Rina Sharma¹, Manish Kumar Misra², Deependra Sharma², Avanish Mishra² and Ratna Thakur¹

¹Department of Obstetrics and Gynecology, S.A.I.M.S., Indore India.

²Department of Biochemistry, S.A.I.M.S., Indore India.

Abstract

Antiphospholipid antibodies have been linked to Obstetric complications from many years. If a lady presents with recurrent pregnancy loss, severe PIH in early pregnancy, IUGR one should suspect of this syndrome. Pre-pregnancy counselling and treatment is ideal for such cases. Starting the treatment timely definitely improves the outcome. Low dose Aspirin and Heparin is the treatment of choice.

Keywords

Antiphospholipid antibody syndrome; PIH; IUGR

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Copy the following to cite this article: Sharma R, Misra M. K, Sharma D, Mishra A, Thakur R. To Study the Association of Antiphospholipid Antibody Syndrome with PIH and IUGR. Biomed Pharmacol J 2010;3(1)

Copy the following to cite this URL: Sharma R, Misra M. K, Sharma D, Mishra A, Thakur R. To Study the Association of Antiphospholipid Antibody Syndrome with PIH and IUGR. Biomed Pharmacol J 2010;3(1). Available from: http://biomedpharmajournal.org/?p=1386

Introduction

The present study is undertaken to find the association of Antiphospholipid antibody in cases of Pregnancy Induced Hypertension and Intra Uterine Growth Retardation with maternal outcome.

Antiphospholipid Antibody Syndrome (APAS) is a disease entity with a noninflammatory thrombotic occlusion of small or large vessels causing recurrent thrombosis and/or fetal loss.

High titers of IgG & IgM anticardiolipin antibodies are associated with an increased frequency of fetal wastage.Raised titers are also found in arterial and venous thrombosis, thrombocytopenia, livedo reticularis, primary pulmonary hypertension and neurologic disorders.These antibodies are also related with adverse obstetric outcome such as PIH, IUGR, placental abruption, missed abortion, recurrent stillbirth, choria gravidarum, and neonatal thrombosis.

Clinically important Antiphospholipid antibodies are –

Anticardiolipin antibodies- IgG, IgM

Lupus anticoagulant

Biologically false positive test for Syphilis (BFP-STS)

Material and Method

Work place

Dept. of Obst. & Gynaec and Dept. of  Biochemistry at     S.A.I.M.S.  , Indore.

Selection of  cases

100   cases   were studied.                            

Essential criteria for case selection

PIH of early onset (B.P. of > 140/90 mmHg after     20 weeks of gestation but before 32 weeks) with or without proteinuria (preeclampsia) and oedema.

Convulsions in hypertensive pregnant women in     between 20-32 weeks of gestation without any prior history of seizures.

Presence of IUGR, especially in cases of associated PIH of early onset.

Parameters Estimated     

Age , Parity , Blood Pressure, Proteinuria, Oedema , Fundus Examination Platelet count, Renal Function Test ,Liver function Tests , along with specific investigation for APAS (Anticardiolipin antibody, Lupus anticoagulant, BFP- STS )

Observation Tables

Table 1: Comparison of APA with Age, Rural and Urban Group and Parity

		APA POSITIVE	APA NEGATIVE
AGE	≤ 20 YEARS	3	28
	20-25 YEARS	9	39
	≥ 25 YEARS	3	18
	Maximum Percentage	60 % in 20-25 yrs	46 % in 20-25 yrs
RURAL AND URBAN GROUP	RURAL	5	52
	URBAN	10	33
	Maximum Percentage	67 % in urban group	61 % in rural group
PARITY	G1P0	9	42
	G2P1	2	25
	≥G3P2	4	18
	Maximum Percentage	60% in G1P0	49% in G1P0

 

Table 2: Comparison of APA with Platelet count and Fundus Examination 

		APA POSITIVE	APA NEGATIVE
PLATELET ( lakh/ cumm )	≤ 1 lakh	8	11
	1-1.5 lakh	4	42
	≥ 1.5 lakh	3	32
FUNDUS	WNL	5	47
	CHANGES	10	38

