ◽

Antiphospholipid Syndrome ◽

Pregnancy Loss ◽

Low Dose ◽

Recurrent Pregnancy Loss ◽

Fetal Loss ◽

Successful Pregnancy ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

High Index Of Suspicion

Antiphospholipid syndrome (APS) manifests clinically as recurrent venous or arterial thrombosis and/or fetal loss. Diagnosis requires a high index of suspicion during evaluation of women with recurrent pregnancy loss and vascular thrombosis. Low dose aspirin combined with heparin can reduce morbidity and improve the pregnancy outcome. Here we report a case of a 22 year old lady having APS who presented with arthritis, recurrent miscarriages and venous thrombosis. Birdem Med J 2013; 3(1): 44-46 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17126

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Early Pregnancy Loss: Role of Cytokines in Implantation and Possible Implications in Systemic Lupus Erythematosus and Antiphospholipid Syndrome

American Journal of Reproductive Immunology ◽

10.1111/j.1600-0897.1992.tb00826.x ◽

1992 ◽

Vol 28 (3-4) ◽

pp. 292-292

Author(s):

BORIS TARTAKOVSKY ◽

ZEV STHOEGER ◽

EDNA MOZES

Keyword(s):

Systemic Lupus Erythematosus ◽

Antiphospholipid Syndrome ◽

Early Pregnancy ◽

Lupus Erythematosus ◽

Pregnancy Loss ◽

Early Pregnancy Loss ◽

Systemic Lupus

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Antiphospholipid syndrome, heritable thrombophilia and early pregnancy loss

Textbook of Periconceptional Medicine - Reproductive Medicine and Assisted Reproductive Techniques ◽

10.3109/9780203092200.033 ◽

2008 ◽

pp. 349-356

Author(s):

Benjamin Brenner ◽

Anat Aharon ◽

Galit Sarig

Keyword(s):

Antiphospholipid Syndrome ◽

Early Pregnancy ◽

Pregnancy Loss ◽

Early Pregnancy Loss

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Association of The Mthfr C677t, Factor V (Leiden) G1961a and Prothrombin G20210a Gene Mutations with Recurrent Spontaneous Aboration (Rsa) in Duhok Province

Science Journal of University of Zakho ◽

10.25271/sjuoz.2018.6.3.509 ◽

2018 ◽

Vol 6 (3) ◽

pp. 85-88

Author(s):

Shaima S. Mohammed ◽

Rana A. Al-Timimy ◽

Jinan N. Hassan ◽

Najat T. Mahmood

Keyword(s):

Early Pregnancy ◽

Pregnancy Loss ◽

Recurrent Pregnancy Loss ◽

Factor V Leiden ◽

Pcr Amplification ◽

Mthfr C677t ◽

Genetic Mutation ◽

Prothrombin G20210a ◽

Factor V ◽

Early Pregnancy Loss

Genetic causes of thrombophilia have been suggested as a possible cause of recurrent pregnancy loss (RPL). Fifty female patients aged between 21- 40 years and experienced at least two times early pregnancy loss were enrolled in the current study. Blood samples were aspirated, infectious (TORCH), hormonal (gonadotrophines, steroids, and thyroid hormones), ultrasonic, and serological (anti-lupus and anti-phospholipid antibodies) evaluations were conducted to exclude any individual candidate who had been suspected to have causes of early pregnancy loss rather than the genetic attribute. DNA from each particular sample was extracted by components of (FVL-PTH and MTHFR)StripAssay®A kit Vienna Lab Diagnostics GmbH, Vienna, Austria).this kit includes three steps: (1) DNA isolation, (2) Multiplex PCR amplification was performed by using biotinylated primers, for detecting different mutations in the three genes of interest (FVL-PTH and MTHFR) (3) Hybridization of amplification products to a test strip containing allele-specific oligonucleotide probes immobilized as an array of parallel lines. The results revealed that 24 samples out of 50 had MTHFR C677T mutations while 2 samples only had FV (G1691A)mutation while prothrombin mutation (G20210A)has not been detected. In conclusion: genetic mutation had significant impact in patients suffered recurrent pregnancy loss.

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