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By Chad Klauser Maternal Fetal Medicine physician in NYC
Lisa Duffett, Marc Rodger
Placenta-mediated pregnancy complications, including preeclampsia, placental abruption, intrauterine growth restriction/small for gestational age and recurrent or late pregnancy loss, affect over 5% of pregnancies and can result in significant maternal and perinatal morbidity and mortality. These complications have been suggested to at least partly arise from placental insufficiency, possibly as a result of inappropriate coagulation activation. This association has led to the hypothesis that anticoagulant therapy, such as low molecular weight heparin, might reduce their occurrence...
March 2015: British Journal of Haematology
Hui Chen, Shuping Nie, Ming Lu
Human plasminogen activator inhibitor-1 (PAI-1) is closely related to embryonic development and pregnancy success. The association between PAI-1 gene polymorphisms (PAI-1-844G/A and PAI-1-675G/A) and the risk of recurrent pregnancy loss (RPL) is controversial. Therefore, we perform this review to clarify the association between PAI-1 gene polymorphisms and RPL risk. We performed a systematic search for studies that described the effect of PAI-1 polymorphisms on RPL risk. The odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were considered under recessive genetic models...
April 2015: American Journal of Reproductive Immunology: AJRI
Deepa R Jayakody Arachchillage, Samuel J Machin, Ian J Mackie, Hannah Cohen
Accurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (< 99th centile) and/or certain clinical criteria such as two unexplained miscarriages, three non-consecutive miscarriages, late pre-eclampsia, placental abruption, late premature birth, or two or more unexplained in vitro fertilisation failures...
January 2015: Thrombosis and Haemostasis
Giacomo Emmi, Elena Silvestri, Danilo Squatrito, Lucia Ciucciarelli, Anna Maria Cameli, Gentian Denas, Mario Milco D'Elios, Vittorio Pengo, Lorenzo Emmi, Domenico Prisco
The antiphospholipid antibody syndrome is a systemic, acquired, immune-mediated disorder characterized by episodes of venous, arterial, or microcirculation thrombosis and/or pregnancy abnormalities, associated with the persistent presence of autoantibodies, confirmed at least in two occasions 12 weeks apart, directed to molecular complexes consisting of phospholipids and proteins. Antiphospholipid antibody syndrome should always be considered as a potential diagnosis especially for young patients presenting with a history of thrombotic events, in particular when they occur without any obvious external trigger or any inherited thrombophilic mutation (even if 2006 criteria do not exclude antiphospholipid antibody syndrome in patients with other inherited or acquired prothrombotic conditions), or for women with recurrent pregnancy losses or later fetal deaths...
2014: TheScientificWorldJournal
Nathalie Bleau, Valerie Patenaude, Haim A Abenhaim
OBJECTIVE: The objective of this study is to evaluate the effect of autoimmune disease on the risk of venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) in pregnant women. METHODS: Using the Health Care Cost and Utilization Project, Nationwide Inpatient Sample database from 2003 to 2011, the risk of developing DVT, PE, and VTE among pregnant patients with selected autoimmune diseases was estimated using unconditional logistic regression analysis...
April 2016: Clinical and Applied Thrombosis/hemostasis
Cecilia Beatrice Chighizola, Maria Gerosa, Laura Trespidi, Alessio Di Giacomo, Federica Rossi, Barbara Acaia, Pier Luigi Meroni
Pregnancy morbidity is part of the clinical spectrum of the antiphospholipid syndrome (APS), a chronic autoimmune condition serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents are the mainstay of the treatment of obstetric APS. However, there is an ongoing debate about the optimal management of women with most severe aPL-mediated obstetric complications, women not fulfilling APS criteria and those with refractory disease. Unfortunately, the literature cannot provide definite answers to these controversial issues, being flawed by many limitations...
