Obstetric Complications Associated with the Lupus Anticoagulant

Abstract

We identified eight patients with the lupus anticoagulant (an autoantibody acquired by some patients with systemic lupus erythematosus), by observation of an increased activated partial thromboplastin time and abnormal results on a tissue thromboplastin-inhibition test. The patients had experienced a total of 30 spontaneous abortions and fetal deaths in 31 previous pregnancies (96.8 per cent). During their next pregnancy, the patients were treated with 40 to 50 mg of prednisone per day and 81 mg of aspirin per day. The therapy shortened their activated partial thromboplastin times, produced normal values for tissue thromboplastin inhibition, and reduced the rate of pregnancy loss to 37.5 per cent. However, preeclampsia developed in the five patients who gave birth to live infants, and fetal growth retardation occurred in three cases. The corticosteroid and low-dose aspirin regimen appears to improve perinatal outcome in cases in which the mother has the lupus anticoagulant, but such practices as careful fetal surveillance and preterm delivery when appropriate are also important to successful obstetric management of such cases.

Antinuclear antibody, lupus anticoagulant, and anticardiolipin antibody in women with idiopathic habitual abortion. A controlled, prospective study of forty‐four women

“…This is the first prospective controlled study to examine the frequency of subclinical lupus, anti-Ro, LAC, and ACL antibodies in women who were habitual aborters. Previous reports have included women who did not meet the standard definition of habitual abortion (3 or more consecutive spontaneous abortions) (8,10,20).…”

“…The LAC may play a role in fetal loss through uteroplacental thrombosis (26). The impression is given in the literature that there is a clearly established relationship between antiphospholipid antibodies and recurrent abortions, and furthermore, that treatment may lead to successful pregnancy, whereas lack of treatment almost uniformly results in unsuccessful pregnancy (3,7,8,17). Series of lupus patients with antiphospholipid antibodies and recurrent abortions have been described (3,4,7,15), but a similarly strong association between LAC and recurrent abortion has been believed to exist in women without clinical lupus To ensure detection of relevant antiphospholipid antibodies, we employed 3 assays, APTT, RVVT (a coagulation assay for LAC), and ACL, in our study.…”

“…No previous study has examined the frequency of laboratory findings that are generally associated with lupus (antinuclear antibodies [ANA], anti-Ro, lupus anticoagulant [LAC], and anticardiolipin [ACL] antibody among women with idiopathic habitual abortion ( 3 or more consecutive spontaneous abortions) compared with the frequency among normal controls. In the absence of controlled trials, it has been proposed that ANA, anti-Ro, LAC, and ACL, antibodies play a causal role in idiopathic habitual abortion and that treatment of the problems indicated by these laboratory findings may be necessary (7)(8)(9)(10).…”

Thrombophilia and pregnancy

“…Since in early-onset severe preeclampsia most studies found an association with positive tests for aCL, testing in these patients may have therapeutic implications for future pregnancies. Women with APS are also at a substantial risk for IUGR [40,51,53] which is around 30%. In one study, 24% of mothers delivered of IUGR infants had medium or high positive tests for aCL [54].…”

Origin and pathogenesis of antiphospholipid antibodies

“…Women with SLE and aPL have a rate of fetal death up to six times higher when compared with healthy women (27,28). Moreover, among women with high levels of aPL, a history of prior fetal losses appears to compound the risk for further fetal demise.…”