THE CORRELATION BETWEEN ANTICARDIOLIPIN ANTIBODIES, LUPUS ANTICOAGULANT AND UTERINE ARTERY DOPPLER IN CASES OF RECURRENT MIDTRIMESTRIC PREGNANCY LOSS
Eman Zein, Loai Ezzat*, Abdalla El-Katab, Omneya Helal and Somaia M. Mousa**
Departments of Obstetrics and Gynecology, *Radiology, **Clinical Pathology, Cairo and Beni-Sueif Universities
Background: Antiphospholipid antibodies detected by anticardiolipin antibodies (aCL) and lupus anticoagulant (LA) were associated with fetal loss due to impairment of utero-placental circulation.
Aim: To assess the role of Transvaginal Doppler Ultrasonography in predicting the risk of pregnancy loss in pregnant patients with antiphospholipid syndrome and to analyze the prevalence of anticardiolipin antibodies and lupus anticoagulants and type of pregnancy failure occurring in this group of patients.
Patients and Methods: forty pregnant patients with history of recurrent pregnancy loss and 20 healthy pregnant women were subjected to transvaginal pulsed Doppler ultrasonography on both uterine arteries in the 2nd trimester of pregnancy (once at 16-18 weeks then another time at 22-24 weeks). Study results were interpreted for resistivity indices (RI) & the presence of uterine artery notch (unilateral or bilateral). Anticardiolipin IgG and IgM antibodies were measured by semi quantitative ELISA and lupus anticoagulants were detected using PTT-LA kit.
Results: The bilateral uterine artery notch was the most sensitive predictor of pregnancy loss especially in the 24 weeks gestation, it was positive in 42.5% of patients (p < 0.05). RI of the uterine artery was higher in patients compared to control women and the difference was statistically significant (p < 0.005). Anticardiolipin IgG and IgM were detected in all patients and a direct highly significant relation was found between aCL IgM antibody level and pregnancy loss (p = 0.002). 55% of patients were positive for LA which is found to be associated significantly with pregnancy loss (p = 0.001).
Conclusion: The second trimester Doppler ultrasound examination is a good predictor of late pregnancy outcome in patients with antiphospholipid syndrome. The magnitude of association between the presence of aCL and/or LA and pregnancy loss varies according to the type and level of antibodies.