scholarly journals Evaluation of the severe preeclampsia classification criterion for antiphospholipid syndrome in a study of 40 patients

2021 ◽  
Author(s):  
Maddalena Larosa ◽  
Veronique Le Guern ◽  
Nathalie Morel ◽  
Mériem Belhocine ◽  
Amelia Ruffatti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Preterm Delivery ◽  
Antiphospholipid Syndrome ◽  
Antibody Test ◽  
Placental Insufficiency ◽  
Large Series ◽  
Severe Preeclampsia ◽  
First Episode ◽  
Classification Criterion ◽  
Rheumatology Unit

Abstract Background The criteria for antiphospholipid syndrome (APS) include severe preeclampsia and/or placental insufficiency leading to preterm delivery before 34 weeks of gestation, but this APS manifestation has been rarely studied. Thus, we reported a large series of severe preeclampsia occurred in patients with APS. Methods We retrospectively analysed data of APS women (Sydney criteria) who experienced severe preeclampsia with delivery before 34 weeks' gestation between 2000 and 2017 at five French internal medicine departments and one Italian rheumatology unit. Results The 40 women had a mean age of 30.5 ± 4.6 years at their first episode of preeclampsia; 21 were nulligravid (52.5%), 12 (30%) had already been diagnosed with APS, and 21 (52.5%) had a triple-positive antiphospholipid (aPL) antibody test.

scholarly journals Evaluation of the severe preeclampsia classification criterion for antiphospholipid syndrome in a study of 40 patients

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Maddalena Larosa ◽  
Véronique Le Guern ◽  
Nathalie Morel ◽  
Mériem Belhocine ◽  
Amelia Ruffatti ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Gestational Age ◽  
Lupus Erythematosus ◽  
Placental Abruption ◽  
Antibody Test ◽  
Severe Preeclampsia ◽  
First Episode ◽  
Foetal Death ◽  
Rheumatology Unit

Abstract Background The criteria for antiphospholipid syndrome (APS) include severe preeclampsia and/or placental insufficiency leading to preterm delivery before 34 weeks of gestation, but this APS manifestation has been rarely studied. Thus, we report a series of severe preeclampsia occurred in patients with APS. Methods We retrospectively analysed data of women with APS (Sydney criteria) who experienced severe preeclampsia with delivery before 34 weeks’ gestation between 2000 and 2017 at five French internal medicine departments and one Italian rheumatology unit. Results The 40 women had a mean age of 30.5 ± 4.6 years at their first episode of preeclampsia; 21 were nulligravid (52.5%), 12 (30%) had already been diagnosed with APS, and 21 (52.5%) had a triple-positive antiphospholipid (aPL) antibody test. Preeclampsia occurred at a median gestational age of 25.5 weeks (IQR 23-29). It was associated with HELLP in 18 cases (45%), eclampsia in 6 (15%), placental abruption in 3 (7.5%), catastrophic APS in 3 (7.5%), and foetal and neonatal death in 11 and 15 cases. Overall, 14 (35%) children survived, born at a median gestational age of 31 weeks. Among other APS criteria, 16 women (40%) experienced at least one thrombosis, 17 (42.5%) an intrauterine foetal death, and 19 (47.5%) at least one episode of HELLP during follow-up (median 5 years, IQR = 2-8). None had three or more consecutive miscarriages. Notably, 12 women (30%) had systemic lupus erythematosus. Conclusions Severe preeclampsia led to high mortality in the offspring. Almost half of these women experienced other APS features, but not three consecutive miscarriages.

scholarly journals AB0433 HIGH RISK OF MATERNAL THROMBOTIC AND SEVERE HEMORRHAGIC COMPLICATIONS IN 119 PROSPECTIVE PREGNANCIES ASSOCIATED WITH ANTIPHOSPHOLIPID SYNDROME (GR2 STUDY)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1515.1-1516
Author(s):  
A. Murarasu ◽  
V. Le Guern ◽  
G. Guettrot Imbert ◽  
E. Pasquier ◽  
C. Yelnik ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Preterm Delivery ◽  
Antiphospholipid Syndrome ◽  
Postpartum Period ◽  
Lupus Anticoagulant ◽  
Placental Insufficiency ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Research Support

