The Influence of Antiphospholipid Antibodies on the Pregnancy Outcome of Patients With Recurrent Spontaneous Abortion

2001 ◽  
Vol 7 (4) ◽  
pp. 281-285 ◽  
Author(s):  
L. Heilmann ◽  
G.-F. v. Tempelhoff ◽  
S. Kuse
Keyword(s):  
Pregnant Women ◽  
Intravenous Immunoglobulin ◽  
Spontaneous Abortion ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Standard Therapy ◽  
Loss Rate ◽  
Fetal Loss ◽  
Negative Group ◽  
History Of

Several therapeutic regimens have been proposed for women with recurrent spontaneous abortion (RSA) and antiphospholipid antibodies (APA). Conflicting results have been reported about women with history of RSA, positive APA, and failure of standard therapy. To evaluate the use of intravenous immunoglobulin in RSA patients with APA and history of treatment failure, we initiated a study with standard therapy (aspirin and low-molecular- weight heparin) and intravenous immunoglobulin. We used an enzyme-linked immunosorbent assay (ELISA)test to screen IgG and IgM anticardiolipin antibodies, and a diluted Russel viper venom time assay for the lupus anticoagulant activity. Altogether. 66 pregnant women with positive APAs at the first visit could be included. Patients with hereditable thrainbaghilic factors were excluded. After confirmation of the pregnancy, women received a basis immunization of 0.3 g/kg immunoglobulin in a 4-week cycle until the 28th to 32nd week of gestation. All patients received 100 mg/d aspirin and 3,000 anti-Xa U/d certoparin. Among the 66 pregnant women, 17 were persistently autoantibody positive (25.8%), of whom 11 (16.7%) were ACA positive alone, 2 (3%) were lupus anticoagulant positive, and 4 (6.4%) had both antibody types. A total of 49 patients had positive APAs at the initial test, but were negative for ACA and lupus anticoagulant at the second test administered approximately 5 weeks after the start of therapy. We described this group in our following observation as "antibody negative." Sixteen of the 17 autoantibody-positive patients (94.1 %) were delivered of live infants compared with 40 patients (81.6%) in the antibody-negative group (odds ratio [OR]: 1.2; 95% CI: 0.98 to 1.4). The overall miscarriage rate was 12.1% and the fetal loss rate was 15.2%. Four patients (25%) in the antibody-positive group developed symptoms of preeclampsia and fetal growth retardation compared with four patients (9.8%) in the antibody-negative group. In conclusion. we see a reduction of the fetal loss rate in patients with RSA and positive APA (5.8%) compared with APAnegative (18.4%) women with the same therapy (OR: 0.3; 95% CI: 0.04 to 2.3).

scholarly journals Antiphospholipid Antibodies in Iraqi Women with Recurrent Mid-Trimester Abortions

2012 ◽  
Vol 4 (02) ◽  
pp. 078-082
Author(s):  
Amel AA Al-Samarrai ◽  
Ferial A Hilmi ◽  
Nasir AS Al-Allawi ◽  
Amal F Murad
Keyword(s):  
Family History ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Fetal Loss ◽  
Anticardiolipin Antibodies ◽  
Screening Tests ◽  
Trimester Abortion ◽  
History Of ◽  
Iraqi Women ◽  
Kaolin Clotting Time

ABSTRACT Purpose: Antiphospholipid antibodies are often associated with recurrent pregnancy loss, and although many studies have addressed this association in Western countries, such studies are not so frequent from developing countries. The current study aims to determine the frequency of Antiphospholipid antibodies (Anticardiolipin antibodies and Lupus anticoagulant) among Iraqi women with recurrent mid-trimester abortions and to evaluate various tests used for their detection. Materials and Methods: Two hundred women with recurrent mid-trimester abortions were randomly enrolled from a main referral center in Baghdad-Iraq. The enrollees had their IgG and IgM anticardiolipin antibodies assayed by ELISA, and Lupus anticoagulant by a combination of the following screening tests: Activated Partial Thromboplastine Time (APTT), and Partial Thromboplastine Time-LA (PTT-LA), Kaolin Clotting Time (KCT) and confirmation was made by Hexagonal phospholipid neutralization test. Results: The women were aged between 19 and 45 years (median 30 years). Fifty three (26.5%) had one or both anticardiolipin antibodies present, while 27 (13.5%) were positive for lupus anticoagulant. The KCT and KCT index appeared to be the most sensitive tests, while the KCT index and APTT were the most specific for Lupus anticoagulant. Patients with antiphospholipid antibodies had higher rates of history of thrombosis, thrombocytopenia and family history of recurrent abortion (P = 0.0009, 0.0056 and 0.0003 respectively). Conclusions: Antiphospholipid antibodies constitute an important cause of recurrent mid-trimester abortion in Iraqi women, with frequencies intermediate between Western and Indian reports. While thrombocytopenia and thrombosis are well documented associations of antiphospholipid antibodies, the significant association with family history of recurrent fetal loss is intriguing and requires further scrutiny.

