Background: Antiphospholipid antibodies (APLA) are the most important autoimmune cause of recurrent pregnancy loss (RPL). These pregnancies can be saved if diagnosed and treated adequately. This can be achieved by routine screening for APLA in pregnant women with a bad obstetric history (BOH) and unexplained fetal loss.
Aims and Objective: To study the association of antiphosholipid antibodies in women with BOH and thus evaluating the usefulness of routine screening of serum antiphosholipid antibodies in patients with unexplained fetal wastage and BOH for better outcome.
Material and method: The present study was a prospective study carried out in Department of Obstetrics and Gynaecology at SDM College of Medical Science and Hospital, Dharwad, India, over a period of 1 year from November 2015 to October 2016. Women with bad obstetric history meeting the inclusion and exclusion criteria were recruited in the study and underwent screening for APLA which included Lupus Anticoagulant (LA), Anticardiolipin (ACL) and Anti Beta 2 glycoprotein (β2-GP1) 1 IgG/ IgM. Those tested positive were retested 12 weeks later to confirm the result. Then the various adverse pregnancy outcomes were studied in both APLA positive and negative groups. The APLA positive cases were started with low dose aspirin and heparin.
Results: The study showed that 12 out of 57 cases of BOH were APLA positive. Among the positive APLA group, 2 samples were positive for ACL IgM, 8 samples were LA positive and 1 positive for Anti β2-GP1 IgG and IgM each. The maternal and fetal outcomes were analysed in the study. There was statistically significant difference in the obstetric outcome among the APLA positive patients started on heparin as compared to APLA negative patients.
Conclusion: It is a proved fact that APLA interferes with the normal development of the uteroplacental circulation to cause early and late pregnancy loss. Hence screening for APLA in patients with BOH will help in identifying the cause of recurrent fetal loss and its treatment will improve the obstetric outcome.