 

Table 3: Comparison of APA with Liver and Renal Function Test

			APA POSITIVE	APA NEGATIVE
LFT	SGOT	+	8	58
		+ +	7	27
	SGPT	+	8	53
		+ +	7	32
	LDH	+	10	69
		+ +	5	16
RFT	Sr.CREATININE	+	9	64
		+ +	6	21
	PROTEINURIA	Nil	0	34
		+	6	39
		+ +	9	12

 

Table 4: Investigations for APAS showing association with severity of PIH

	LAC  POSITIVE	LAC  NEGATIVE
Mild PIH	2	36
Moderate PIH	4	29
Severe PIH	9	20

 

	ACA ( Ig G )		ACA ( Ig M )
	POSITIVE	NEGATIVE	POSITIVE	NEGATIVE
Mild PIH	2	34	2	38
Moderate PIH	4	30	3	26
Severe PIH	9	21	10	21

 

No association was shown with VDRL in the present study.

Table 5: Association of ACA Positivity with severity of PIH & IUGR

ACA	PIH			IUGR
	MILD	MODERATE	SEVERE	MILD	MODERATE	SEVERE
MILD POSITIVE	2	–	–	2	–	–
MODERAT E POSITIVE E	–	4	–	–	5	–
SEVERE POSITIVE	–	–	9	–	–	8

 

Table 6: Association of APA positivity with gestational age of onset of PIH

Gestational Age	APA POSITIVE	APA NEGATIVE
20-26 weeks	11	33
26-32 weeks	4	52

 

Table 7: Maternal complications related with APA

	APA POSITIVE	APA NEGATIVE
APH ( Abruptio )	4	13
PPH	2	14
ANAEMIA	9	58

 

Table 8: Fetal outcome related with APA positivity

	APA POSITIVE	APA NEGATIVE
Mild IUGR	2	35
Moderate IUGR	5	21
Severe IUGR	8	29

 

Baby Weight	APA POSITIVE	APA NEGATIVE
≤1 kg	5	22
1-1.5 kg	7	16
≥ 1.5 kg	3	47

 

Summary

The incidence of severe PIH & IUGR was 60% & 53% in APA positive patients respectively while the same was 24% and 34% in APA negative patients. The above findings show that APA positive patients had a more severe disease at an early second trimester.Renal function, platelet count and liver functions were deranged in APA positive patients. Thrombocytopenia was seen in 53% of APA positive patients. In urban population more APA positive patients` association can be due to increased awareness and affordability.

More patients were nulliparous between 20-25 years age group.

Mode of delivery was vaginal in both groups but rate of induction was found higher in APA positive cases. There was increased maternal morbidity and poor fetal outcome in APA positive patient

Conclusion

Antiphospholipid antibodies have been linked to Obstetric complications from many years. If a lady presents with recurrent pregnancy loss, severe PIH in early pregnancy, IUGR one should suspect of this syndrome. Pre-pregnancy counselling and treatment is ideal for such cases. Starting the treatment timely definitely improves the outcome. Low dose Aspirin and Heparin is the treatment of choice.

Now a days low molecular weight heparin is new choice of therapy for Antiphospholipid Antibody Syndrome in pregnancy. Last but not the least patient should be counselled regarding the risk of future pregnancies and advised to practice contraception or sterilization whichever suits the patient. She should be stressed to follow “One Family Norm “.

References

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3. Branch DW, Scott JR, Kochenour NK, et al. Obstetric complications associated with the lupus anticoagulant. N Engl J Med.1985;313:1322-1326.
4. Kaleli B, Kaleli I , Aktan E, Turan C, Askit F. Antiphospholipid antibodies in eclamptic women. Gynecol O               bstet Invest 1998;45(2):81-4.
5. Lima F ,Khamashta MA, Buchanan NM, et al. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol .1996;14:131-136.

 

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