November 2014: Expert Review of Clinical Immunology
Marc A Rodger, William M Hague, John Kingdom, Susan R Kahn, Alan Karovitch, Mathew Sermer, Anne Marie Clement, Suzette Coat, Wee Shian Chan, Joanne Said, Evelyne Rey, Sue Robinson, Rshmi Khurana, Christine Demers, Michael J Kovacs, Susan Solymoss, Kim Hinshaw, James Dwyer, Graeme Smith, Sarah McDonald, Jill Newstead-Angel, Anne McLeod, Meena Khandelwal, Robert M Silver, Gregoire Le Gal, Ian A Greer, Erin Keely, Karen Rosene-Montella, Mark Walker, Philip S Wells
BACKGROUND: Thrombophilias are common disorders that increase the risk of pregnancy-associated venous thromboembolism and pregnancy loss and can also increase the risk of placenta-mediated pregnancy complications (severe pre-eclampsia, small-for-gestational-age infants, and placental abruption). We postulated that antepartum dalteparin would reduce these complications in pregnant women with thrombophilia. METHODS: In this open-label randomised trial undertaken in 36 tertiary care centres in five countries, we enrolled consenting pregnant women with thrombophilia at increased risk of venous thromboembolism or with previous placenta-mediated pregnancy complications...
November 8, 2014: Lancet
William H Kutteh, Candace D Hinote
Antiphospholipid antibodies (aPLs) are acquired antibodies directed against negatively charged phospholipids. Obstetric antiphospholipid antibody syndrome (APS) is diagnosed in the presence of certain clinical features in conjunction with positive laboratory findings. Obstetric APS is one of the most commonly identified causes of recurrent pregnancy loss. Thus, obstetric APS is distinguished from APS in other organ systems where the most common manifestation is thrombosis. Several pathophysiologic mechanisms of action of aPLs have been described...
March 2014: Obstetrics and Gynecology Clinics of North America
William B Davenport, William H Kutteh
Historically, much controversy has existed regarding the association of inherited thrombophilias with adverse pregnancy outcomes. The current guidelines do not recommend screening unless a personal history of venous thromboembolism is present, but the authors' survey of physician screening patterns has suggested that up to 40% of physicians may screen contrary to the current guidelines. This article summarizes the existing evidence for each inherited thrombophilia and reviews the current guidelines.
March 2014: Obstetrics and Gynecology Clinics of North America
D Mohadeb, E Jeffries, Pj Marsden, J Hanley
INTRODUCTION: Thrombophilia has been linked to adverse pregnancy outcomes; however the timing and role of thrombophilia testing following pregnancy loss remains controversial. The RCOG guideline on late pregnancy loss advises thrombophilia testing at delivery whereas BSH guidance states the evidence for this is limited and conflicting. The aim of this study was to assess whether thrombophilia testing was performed at delivery following late pregnancy loss (and whether repeated if abnormal) and to assess whether genuine thrombophilia is associated with fetal growth restriction...
June 2014: Archives of Disease in Childhood. Fetal and Neonatal Edition
Amelia Ruffatti, Elisa Salvan, Teresa Del Ross, Maria Gerosa, Laura Andreoli, Aldo Maina, Jaume Alijotas-Reig, Sara De Carolis, Arsene Mekinian, Maria Tiziana Bertero, Valentina Canti, Antonio Brucato, Katarina Bremme, Véronique Ramoni, Marta Mosca, Emma Di Poi, Paola Caramaschi, Mauro Galeazzi, Angela Tincani, Laura Trespidi, Pier Luigi Meroni
Previous thrombosis, diagnosis of systemic lupus erythematosus (SLE) and triple antiphospholipid (aPL) antibody positivity have recently been found to be independent factors associated to pregnancy failure during conventional therapy in women with antiphospholipid syndrome (APS). This study aimed to assess the effect of various treatment strategies on pregnancy outcomes in women with APS and the risk factors for pregnancy failure. One hundred ninety-six pregnancies of 156 patients diagnosed with APS were analysed: 118 (60...
October 2014: Thrombosis and Haemostasis
Paulien G de Jong, Stef Kaandorp, Marcello Di Nisio, Mariëtte Goddijn, Saskia Middeldorp
BACKGROUND: Since hypercoagulability might result in recurrent miscarriage, anticoagulant agents could potentially increase the chance of live birth in subsequent pregnancies in women with unexplained recurrent miscarriage, with or without inherited thrombophilia. OBJECTIVES: To evaluate the efficacy and safety of anticoagulant agents, such as aspirin and heparin, in women with a history of at least two unexplained miscarriages with or without inherited thrombophilia...
July 4, 2014: Cochrane Database of Systematic Reviews
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