Background:Women are at higher risk of thrombotic or severe bleeding complications during pregnancy, especially in the postpartum period (around 1%), but no prospective data have been available for women with antiphospholipid syndrome (APS). We report the first results of the French GR2 prospective study of pregnancy and rare diseases.Objectives:To describe the thrombotic and haemorrhagic events in APS patients included in the GR2 study and to identify risk factors associated with these complications.Methods:Women with APS and an ongoing pregnancy at 12 weeks of gestation were eligible for prospective inclusion in the GR2 study. Exclusion criteria were proteinuria (ratio > 1 g/g), serum creatinine > 100 µmol/L, or a multifetal pregnancy. Severe bleeding was defined as the need for transfusion, intensive care admission, or invasive treatment. Uteroplacental vascular insufficiency was defined as intrauterine growth restriction, preeclampsia, or HELLP syndrome.Results:The study included 119 pregnancies in 119 APS patients (53% thrombotic and 47% obstetric only APS). Treatment included aspirin (99%) and heparin (98%, in the therapeutic range for 50%).Twelve women (10%) had a thrombotic (n=5) and/or a severe haemorrhagic event (n=9).The thrombotic events included stroke (at 11 weeks; n=1), catastrophic APS (CAPS) (n=2), a pulmonary embolism (n=1), and portal vein thrombosis (n=1)(in the postpartum). Placental insufficiency was also present in 6 of these 12 women.Among the 22 (18.5%) women with at least one bleeding event (n=28), 9 (7.6%) had events defined as severe. Six of nine (67%) severe haemorrhages occurred in the postpartum and were directly related to the delivery. Two required an intrauterine balloon tamponade, two uterine arterial embolisation, and three surgery, including one hysterectomy.No women died.Finally, thrombotic and/or severe bleeding events during the postpartum period (n=9) were more frequent in women with lupus anticoagulant (14% versus 0%; P=0.01), with associated placental insufficiency (29% versus 3%; P=0.001) and with preterm delivery ≤34 weeks (33% versus 4%, P=0.002).Conclusion:Even though most women in our cohort received treatment based on current recommendations, a substantial number of maternal thrombotic and haemorrhagic events (10%) occurred. Despite several life-threatening complications, including CAPS, no women died.Most of the thrombotic or haemorrhagic events occurred in the peripartum period, and they were more frequent in women with the lupus anticoagulant, placental insufficiency, and preterm delivery.Although this morbidity rarely appears preventable, knowledge of the risk factors should increase awareness and help physicians to manage APS patients at particularly high risk.Disclosure of Interests:Anne Murarasu: None declared, Véronique LE GUERN Grant/research support from: UCB for GR2 study (to our institution), Gaêlle Guettrot Imbert: None declared, Elisabeth Pasquier: None declared, cecile yelnik: None declared, Viviane Queyrel: None declared, Nicolas Schleinitz: None declared, Nicole Ferreira-Maldent: None declared, Vincent Langlois: None declared, Geoffrey Urbanski: None declared, Catherine Deneux-Tharaux: None declared, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution

THE RELATIONSHIP BETWEEN THE ONSET OF SEVERE PREECLAMPSIA AND PERINATAL COMPLICATIONS AT RUMKITAL Dr. RAMELAN IN SURABAYA

2021 ◽  
Vol 5 (2) ◽  
pp. 139
Author(s):  
Widya Retno ◽  
Ivon Diah Wittiarika ◽  
Muhammad Aldika Akbar
Keyword(s):  
Preterm Delivery ◽  
Early Onset ◽  
Late Onset ◽  
Previous History ◽  
Severe Preeclampsia ◽  
P Value ◽  
Chronic Hypertension ◽  
Perinatal Complications ◽  
Exact Test ◽  
The Relationship

 Abstract Background: Preeclampsia is one of the biggest causes of maternal-fetal morbidity and mortality. Based on the prognosis, the classification of Preeclampsia is early onset (<34 weeks) and late onset (> 34 weeks). Purpose: to investigate the relationship between the onset of severe Preeclampsia and perinatal complications. Method: This research is a quantitative study with a retrospective observational analytic study type and collected medical record data. The study population was severe Preeclampsia  patients who gave birth at RUMKITAL Dr. Ramelan Surabaya for the period January 2018 - June 2020 and has no previous history of chronic hypertension. The research sample was 79 subjects with 44 subjects early onset, and 35 subjects late onset. Perinatal complications  examined are preterm delivery, asphyxia, LBW, IUGR, stillbirth. The chi-square test or Fisher’s Exact Test was used to analyze relationships. Result: From the results of the study, the comparison of the percentage from early onset and late onset that experienced complications was 93.2% vs 48.6%, p-value = 0.000, OR = 14.5, CI = 3,764–55,635.  At preterm delivery, it was found that 75% vs 28.6%, p-value = 0.000,  OR = 7.5, CI = 2,754-20,422. . In asphyxia, it was found 41.7% vs 31.4%, p-value = 0.46. At LBW, it was found 72.7% vs 17.1%, p-value = 0,000, OR = 12.9, CI = 4,285-38,771. In IUGR, it was found that 15.9% vs 2.9%, p-value = 0.000. In stillbirth, it was found 18.2% vs 0% and p-value = 0.008. Conclusion: the onset of severe Preeclampsia is related with perinatal complications. Complications associated with the onset severe Preeclampsia are preterm, LBW, stillbirth. Meanwhile, complications that are not related with the onset severe Preeclampsia are asphyxia and IUGR  

Pregnancy outcomes in systemic lupus erythematosus (SLE) women

2019 ◽  
Vol 40 (3) ◽  
Author(s):  
Aida Kalok ◽  
Rizna Abdul Cader ◽  
Ima Indirayani ◽  
Abdul Kadir Abdul Karim ◽  
Shamsul Azhar Shah ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Preterm Delivery ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Foetal Loss ◽  
Active Disease ◽  
In Pregnancy

