Uterine Artery Doppler in Predicting Pregnancy Outcome in Women With Antiphospholipid Syndrome:

Vascular dysfunction in women with recurrent pregnancy loss: Possible association with antiphospholipid antibodies

OBJECTIVE

Antiphospholipid antibodies (aPL) are recognized to have a pivotal role in recurrent pregnancy loss (RPL) and cardiovascular disease. Therefore, we assessed the vascular function of women with RPL and examined the association with each type of aPL.

METHODS

In this retrospective study, 569 women with RPL and 55 healthy women who had never experienced pregnancy loss were recruited. We performed blood tests for aPL and acceleration plethysmography (APG) to evaluate peripheral vascular function.

RESULTS

The differential pulse wave index (DPI), indicating vascular elasticity, was significantly lower in women with RPL (115.6 ± 4.1) compared to the control group (117.0 ± 2.3). DPI in RPL women with anti-β2 glycoprotein I (aβ2GPI) IgG was significantly lower than those without. Remained blood volume (RBV), indicating post-vasoconstriction blood content, was significantly higher in RPL women with aβ2GI IgG than in those without. Regression analysis showed aβ2GPI IgG and body mass index (BMI) linked negatively with DPI.

CONCLUSION

Women with RPL have subclinical vascular dysfunction even at reproductive age. It is possible that aβ2GPI IgG is associated with vascular dysfunction in RPL women.

The second trimester Doppler ultrasound examination is the best predictor of late pregnancy outcome in systemic lupus erythematosus and/or the antiphospholipid syndrome

OBJECTIVE

To examine the predictive value of clinical examination, laboratory tests and Doppler ultrasound examination in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) pregnancies.

METHODS

A prospective study of 116 pregnancies followed in a single tertiary referral centre. Outcomes analysed were fetal/neonatal death and adverse pregnancy outcome. Univariate analysis was performed for: (i) medical and obstetric history; (ii) medical and obstetric clinical examination; (iii) biological data; (iv) Doppler ultrasound examination. Variables significantly associated with the outcomes in the univariate analysis were entered into a logistic regression model.

RESULTS

Sixteen out of 116 pregnancies ended in 12 fetal deaths and 4 embryonic losses. Hence, data for 100 pregnancies were analysed. Seven fetal deaths and one neonatal death occurred, associated with abnormal end-diastolic umbilical artery Doppler flow at the second trimester (P < 0.006), a history of thrombophlebitis (P < 0.001) or notched uterine artery and growth restriction at the second trimester (P < 0.002). Multivariate analysis retained abnormal end-diastolic umbilical artery Doppler flow (P = 0.047) and history of thrombophlebitis (P = 0.018) as significant predictors. Thirty-one adverse pregnancy outcomes occurred, associated with notched uterine artery (P < 0.00003), abnormal end-diastolic umbilical artery Doppler flow (P < 0.0006) and fetal growth restriction at the second trimester (P < 0.008), growth restriction (P < 0.00001) and notched uterine artery at the third trimester (P < 0.0008), use of heparin (P < 0.05) and history of thrombophlebitis (P < 0.04). Notched uterine artery at the second trimester remained the only predictor in multivariate analysis (P = 0.001).

CONCLUSIONS

Results of the second trimester Doppler ultrasound examination are the best predictors for late pregnancy outcome in SLE and/or APS.