Antiphospholipid syndrome in miscarriage
Tat’yana Nikolaevna ShlyakhtenkoEkaterina Anatol’yevna Alyab’yevaOlga N. ArzhanovaS. А. SelkovTamara Aleksandrovna PluzhnicovaSergey V. Chepanov
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Abstract:
Purpose: the frequency of antiphospholipid in patients with reproductive failures was defined. The algorithm of the treatment of these patients was presented. Materials and methods: the study included 2150 patients: 1650 with a history of the repeated pregnancy losses; 450 with sterility and 50 healphy women. Results: the high levels of AFA were founded in 24 % of patients with spontaneous abortions and in 20 % of patients with sterility. Conclusion: Pregravid preparation and permanent monitoring the state of patients reduce frequency of unfavorable ends of pregnancy effectively.Keywords:
Recurrent miscarriage
The histopathological appearance of conception products from 44 women with recurrent miscarriage was compared with those obtained from 105 women with sporadic miscarriage. Abnormal villi, suggesting fetal chromosomal abnormalities, were found in 62% of women with a recurrent miscarriage and in 58% of those with sporadic miscarriage. This difference is not statistically significant.
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Previously, the rat embryo model has been used as an experimental technique in investigations of the aetiology of idiopathic recurrent miscarriage. The aim of the present study was to validate it as a tool in the investigation of the aetiology of this condition. Subjects (n = 36) with a history of recurrent miscarriage were recruited from two dedicated recurrent miscarriage clinics and compared with control women with at least one previous pregnancy resulting in a live birth (n = 23). Serum from each woman was used as culture medium in the rat embryo model. Cultured embryos were scored for growth and differentiation. No statistical difference was found in any parameter between the two groups. Furthermore, patients from the recurrent miscarriage group whose serum demonstrated a trend towards lower scores, subsequently conceived and underwent uncomplicated pregnancies.
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Recurrent miscarriage
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Recurrent miscarriage is classically defined as three or more consecutive pregnancy losses. Established causes of recurrent miscarriage are antiphospholipid antibodies, uterine anomalies and abnormal chromosomes in either partner, particularly translocations. Embryonic aneuploidy is the most important cause of miscarriage before ten weeks' gestation. It can be speculated that about 51% of patients with a history of three miscarriages experienced these because of abnormal embryonic karyotypes. It is not necessary to give any medication for such cases caused by an abnormal embryonic karyotype. Psychological support might be the most important requirement to continue conceiving till live birth results.
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Recurrent miscarriage is defined as loss of three or more consecutive pregnancies. It affects 1% of all women. This incidence is greater than that expected by chance alone as, based on a 10–15% risk of spontaneous miscarriage among clinically recognised pregnancies, this would be expected to be around 0.34%. So it is understandable that only a small proportion of women will be found to have an underlying aetiology identified as the cause for recurrent miscarriage. Recurrent miscarriage could be further labelled as ‘primary recurrent miscarriage’, where women have had no successful pregnancies, or as secondary recurrent miscarriage, where women miscarry repetitively after a successful pregnancy or pregnancies.
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Miscarriage is the commonest complication of pregnancy, occuring in one in six clinically recognised pregnancies.1 Recurrent miscarriage is the loss of three or more consecutive pregnancies. Women with recurrent miscarriage (in contrast to women with sporadic miscarriage) tend to lose genetically normal pregnancies.1 After comprehensive investigation, a cause for recurrent miscarriage is identified in less than half of couples.1 Most couples are therefore labelled as having unexplained recurrent miscarriage.
Progesterone, secreted by the corpus luteum and the placenta, has a central role in maintaining a pregnancy.1 It is theoretically plausible that progesterone supplementation may reduce the risk of miscarriage in women with a history of recurrent miscarriages, and the first trial using progesterone for such women was published in the BMJ in 1953.2 This …
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The perinatologists are emerging as the physicians who evaluate and treat women with recurrent pregnancy loss. Recurrent miscarriage, previously referred to as habitual abortion, affects almost 1 % of couples. The etiologies of recurrent miscarriage are diverse and may be divided into genetic defects, such as chromosomal anomalies; maternal reproductive anatomic disease, both developmental and acquired, such as septate uterus or cervical incompetence; and systemic maternal disease such as antiphospholipid antibody syndrome or maternal diabetes. A cause for recurrent miscarriage can be identified approximately 60% of the time. We emphasize the tremendous psychological impact of recurrent miscarriage. We contrast any proposed treatments with the empiric fact that with no treatment after recurrent losses, couples still have a 60 to 70% chance of delivering a viable infant.
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