Brucellosis Serostatus among Pregnant Women with Spontaneous Abortion and Stillbirth

2021 ◽  
Vol 17 ◽  
Author(s):  
Ezatollah Rafiei Alavi ◽  
Niloofar Rafiei Alavi ◽  
Romina Rafiei Alavi ◽  
Ermia Farokhi
Keyword(s):  
Pregnant Women ◽  
Spontaneous Abortion ◽  
Cross Sectional Study ◽  
Case Group ◽  
Cross Sectional ◽  
Still Birth ◽  
Rural Living ◽  
Dairy Consumption ◽  
Education Levels ◽  
History Of

Background: Brucellosis in pregnancy is associated with serious outcomes ranging from abortion to neonatal development problems. Objective: The aim of this study is to evaluate the seroprevalence of brucellosis antibodies among pregnant women presented with spontaneous abortion and still birth. Methods: In this cross-sectional study, 80 cases (still birth or spontaneous abortion) and 80 healthy pregnant women were serologically examined for brucellosis antibodies using Coombs, Wright and 2-mercaptoethanol (2ME) brucella agglutination tests. The questionnaire consisting of the following data was prepared for all the participants: gestational age, age, history of abortion, parity, source of dairy consumption, contact with livestock, urban or rural living setup, serological outcomes and education levels. Results: The two groups were not significantly different in term of brucellosis test. Patients in case group with and without infection were not significant in terms of contact with livestock, place of residence, dairy consumption and history of abortion. However, education level was significantly different in the two, seropositive and seronegative, groups. Conclusion: Our study did not find significant number of brucellosis seropositive cases associated with stillbirth and spontaneous abortion. Further studies with greater samples are therefore recommended.

scholarly journals Pregnancy outcome in patient who had first trimester bleeding in previous pregnancy: a prospective study

2020 ◽  
Vol 9 (4) ◽  
pp. 1559
Author(s):  
Faswila M. ◽  
Ramya N. R.
Keyword(s):  
Pregnancy Outcome ◽  
Preterm Delivery ◽  
Spontaneous Abortion ◽  
Adverse Pregnancy Outcome ◽  
Placenta Previa ◽  
Previous History ◽  
Fetal Loss ◽  
Previous Pregnancy ◽  
Increased Risk ◽  
History Of

Background: Patient who had history of spontaneous abortion in her previous pregnancy is associated with adverse outcome in her present pregnancy.Methods: A total 63 pregnant women attending OPD and admitted in department of obstetrics and gynecology, Yenepoya Medical College, from April 2017 to September 2017, considered and outcome were studied.Results: Out of 63 patient’s majority (57.1%) of patients belong to the age group 21-29 year. Anemia was found to be very severe in 4.3%, severe in 10% and moderate in 30% patients. Maximum patients (45.7%) were with history of previous one abortion followed by previous two abortions (38.6%). The final outcomes were term livebirth 47 (74.3%), abortion 9 (14.3%), preterm delivery 5 (8.6%), and stillbirth 2 (2.8%) caesarean section (23.3%) for various indications. 19.23% had term PROM, 9.09% had PPROM, 5.76% had term IUGR, 3.84% term IUD, preterm IUD accounts for 9.09% and still birth accounted for about 1.92% which was term, pre-eclampsia accounted for 4.76%, malpresentation for 7.93%, total 3 cases of antepartum hemorrhage out of which  placenta previa accounts for about 3.1% and abruption for 1.58%, manual removal of placenta 4.7% and low birth weight 7.6%.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss which can be reduced by booking and giving antenatal care.

