Antiphospholipid antibodies and the investigation of recurrent miscarriage (original) (raw)
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Clinical and Applied Thrombosis/Hemostasis, 2016
Background: Recurrent miscarriage (RM) is one of the most common clinical problems in reproduction with no definite cause in about 50% of the cases. The study aims to evaluate the effect of low-molecular-weight heparin (LMWH) in the treatment of women with RM negatively tested for antiphospholipid antibodies (APAs). Methods: An open-labeled registered randomized controlled study (NCT 01608347) included women who attended the outpatient clinic in Assiut Women Health Hospital and Nag-Hamady Central Hospital, Egypt, with 3 or more unexplained RM. Eligible participants were randomly assigned into 2 groups. The study group included 150 patients receiving LMWH (Tinzaparin sodium 4500 IU) subcutaneous daily injection with 500 µg folic acid once daily orally started once positive pregnancy test till the 20th week of gestation. The control group included 150 patients receiving the same dose of folic acid alone. The primary outcome of the study was the rate of continuation of a viable pregnan...
Role of Antiphospholipid Antibodies in Unexplained Recurrent Abortion and Intrauterine Fetal Death
2013
Background: Women with antiphospholipid antibodies (aPL) have a significant risk of reproductive failure and adverse pregnancy outcomes, the recurrent miscarriages, intrauterine fetal deaths, and intrauterine fetal growth restriction is significant among these patients. Women with a history of recurrent abortion and unexplained fetal death or a history of recurrent thrombotic episodes should be screened for the presence of antiphospholipid antibodies. We studied the incidence of anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) factor in recurrent unexplained miscarriages and intrauterine fetal deaths. Subjects and Methods: We performed a cohort study among women who attended the department of Obstetrics and Gynecology, Assiut University hospitals, Assiut, Egypt, between October 2007 and October 2011 after being referred due to recurrent miscarriage (≥ 2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Recurrent miscarriage affects 1–2% of women. Recurrent pregnancy loss (RPL) is the loss of three or more consecutive pregnancies before or during the 20th week of gestation. The most important association between gestational loss and autoimmune phenomena is the presence of antiphospholipid antibodies represented by the lupus anticoagulants and or anticardiolipin antibodies (Antiphospholipid Antibody Syndrome). The antiphospholipid syndrome is an acquired autoimmune. The clinical features are thrombosis (venous, arterial and microvascular) and/or pregnancy complications; the most prominent of which is recurrent abortion.Methods: Twenty-two selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome had received low dose aspirin (75 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day).Results: There are live born in 86% cases compared to abortion (< 20 weeks gestational age) in 14 % cases. From 19 liveborn b...
2009
The aim of this retrospective, observational study was to determine the impact of low-dose enoxaparin (20 mg) in conjunction with low-dose aspirin on the pregnancy outcome of women with antiphospholipid syndrome and recurrent miscarriage. The study was conducted in a tertiary referral teaching hospital. A total of 35 women with antiphospholipid syndrome were treated with low-dose enoxaparin and aspirin as soon as pregnancy was confirmed. The outcome of pregnancy was analysed. The miscarriage rate was 7/35 (20%) whereas the live birth rate was 28/35 (80%). In conclusion, low-dose (20 mg) enoxaparin in conjunction with low-dose aspirin treatment produced encouraging results. The findings in this study suggest that there is a case for randomized controlled trials to compare low-dose (20 mg) enoxaparin with higher doses.
Obstetrics & Gynecology, 2003
To examine whether there are characteristic histological features in placentas from ongoing pregnancies of patients with a history of recurrent miscarriage, with and without primary antiphospholipid antibody syndrome, in relation to clinical pregnancy outcome. METHODS: Patients attending a recurrent miscarriage clinic were investigated and treated according to an established protocol. One hundred twenty-one consecutive patients achieving a potentially viable pregnancy (at least 24 completed weeks' gestation), including 60 primary antiphospholipid antibody syndrome-positive cases and 61 primary antiphospholipid antibody syndrome-negative cases were included. After delivery, placental pathologic examination was carried out by a pathologist unaware of the clinical details. Histological sections were examined by two pathologists independently. Pregnancy outcome and placental findings were reviewed in relation to the maternal antiphospholipid antibody status. RESULTS: Pregnancy outcome was similar in primary antiphospholipid antibody syndrome-positive and primary antiphospholipid antibody syndrome-negative groups regarding gestation at delivery and antepartum obstetric complications. Several histological placental abnormalities were identified in both groups, but most pregnancies were clinically uncomplicated, with no significant placental abnormalities. In cases with pregnancy complications, the placental pathology was primarily that of uteroplacental vasculopathy, such as placental infarction and preeclampsia, but there were no specific placental lesions or patterns of abnormalities characteristic of primary antiphospholipid antibody syndrome-positive patients. A small subgroup of primary antiphospholipid antibody syndromepositive patients may be at increased risk of development of maternal floor infarction or massive perivillus fibrin deposition. CONCLUSION: There are no specific histopathologic placental abnormalities characteristic of treated patients with antiphospholipid antibody syndrome and poor reproductive history, but complications of uteroplacental disease are more common.
Annals of clinical biochemistry, 2016
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis, fetal losses and thrombocytopenia associated to antiphospholipid (APL) antibodies (Abs). They are directed to phospholipids, such as cardiolipins (a-cardiolipin, ACA) and lupus anticoagulant (LA), or to complexes formed by phospholipids and protein cofactors, such as β2 glycoprotein 1 (a-β2GP1) and annexin V (a-annexin V). These auto Abs may be considered as a family of Abs involved in thrombotic events and APL activity. On the other hand, some proangiogenic factors are involved in the normal development of placental vasculature, such as the vascular endothelial growth factor (VEGF). Overexpression of VEGF receptor in its soluble form (sVEGFR-1) has been associated to a higher antiangiogenic activity. Our aim was to analyze the association between ACA, LA, a-β2GP1, a-annexin V and sVEGFR-1 with recurrent miscarriage before week 10 of gestation in women with APS. We studied 24 women (primary or seco...