A favorable outcome of pregnancies in women with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome.

OBJECTIVE: To study the outcome of pregnancies in women with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome treated with the standard treatment regimes including intravenous immunoglobulin (IV Ig). METHODS: Forty three patients with recurrent pregnancy loss associated with antiphospholipid syndrome diagnosed before pregnancy and subdivided into primary (18) and secondary (25) subgroups were closely monitored all through pregnancy with serial blood tests and ultrasonography until the pregnancy ended in miscarriage or delivery. The patients were treated with low-dose aspirin and heparin and or steroids and IV Ig given to some selected patients. The maternal and fetal outcomes were analysed. RESULTS: The mean age of the patients in the primary subgroup (24.60 +/- 4.30) years was significantly lower than the mean age of the secondary recurrent pregnancy loss group (31.50 +/- 4.50) years, (p < 0.0001). 85.00% of all the previous miscarriages were in the first trimester. There was no significant difference in the incidence of live births in the primary (77.80%) and secondary (84.00%) groups, (p > 0.05); the babies were of normal birth weight. The incidence of caesarean section in the primary and secondary groups, 22.23% and 12.00% respectively, were not significantly different (p > 0.05). Intravenous immunoglobulin added to the standard therapy resulted in 100% live births. Maternal complications were negligible. CONCLUSIONS: The fetal and maternal outcome of pregnancies in patients with primary and secondary recurrent pregnancy loss associated with antiphospholipid syndrome were virtually identical and quite satisfactory. Intravenous immunoglobulin added to the standard therapy resulted in excellent fetal and maternal outcome, although its definitive role will have to wait for the outcome of randomised trials.

Human leucocyte antigens in pregnant women with pre-eclampsia associated with intrauterine growth retardation and in normal controls.

OBJECTIVE: To investigate the association between maternal HLA class II and intrauterine growth retardation with associated birthweight of the newborn, in women with preeclampsia. METHODOLOGY: Thirty preeclamptics and 30 normotensive matched for age, parity and gestation were investigated for HLA class II profile using Terasaki microlymphocytotoxicity test as the typing technique. The outcome of the pregnancy in terms of intrauterine growth retardation, birthweight and placental weight, were investigated to elucidate a susceptibility factor in the HLA Class II profile of the preeclamptic women. RESULTS: HLA class II DR2, DR4, DRw11, DRw14 and DQw2 were more common in the preeclamptic women (p < 0.04, 0.03, 0.05, 0.03, 0.05), while DQw3 was more common in the controls (p < 0.05). Mean birthweight was 2.71 +/- 0.73 kg with preeclampsia compared to 3.4 +/- 0.4 kg for controls (p < O.01). Low birthweight was 56.7% versus 6.1% (p < 0.001) and mean placental weight was 474.8 +/- 100.8 gm versus 692.1 +/- 107.3 gm (p < 0.01). DR4 and DQW2 were significantly associated with intrauterine growth retardation with associated low birthweight and placental weight (p < 0.01). CONCLUSION: HLA class II hyaplotypes DR4, and DQw2 are associated with intrauterine growth retardation with associated low birthweight and placental weight through preeclampsia. The association between intrauterine growth retardation and HLA may be a direct susceptibility factor. This needs further elucidation.