Anticardiolipin antibodies in patients with recurrent pregnancy wastage: treatment and uterine blood flow

Article Abstract:

Antibodies against cardiolipin (anticardiolipin antibodies), such as lupus anticoagulant, have been implicated in repeated fetal loss, but little is known about their role in miscarriage. As many as 13 percent of the women who have suffered miscarriages and who have lupus anticoagulant also have anticardiolipin antibodies. To learn more about the possible role of these antibodies in miscarriage, 67 women who had undergone between 2 and 12 pregnancy losses were assessed. Results from this group were compared with results of 12 normal pregnant women and 116 pregnant women with high blood pressure (hypertension) and no anticardiolipin antibodies. Thirty-four of the 67 women with recurrent pregnancy loss had anticardiolipin antibodies; of these, 17 became pregnant. They were treated with a corticosteroid drug (fluocortolone) and aspirin. Results showed that 12 women (of the remaining 33) without anticardiolipin antibodies, and one with those antibodies, developed severe preeclampsia during pregnancy (very high blood pressure and other signs). Twelve of the 17 pregnancies reached term and the women delivered live infants with normal Apgar scores (measures of physical function in the newborn). Three deliveries were premature, and one of these infants died. Studies carried out of the uterine blood flow in women with hypertension, nine of whom had been treated (with fluocortolone and aspirin), showed that resistance in the uterine artery (to blood flow) was reduced in the treated group. The overall survival of infants born to treated women was 82 percent, compared with 18 percent in their previous pregnancies. The results suggest that treating hypertensive women who have anticardiolipin antibodies with corticosteroids and aspirin may improve uteroplacental blood flow (between the uterus and placenta), reducing the risk of miscarriage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Causes of, Corticosteroids, Adrenocortical hormones, Aspirin

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Betamethasone and the human fetal ductus arteriosus

Article Abstract:

Fetuses have an anatomical characteristic known as the ductus arteriosus, a channel of communication between the pulmonary trunk (which will take blood from the heart to the lungs) and the aorta (which will take blood from the heart to the body). This structure normally closes soon after birth. There is evidence that glucocorticoid (steroid) drugs given during pregnancy may induce early closing of this passageway in the fetus. Since glucocorticoids are sometimes given before birth to promote maturation of the fetal lungs, information regarding any potential effect of the drugs upon the ductus arteriosus is needed. To learn more about this, the fetuses of 11 women with placenta previa (a placenta implanted in the lower region of the uterus, an abnormal location) were studied. The patients received betamethasone (a steroid drug) because of the prematurity of their infants or because results from amniocentesis (sampling of the fluid in which the fetus floats) indicated the fetal lungs were too immature. Ultrasound methods were used to evaluate the patency (openness) of the ductus arteriosus before the first injection of betamethasone and at regular intervals thereafter. Results showed that mild constriction occurred in two of 11 trials five hours after the first shot of betamethasone was given, but no signs of severe constriction developed. All constriction had vanished by 30 hours after the first injection, which was also five hours after the second (the injections were 24 hours apart). On balance, these brief, limited effects are probably not significant, and glucocorticoids can be safely used to treat the immature fetal lung. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Diseases, Pregnant women, Infants (Premature), Premature infants, Patent ductus arteriosus, Betamethasone, Ductus arteriosus

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Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies

Article Abstract:

Pregnancy loss and stillbirth are associated with the presence of antibodies to lupus anticoagulants and anticardiolipin (antiphospholipid antibodies) in the mother's blood, most likely as a result of thrombosis (blood clots) and infarction (blockage of blood supply) in the placenta. To determine the effects of treatment with heparin (an anticoagulant agent) on pregnancy outcome, 14 women with a history of at least one abnormal pregnancy outcome were studied. (This group had experienced a total of 28 spontaneous abortions.) All patients had lupus anticoagulant and/or anticardiolipin antibodies when treatment began, at an average gestational age of approximately 10 weeks. Heparin was administered every 12 hours for the remainder of the pregnancy, and prenatal examinations were performed weekly from the 24th gestation until delivery. Fourteen of the 15 pregnancies had successful outcomes, with the infants' birth weights averaging values in the 57th percentile. One newborn developed respiratory distress, which resolved; the remaining 13 infants were healthy. The reasons why antiphospholipid antibodies are associated with thrombosis are not known; different treatment regimens for pregnant women with this condition are evaluated. No bleeding problems were observed with the doses of heparin used in this study; however, pregnancies in women with these antibodies are considered to be in the high-risk category. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Pregnancy, Heparin, Hematologic diseases, Blood diseases in pregnancy

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