Lupus anticoagulant in pregnancy

Abstract

summary In a group of 10 women with circulating lupus anticoagulant 25 intrauterine deaths were previously documented in the nine multigravidae. The presence of lupus anticoagulant activity was confirmed by showing prolongation of the activated partial thromboplastin time and kaolin clotting time with failure of correction of the prolongation on incubation with normal plasma. A clinical diagnosis of systemic lupus erythematosus (SLE) was made in four women. Three had deep vein thrombosis in pregnancy, one chorea gravidarum while two had only recurrent fetal losses. All the women had positive antinuclear antibody tests and blood platelet counts <175 × 109/1. Anti‐smooth muscle antibody and VDRL tests were each positive in half the patients; anti‐DNA antibody was present in two patients with clinically active SLE. In six pregnancies correction of the activated partial thromboplastin and kaolin clotting time was attempted using prednisone (40–60 mg/day); aspirin, 75 mg/day, was added. Five live infants were obtained, four by spontaneous delivery, when the restoration of the clotting abnormalities to normal was achieved. In one woman presenting with extensive deep vein thrombosis a live infant was delivered following therapeutic doses of heparin and low dose aspirin. Maternal lupus anticoagulant activity has major implications for pregnancy and should be excluded in women with a clinical suspicion of SLE, a positive antinuclear antibody test, thrombotic episodes, biologically false‐positive VDRL and unexplained late or repetitive early fetal losses.

The prevalence of lupus anticoagulant and anticardiolipin antibodies in women with a history of first trimester miscarriages

“…It has been recognised that women who are positive for LA or who have raised ACAs are at increased risk of repeated early miscarriages, and second or third trimester intrauterine deaths (Nilsson et al 1975). Examination of the placenta in individuals with antiphospholipid antibodies has shown thrombosis of the placental and decidual vessels and multiple placental infarcts (Lubbe et al 1984). The extent of placental infarction alone is usually insufficient to account for fetal death.…”

Female infertility due to abnormal autoimmunity: frequently overlooked and greatly underappreciated. Part I

“…An association between classic abnormal autoimmunity and reproductive failure was probably first recognized by Lubbe and colleagues when reporting on the association between lupus anticoagulant and repeated pregnancy loss [82]. Among others, we then expanded this finding by demonstrating that lupus anticoagulant was only one sign of a polyclonal activation of autoimmune function [83].…”

“…Moreover, as Lubbe and colleagues had demonstrated in their initial publication, for the internist, a thrombotic event is usually the presenting symptom and, therefore, the initial observation, while miscarriage and infertility risk are interesting anecdotal side stories [82]. By contrast, to the gynecologist or reproductive endocrinologist, the primary clinical presentation will be either infertility or pregnancy loss, with thrombotic events being rare secondary, and mostly historical, findings.…”

Das Antiphospholipid-Syndrom

“…Rezidivierende Spontanaborte, intrauteriner Fruchttod und Frühgeburten sind mögliche Schwangerschaftskomplikationen bei einem APS [47). Die Aborte treten nicht selten im 2. und 3.…”