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Placental pathology in systemic lupus erythematosus: a prospective study
M S Magid1, C Kaplan, L R Sammaritano
1Department of Pathology, Hospital for Special Surgery, New York Hospital-Cornell Medical Center, New York, USA.
American Journal of Obstetrics and Gynecology
|August 15, 1998
Summary
Systemic lupus erythematosus (SLE) and antiphospholipid antibodies negatively impact pregnancy outcomes. Decidual vasculopathy appears to be a key factor in these adverse effects, with antiphospholipid antibodies often predicting fetal death.
Area of Science:
- Obstetrics and Gynecology
- Rheumatology
- Pathology
Background:
- Systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPL) are linked to adverse pregnancy outcomes.
- Differentiating the specific impact of SLE and aPL on pregnancy is crucial.
Purpose of the Study:
- To investigate the independent effects of SLE and aPL on gestational outcomes.
- To identify placental pathologies associated with SLE and aPL in pregnant patients.
Main Methods:
- Prospective study of 37 pregnancies and 40 placentas from 33 women with SLE.
- Analysis of gestational outcomes and placental pathology.
Main Results:
- SLE, independent of disease activity, correlated with increased spontaneous abortions, preterm births, and fetal growth restriction.
- Placental findings included ischemic-hypoxic changes, decidual vasculopathy, thrombi, chronic villitis, and reduced placental weight.
- Antiphospholipid antibodies were associated with extensive infarction and fetal death.
Conclusions:
- Decidual vasculopathy/coagulopathy mediates the negative effects of both aPL and SLE on pregnancy.
- Antiphospholipid antibodies largely predict fetal death, though not invariably.
- Antiphospholipid antibody-independent chronic villitis may be another mechanism of SLE-related pregnancy complications.