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Elevated mid-trimester hCG and maternal lupus anticoagulant
F Clark1, J E Dickinson, B N Walters
1Department of Obstetrics, King Edward Memorial Hospital for Women, Subiaco, Australia.
Prenatal Diagnosis
|November 1, 1995
Summary
Women with lupus anticoagulant may experience abnormal prenatal screening results, particularly elevated human chorionic gonadotrophin (hCG). This condition is linked to severe intrauterine growth restriction and adverse pregnancy outcomes.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Immunology
- Maternal-Fetal Medicine
Background:
- Prenatal serum screening is crucial for identifying fetal aneuploidies.
- Lupus anticoagulant (LA) is an antiphospholipid antibody associated with pregnancy complications.
- Elevated maternal serum human chorionic gonadotrophin (hCG) can be a marker in Down syndrome screening.
Observation:
- Three cases presented women with LA and positive Down syndrome screening.
- Screening abnormalities were primarily driven by disproportionately elevated hCG levels.
- Fetal karyotypes were normal, and ultrasonography showed otherwise normal singleton gestations.
Findings:
- Positive second-trimester serum screening for Down syndrome in women with LA.
- Elevated hCG levels were the main contributor to false-positive screening results.
- Early, severe intrauterine growth restriction (IUGR) was observed in all cases.
Implications:
- Maternal LA testing should be considered with elevated hCG in prenatal screening and normal fetal karyotype.
- LA may significantly impact pregnancy outcomes, leading to IUGR and fetal demise.
- Early identification of LA can guide closer pregnancy monitoring and management.