Abstract Background Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory condition with multi-organ involvement predominantly affecting young women. There are very limited studies in pregnancy in Asian SLE patients and therefore we embarked on this study to identify pregnancy outcomes of Malaysian women with SLE. Materials and methods We performed a retrospective study of pregnancy outcomes in SLE patients in our institution from January 2007 to December 2014. A total of 71 pregnancies from 44 women were analysed. Results The mean age of our cohort was 30.5 ± 3.9 years. The rate of active disease at conception, antiphospholipid syndrome and lupus nephritis were 22.5%, 32.4% and 57.7% respectively. SLE flare occurred in 33 out of 71 pregnancies whereas 19 pregnancies were complicated with preeclampsia. The livebirth rate for our cohort was 78.9%, whilst preterm delivery was 42.9%. On univariate analysis, active disease and flare in pregnancy were both strongly associated with foetal loss and preterm delivery. Lupus nephritis (p = 0.011), SLE flare (p = 0.008) and antiphospholipid syndrome (p = 0.032) significantly increased the risk of preeclampsia. Aspirin and hydroxychloroquine were protective against foetal loss [odds ratio (OR) 0.12] and preeclampsia (OR 0.25), respectively. On multivariate analysis, active disease was a predictor of SLE flare (p = 0.002) and foetal loss (p = 0.018) and SLE flare was the main predictor of preterm delivery (p = 0.006). Conclusions Pregnancies in women with SLE should be planned and aspirin and HCQ use were beneficial in reducing adverse pregnancy outcomes.

Clozapine induced diarrhea

2017 ◽  
Vol 41 (S1) ◽  
pp. s502-s502
Author(s):  
S. Ramos-Perdigues ◽  
M.J. Gordillo ◽  
C. Caballero ◽  
S. Latorre ◽  
S.V. Boned ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Differential Diagnosis ◽  
Therapeutic Option ◽  
Disease Diagnosis ◽  
First Episode ◽  
Psychotic Episode ◽  
Histological Findings ◽  
Anticholinergic Effects ◽  
Severe Diarrhea ◽  
Competing Interest

IntroductionClozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.ObjectivesWe describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.AimsDiscuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.MethodsWe present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.ResultsAt the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)ConclusionsDiarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The role of antiphospholipid antibodies in reproductive failure

1997 ◽  
Vol 6 (3) ◽  
pp. 133-143
Author(s):  
D Ware Branch ◽  
Harry H Hatasaka
Keyword(s):  
Pregnancy Outcome ◽  
Clinical Features ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Fetal Loss ◽  
Placental Insufficiency ◽  
Antiphospholipid Antibody ◽  
The Relationship

The relationship between antiphospholipid antibodies and the clinical features of placental insufficiency, pre-eclampsia, and fetal loss has emerged as one of the most exciting new observations in obstetrics in the last 15 years. Antiphospholipid syndrome is the only convincing ‘immunologic’ disturbance of pregnancy affecting the fetus other than anti-erythrocyte or antiplatelet alloimmunization disorders, and it is now routine to test patients with fetal loss for the two best characterized antiphospholipid antibodies, lupus anticoagulant and anticardiolipin. Although there is no proven mechanism for fetal loss, treatment of antiphospholipid antibody-positive mothers during pregnancy with heparin improves pregnancy outcome.

scholarly journals Does an abnormally elevated maternal alkaline phosphatase pose problems for the fetus?

2019 ◽  
Vol 12 (4) ◽  
pp. e229109 ◽  
Author(s):  
Sarah McErlean ◽  
Chris King
Keyword(s):  
Alkaline Phosphatase ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Delivery ◽  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Placental Insufficiency ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
Potential Association

We report a potential association between an abnormally raised pregnancy level of alkaline phosphatase (ALP) and intrauterine growth restriction (IUGR). There are few reports of women with abnormally high ALP during pregnancy. However, there is work to suggest an association with placental insufficiency, low birth weight and preterm delivery. In conjunction with a rising ALP, fetal IUGR and intermittent absence of umbilical artery end diastolic flow had evolved. A greatly elevated ALP may be a marker for placental insufficiency and IUGR.

OBSTETRIC ANTIPHOSPHOLIPID SYNDROME - A REVIEW

2011 ◽  
Vol 22 (4) ◽  
pp. 265-286
Author(s):  
K SCHREIBER ◽  
O ATEKA-BARRUTIA ◽  
MA KHAMASHTA ◽  
GRV HUGHES
Keyword(s):  
Clinical Features ◽  
Antiphospholipid Syndrome ◽  
Pregnancy Complications ◽  
Arterial Thrombosis ◽  
Placental Insufficiency ◽  
Recurrent Miscarriages ◽  
Obstetric Antiphospholipid Syndrome ◽  
Circulating Antibodies ◽  
Clinical Description

The Antiphospholipid syndrome (APS) is one of the current hot topics embracing rheumatology and obstetrics.The first clinical description of APS was in 1983. Venous or arterial thrombosis, abortion and cerebral manifestations along with circulating antibodies were the first described hallmarks of the syndrome. In the following years other clinical features, which include pregnancy complications, such as recurrent miscarriages (RM), pre-eclampsia or severe placental insufficiency were described.

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