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Multicenter Study
. 2018 Nov 6;20(1):249.
doi: 10.1186/s13075-018-1745-2.

Intrauterine fetal deaths related to antiphospholipid syndrome: a descriptive study of 65 women

Mériem Belhocine  1 , Laetitia Coutte  1 , Nicolas Martin Silva  2 , Nathalie Morel  1 , Gaëlle Guettrot-Imbert  1 , Romain Paule  1 , Claire Le Jeunne  1 , Micaela Fredi  3 , Michel Dreyfus  4 , Jean-Charles Piette  5 , Odile Souchaud-Debouverie  6 , Catherine Deneux-Tharaux  7 , Vassilis Tsatsaris  8 , Emmanuelle Pannier  8 , Véronique Le Guern  1 , Nathalie Costedoat-Chalumeau  9   10
Affiliations
Multicenter Study

Intrauterine fetal deaths related to antiphospholipid syndrome: a descriptive study of 65 women

Mériem Belhocine et al. Arthritis Res Ther. .

Abstract

Objective: Although one of the three obstetric manifestations of antiphospholipid syndrome (APS) is intrauterine fetal death (IUFD), little is known about it in this context. We report the first large series of patients with APS and IUFD.

Methods: We retrospectively analyzed the history and clinical data of women at four French hospitals. All had (1) APS diagnosis (Sydney criteria) and (2) IUFD at or after 10 weeks of gestation (weeks) between 2000 and 2016.

Results: The study included 65 women. Their median age at the index IUFD was 29 years (IQR 26-33); 38 (58%) were primigravidas. The index IUFD was the first APS clinical manifestation in 48 women (74%). Overall, 35% had a triple-positive antibody profile. IUFD occurred at a median gestational age of 24 weeks (IQR 18-27) and was associated with maternal obstetric complications in 16 women (25%), namely, preeclampsia (n = 12), hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) (n = 6), and/or placental abruption (n = 5). Half of the 50 women with available data had a small-for-gestational-age fetus. Overall, including during the follow-up period of 4 years (IQR 2-9), 28 women (43%) had at least one thrombosis, and 29% were diagnosed with systemic lupus erythematosus (SLE). Ultimately, 54 women (83%) had at least one live birth. Only one woman had three consecutive early miscarriages.

Conclusion: IUFD was most often the inaugural sign of APS. Of the APS classification criteria, IUFD, preeclampsia, and thromboses were common in this cohort, while the "3 consecutive early miscarriages" criterion was met only once. With treatment, most of the women successfully had at least one live birth.

Keywords: Antiphospholipid syndrome; HELLP; Intrauterine fetal death; Lupus; Preeclampsia; Pregnancy; Thrombosis.

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Conflict of interest statement

Ethics approval and consent to participate

A French ethics committee (Pitié-Salpêtrière Hospital, Paris) approved the study protocol. Consent to participate is not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Timeline of patients’ obstetrical history
Fig. 2
Fig. 2
Gestational term at intrauterine fetal death
Fig. 3
Fig. 3
Outcome of the pregnancies immediately following the index intrauterine fetal death (IUFD)
See this image and copyright information in PMC

References

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