engleski

ANTIPHOSPHOLIPID SYNDROME AND FETAL OUTCOME

BACKGROUND Antiphospholipid syndrome is associated with adverse pregnancy outcome( spontaneous abortions, stillbirths, thrombocytopenia, thrombosis and preeclampsia).The goal of our study was to analyze the frequency of LAC (lupus anticoagulant) and ACA (anticardiolipin antibodies) in healthy women and in women with adverse reproductive history and their association with fetal outcome. METHODS We analyzed a total of 368 women during 9-year period from 1991-2000. The study group comprised 222 women with three or more spontaneous abortions prior to this pregnancy. The exclusion criteria were SLE or any other autoimmune disease and abnormal karyotype. Control group comprised 146 pregnant women who at least once prior to this pregnancy delivered healthy infant on term. In all women ACA (IgG and IgM) and LAC were determined using ELISA for ACA and thromboplastin inhibition test (TTI) for LAC.LAC > 1.3 and ACA IgG>20 and IgM>20 were considered positive. All the data were statistically compared using Chi-square test . RESULTS LAC was found in 26.1% (n=58) of study group women and in 1.4% (n=2) of controls. ACA IgG was positive in 17.1% and ACA IgM in 19.8% of study group women. In control group ACA IgG was found in 8.2% and ACA IgM in 6.8%. Platelet count was significantly lower during first trimester in study group. Thrombocytopenia was found in 19% (n=42) of study group women and in 1.4% of controls (p<0, 01). LAC was found in 71, 4% (n=30), ACA IgG in 90, 4% (n=38) and ACA IgM in 80, 8% (n=34) of these patients. ACA IgG and IgM were strongly positive in 33, 3% versus 23, 8% women. The study group had significantly higher occurrence of early and late abortions, fetal deaths, preterm deliveries and hypotrophic newborns (p<0, 01). Preeclampsia was found in 4.5% of study group women and in 2, 7% of controls. The difference was not statistically significant (p=0.39). Pathological examination of placental tissue revealed that in study group thrombosis and multiple infarcts were found in 42.9% of APLA(+) women and in 36.23% of APLA(-) women. No statistically significant difference between these two groups was found (p=0.325). However significant difference in pathological findings (thrombosis, multiple infarcts, fibrinoid and focal necrosis) was found between study and control group (64.28% vs 6.8%) (p<0.01). CONCLUSION Our study showed significantly higher occurrence of LAC and ACA (IgG and IGM) in women with adverse reproductive history and this could be the reason why this women have poorer pregnancy outcome compared with controls. However further studies are needed in order to obtain more specific data.

Antiphospholipid syndrome

nije evidentirano