Placental pathology and antiphospholipid antibodies: a descriptive study

Area of Science:

• Obstetrics and Gynecology
• Pathology
• Immunology

Background:

• Antiphospholipid antibody (APL) syndrome is associated with adverse pregnancy outcomes.
• Understanding placental pathology is crucial for managing APL syndrome.
• Previous studies have not fully elucidated the spectrum of placental changes in APL syndrome across different clinical scenarios.

Purpose of the Study:

• To describe and compare placental pathology in antiphospholipid antibody (APL) syndrome.
• To investigate placental findings in treated and untreated APL syndrome pregnancies.
• To analyze placental pathology in relation to recurrent pregnancy loss and serological APL.

Main Methods:

• Histopathological review of 39 placentas from 28 patients with APL.
• Inclusion of placentas from pregnancies with APL syndrome, serological APL, and prior miscarriages.
• Blinded histopathological assessment by a pathologist, with statistical analysis using contingency tables and ANOVA.

Main Results:

• Placentas from treated APL syndrome pregnancies showed a trend towards more perivillous coagulation, avascular villi, and vasculitis compared to serological APL (p=0.07).
• Miscarriages before APL diagnosis (<18 weeks) lacked APL-typical pathology, though chronic intervillositis was noted in 36%.
• Multifocal uteroplacental thromboses occurred in 60% of miscarriages after 18 weeks, compared to 46% in treated APL syndrome and 0% in serological APL.

Conclusions:

• Placental pathology in APL syndrome varies with treatment status and gestational age at loss.
• Uteroplacental thromboses are a significant finding in later miscarriages and treated APL syndrome pregnancies.
• Further research is needed to refine diagnostic criteria and therapeutic strategies for APL-associated pregnancy complications.