Document Detail


Antiphospholipid syndrome and second- or third-trimester fetal death: follow-up in the next pregnancy.
MedLine Citation:
PMID:  15140503     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the efficacy of a uniform management protocol in antiphospholipid-antibody-positive obstetric patients with at least one second- or third-trimester intra-uterine fetal death. STUDY DESIGN: A prospective study of 33 successive pregnancies in antiphospholipid-antibody-positive patients, diagnosed after an intra-uterine fetal death. The management included treatment by a combination of aspirin and low-molecular-weight heparin, and a close follow-up with at least clinical examination, ultrasonography, uterine, and umbilical artery Doppler monthly from the first trimester. In the absence of any anomaly, delivery was induced between 37 and 38 weeks' gestation. RESULTS: In this high risk population, seven recurrences of vascular pathology occurred: five cases of mild, isolated fetal growth retardation and one of preeclampsia associated with fetal growth retardation requiring preterm delivery. Eight patients were delivered before 37 weeks. No recurrence of second- or third-trimester fetal death was observed. Uterine artery Doppler was informative as early as the first trimester (12-15 weeks): a bilateral notch was associated with a lower birthweight (2626+/-688 g versus 3178+/-353 g, respectively, p = 0.01), despite similar gestational age. The negative predictive value of uterine Doppler was more than 92% at 12-15 weeks' gestation and remained high throughout pregnancy. CONCLUSION: Although intra-uterine fetal death is considered at high risk of recurrence in case of antiphospholipid syndrome (APS), a uniform management protocol including aspirin and heparin and close obstetrical follow-up led to a favorable outcome in most cases.
Authors:
A-S Bats; V Lejeune; E Cynober; E Safar; M Gonzales; J Milliez; B Carbonne
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  114     ISSN:  0301-2115     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-13     Completed Date:  2004-09-16     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  125-9     Citation Subset:  IM    
Affiliation:
Service de Gynécologie Obstétrique, Hôpital Saint-Antoine, 184, rue du Faubourg Saint Antoine, Paris 75012, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Anticardiolipin / blood
Antiphospholipid Syndrome / complications*,  therapy
Arteries / ultrasonography
Aspirin / therapeutic use
Female
Fetal Death / epidemiology,  etiology*
Gestational Age*
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Pregnancy
Pregnancy Complications*
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Recurrence
Ultrasonography, Prenatal
Uterus / blood supply
Chemical
Reg. No./Substance:
0/Antibodies, Anticardiolipin; 0/Heparin, Low-Molecular-Weight; 50-78-2/Aspirin

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