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Predictors of pregnancy outcome in antiphospholipid syndrome: a review
Sara De Carolis1, Angela Botta, Stefania Santucci
1Department of Obstetrics and Gynecology, Catholic University of Sacred Hearth, Rome, Italy. saradecarolis@libero.it
Insights
Antiphospholipid syndrome (APS) in pregnancy increases risks like preeclampsia. Uterine artery Doppler velocimetry, false-positive TORCH IgM, and low complement levels are key indicators of poor pregnancy outcomes in APS patients.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Perinatology
Background:
- Antiphospholipid syndrome (APS) in pregnancy is linked to severe complications, including preeclampsia and fetal growth restriction, stemming from uteroplacental insufficiency.
- Identifying predictive markers for obstetric outcomes in APS pregnancies is crucial for improved management and patient care.
Purpose of the Study:
- To evaluate the predictive value of uterine artery Doppler velocimetry, false-positive IgM for TORCH complex, and complement component levels for adverse pregnancy outcomes in patients with APS.
Main Methods:
- Utilized uterine artery Doppler velocimetry as a non-invasive method to assess uteroplacental blood flow and detect impaired placental perfusion.
- Analyzed the association between false-positive IgM for TORCH (Toxoplasmosis, Others, Rubella, Cytomegalovirus, Herpes simplex virus) complex and pregnancy outcomes.
- Investigated the correlation between low levels of complement components and the incidence of obstetric complications in APS pregnancies.
Main Results:
- Uterine artery Doppler velocimetry has proven effective in identifying APS pregnancies at higher risk for adverse outcomes.
- False-positive IgM for TORCH complex indicates immune system dysregulation, potentially amplifying placental autoimmune damage and worsening pregnancy outcomes.
- Low complement component levels are associated with increased obstetric complications, suggesting a role for immune complex deposition and complement activation in APS-related placental failure.
Conclusions:
- Abnormal uterine Doppler velocimetry, false-positive TORCH IgM, and low complement component levels serve as significant prognostic indicators for poor pregnancy outcomes in Antiphospholipid syndrome.
Abstract:
In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk of preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In the last two decades, several studies were performed to identify the predictive role of some parameters in relation to obstetric outcome in APS patients. Among these, the uterine velocimetry Doppler is the most studied. It provides a non-invasive method for the study of uteroplacental blood flow, being able to detect a condition of impaired placental perfusion, due to the presence of circulating antiphospholipid antibodies (aPL). To date, the uterine artery Doppler velocimetry resulted to be a useful tool to identify APS pregnancies at higher risk of adverse pregnancy outcome. False-positive IgM for toxoplasmosis, others, rubella, cytomegalovirus, herpes viruses (TORCH) complex is associated to a worse pregnancy outcome because it reflects a dysregulation of the immune system which may amplify placental autoimmune damage. Moreover low levels of complement components are related to an increased incidence of obstetrical complications, suggesting that placental deposition of immune complexes and activation of complement cascade may contribute to placental failure APS related. The abnormal uterine Doppler velocimetry, false-positive TORCH IgM and low levels of complement components can be considered prognostic indexes of poor pregnancy outcome in APS.