Pregnancy outcome in women with antiphospholipid syndrome and alloimmunity
a case report
Keywords:
Antiphospholipid syndrome, Habitual abortion, Heparin, Aspirin, ImmunotherapyAbstract
CONTEXT: Patients with antiphospholipid syndrome and alloimmunity have poor pregnancy outcomes. Several diagnostic and therapeutic options exist for these disorders, although there is no consensus as to the best treatment. CASE REPORT: We present here the clinical course and treatment of a woman with a history of two miscarriages who joined our program 10 years ago and has been followed up ever since. After antiphospholipid syndrome and alloimmune failure were diagnosed, she was given preconceptional treatment using unfractionated heparin, aspirin, prednisone and lymphocyte immunizations. She delivered two premature babies in the following two pregnancies. At present both children are healthy and are attending school. The fifth pregnancy was unsuccessful, in spite of having undergone a similar but postconceptional therapeutic scheme. We discuss this case focusing on the pathogenic mechanisms and the therapeutic aspects of these disorders.
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References
Wilson WA, Gharavi AE, Koike T, et al. International consen- sus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international work- shop. Arthritis Rheum 1999;42(7):1309-11.
Rai RS, Clifford K, Cohen H, Regan L. High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriage and antiphospholipid antibodies. Hum Reprod 1995;10(12):3301-4.
Rote NS. Antiphospholipid antibodies and recurrent pregnancy loss. Am J Reprod Immunol 1996;35(4):394-401.
Beer AE. Immunologic aspects of normal pregnancy and recur- rent spontaneous abortion. Semin Reprod Endocrinol 1988;6(2):163-78.
Kwak JY, Gilman-Sachs A, Beaman KD, Beer AE. Reproduc- tive outcome in women with recurrent spontaneous abortions of alloimmune and autoimmune causes: preconception versus postconception treatment. Am J Obstet Gynecol 1992;166(6 Pt 1):1787-95; discussion 1795-8.
Peña RB, Cadavid AP, Botero JH, García GP, Gallego MI, Ossa JE. The production of MLR-blocking factors after lymphocyte immunotherapy for RSA does not predict the outcome of preg- nancy. Am J Reprod Immunol 1998;39(2):120-4.
Rand JH. Molecular pathogenesis of the antiphospholipid syn- drome. Circ Res 2002;90(1):29-37.
Sedano M, Palma S, González P, et al. Pérdida recurrente del embarazo en pacientes com anticuerpos anticardiolipinas (AACL) [Recurrent loss of pregnancy in patients with anticardiolipin antibodies (ACAb)]. Rev Chil Obstet Ginecol 1992;57(5):327-32.
Yasuda M, Takakuwa K, Tokunaga A, Tanaka K. Prospective stud- ies of the association between anticardiolipin antibody and out- come of pregnancy. Obstet Gynecol 1995;86(4 Pt 1):555-9.
Couto E, Barini R, Pinto e Silva JL, de Moraes DR, de Carvalho LM. Anticardiolipin antibody in recurrent spontaneous abort- ing and fertile women. Rev Paul Med 1998;116(4):1760-5.
Rote NS, Walter A, Lyden TW. Antiphospholipid antibodies-lobsters or red herrings? Am J Reprod Immunol 1992;28(1):31-7.
Branch DW, Rodgers GM. Induction of endothelial cell tissue factor activity by sera from patients with antiphospholipid syn- drome: a possible mechanism of thrombosis. Am J Obstet Gynecol 1993;168(1 Pt 1):206-10.
Rand JH, Wu XX, Guller S, Scher J, Andree HA, Lockwood CJ. Antiphospholipid immunoglobulin G antibodies reduce annexin-V levels on syncytiotrophoblast apical membranes and in culture media of placental villi. Am J Obstet Gynecol 1997;177(4):918-23.
Vogt E, Ng AK, Rote NS. Antiphosphatidylserine antibody re- moves annexin-V and facilitates the binding of prothrombin at the surface of a choriocarcinoma model of trophoblast differentiation. Am J Obstet Gynecol 1997;177(4):964-72.
Vogt E, Ng AK, Rote NS. A model for the antiphospholipid antibody syndrome: monoclonal antiphosphatidylserine anti- body induces intrauterine growth restriction in mice. Am J Obstet Gynecol 1996;174:(2)700-7.
Ober C, Karrison T, Odem RR, et al. Mononuclear-cell immu- nisation in prevention of recurrent miscarriages: a randomised trial. Lancet 1999;354(9176):365-9.
Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol 1996;174(5):1584-9.
Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid anti- bodies (or antiphospholipid antibodies). BMJ 1997; 314(7076):253-7.
Cadavid A, Peña B, García G, et al. Heparin plus aspirin as a “single” therapy for recurrent spontaneous abortion associated with both allo- and autoimmunity. Am J Reprod Immunol 1999;41(4):271-8.
Silver RK, MacGregor SN, Sholl JS, Hobart JM, Neerhof MG, Ragin A. Comparative trial of prednisone plus aspirin versus as- pirin alone in the treatment of anticardiolipin antibody-positive obstetric patients. Am J Obstet Gynecol 1993;169(6):1411-7.