scholarly journals Pregnancy outcomes after spontaneous conception with previous spontaneous abortion preceding present pregnancy

2021 ◽  
Vol 10 (8) ◽  
pp. 3035
Author(s):  
Shree Kant Dadheech ◽  
Meenakshi K. Bharadwaj ◽  
Brig Aruna Menon
Keyword(s):  
Preterm Delivery ◽  
Spontaneous Abortion ◽  
Pregnancy Outcomes ◽  
Previous History ◽  
Fetal Loss ◽  
Intrauterine Death ◽  
Spontaneous Conception ◽  
Increased Risk ◽  
History Of ◽  
Present Pregnancy

Background: The objective of the present study was to study pregnancy outcomes in patients with Spontaneous conception with history of previous spontaneous abortion preceding present pregnancy.Methods: A prospective study included patients with spontaneous conception with history of previous spontaneous abortion preceding present pregnancy admitted in the department of obstetrics and gynecology, command hospital, Pune between October 2018 and April 2020. The patients were booked (minimum 3 visits in antenatal outdoor clinic) or admitted for the first time as an emergency. The detailed history about previous abortions was taken and routine as well as investigations for possible etiologies of previous abortions were done. Cases with history of mid-trimester abortion were investigated for cervical incompetence. All the patients were observed for complications during present pregnancy like threatened abortion, preeclampsia, preterm labour, intrauterine death and final outcome.Results: A total of 110 patients with history of previous spontaneous abortion were admitted, all patients were booked. Majority (51.8 %) of patients belong to the age group 25-30 years. All patients were with history of previous one abortion followed by pregnancy with spontaneous conception. The final outcomes were term live birth (86.4%), abortion (8.2%), preterm delivery (5.4%), and no still birth. Caesarian section was done in 32.7% patients for various indications.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions. These complications and fetal loss can be reduced by booking the patients and giving due antenatal care.

Anticardiolipin Antibodies Block the Inhibition by β2-Glycoprotein I of the Factor Xa Generating Activity of Platelets

1993 ◽  
Vol 70 (02) ◽  
pp. 342-345 ◽  
Author(s):  
Wei Shi ◽  
Beng H Chong ◽  
Philip J Hogg ◽  
Colin N Chesterman
Keyword(s):  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Fetal Loss ◽  
Factor Xa ◽  
Anticardiolipin Antibodies ◽  
Recurrent Fetal Loss ◽  
Glycoprotein I ◽  
Activated Platelets ◽  
Inhibit Factor

SummaryAntiphospholipid antibodies, defined either by lupus anticoagulant (LA) activity or positive anticardiolipin immunoabsorbent assay (ACA) are associated with a predisposition to thromboses, recurrent fetal loss or thrombocytopenia. The mechanisms for these predispositions remain undefined. We have enriched immunoglobulin fractions from two patient plasmas to obtain antibodies with LA activity but no ACA, or conversely, with ACA positivity but no LA, in order to investigate in vitro characteristics which might explain a thrombotic propensity. β2-glycoprotein I (β2-GPI), the plasma cofactor required for ACA binding to negatively charged phospholipid, has previously been shown to inhibit prothrombinase generation in the presence of activated platelets (8). We now report that β2-GPI, at physiological concentrations, inhibits the generation of factor Xa in the presence of activated gel-filtered platelets. Further, ACA interferes with this inhibition, resulting in protracted, unopposed factor Xa generation. This interference with β2-GPI, a natural anticoagulant component of plasma, is potentially prothrombotic. LA immunoglobulins behave differently and inhibit factor Xa generation in a manner similar to β2-GPI. These findings provide the basis for a previously unsuspected mechanism for thrombosis in patients with aPL.

Performance of a New Global Chromogenic Assay for Protein C Pathway (HemosIL ThromboPath) in the Diagnosis of Lupus Anticoagulant and Antiphospholipid Antibodies.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2279-2279
Author(s):  
Pierre A. Toulon ◽  
Isabelle Martin-Toutain ◽  
Jean-Charles Piette ◽  
Marie-Claude Diemert ◽  
Annick Ankri
Keyword(s):  
Antiphospholipid Antibodies ◽  
Arterial Thrombosis ◽  
Lupus Anticoagulant ◽  
Control Group ◽  
Test Results ◽  
Chromogenic Assay ◽  
Apc Resistance ◽  
Significant Difference ◽  
History Of ◽  
Test Result

Abstract Background: The HemosIL ThromboPath assay (Instrumentation Laboratory) is a new chromogenic assay designed to globally evaluate the functionality of the PC pathway. It is based on the ability of endogenous APC generated after activation of PC by a snake venom extract (Protac) to reduce the thrombin generation induced by a reagent containing tissue factor. Briefly, optical density is measured after addition of a thrombin-specific chromogenic substrate in the presence (OD A) or absence (OD B) of Protac. It is recommended by the test manufacturer to express results as the Protac-Induced Coagulation Inhibition percentage (PICI%) which corresponds to the ratio [OD B - OD A]/OD B x 100. Previous studies demonstrated a high sensitivity (over 96%) for PC pathway abnormalities i.e. PC/PS deficiency, and FV Leiden-related APC Resistance, but also for lupus anticoagulant (LA), known to be associated with acquired APC Resistance. The aim of the present study was to evaluate the sensitivity of that assay for antiphospholipid antibodies (APL), especially in connection with the occurrence of thrombotic complications. Actually, APL is a heterogeneous family of antibodies which have a significant impact on coagulation tests (LA) or could be detected using ELISA anticardiolipin assays (ACL). Methods: We retrospectively evaluated the frozen plasma samples from 178 patients previously diagnosed as positive for LA or as having high ACL levels. There were 48 M and 130 F with a mean age=43 years (range 14 – 87). None was on vitamin K-antagonist. Screening for LA, performed according to the ISTH criteria (Thromb Haemost1995;74:1185), was positive in 126 patients (LA+ patients) and negative in 52 patients, all of the latter having high ACL levels (LA- patients). Among LA+ patients, 41 had antiphospholipid syndrome (APS) i.e. 18 with a history of venous thrombosis (VT), 10 with arterial thrombosis (AT), 7 with obstetrical complication (OB) and 6 with combined vascular complications (CVC). The same applied to 39 LA- patients with high APL levels i.e. VT (n=13), AT (n=8), OB (n=12) and CVC (n=6). The control group consisted of 29 age- and sex-matched healthy subjects without a history of vascular or auto-immune disease. The HemosIL ThromboPath assay was performed by an operator blinded of the specific biological test results and of the clinical status of the patients. Results: Test result was significantly lower in LA+ patients than in LA- patients or in healthy controls (Table). Similarly, the percentage of abnormal test results i.e. PICI% below 85.0% as the cut-off value, was significantly higher in LA+ patients than in the two other groups (p<0.0001 in both cases). That cut-off value for the PICI% was determined, according to the recommendations of the reagent manufacturer, as the mean minus 1 SD of the values measured in the plasma of 29 healthy control subjects. Despite significantly lower PICI% in LA- patients than in controls (p<0.05), the proportion of abnormal test results was not significantly different (p<0.10) in these two groups. LA+ Patients (n=126) LA-Patients (n=52) Controls (n=29) Test Result (PICI%) 74.5 ± 13.1 86.7 ± 9.4 90.3 ± 5.3 PICI%<85% (n, %) 99 (78.6%) 15 (28.8%) 3 (10.3%) Moreover, test result was not significantly different in LA+ patients with and without a history of vascular thrombosis (PICI%=74.4 ± 12.9, n=51 vs. 74.5 ± 13.5 n=75, p=0.91) and the same applied for the percentage of abnormal test results (n=41/51 (80.4%) vs. n=58/75 (77.3%); p=0.83). There was no significant difference between LA+ patients with venous, arterial thrombosis and obstetrical complications. Conclusion: The HemosIL ThromboPath assay was highly sensitive for LA (78.6%) but it did not allow to distinguish between LA+ patients those with APS. It was found to be weakly sensitive (28.8%) to high ACL levels without LA activity, despite a higher percentage of abnormal test results. The potential interest of the HemosIL ThromboPath assay as part of the screening strategy of LA deserves to be further investigated prospectively.

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