Gestation in patients with a combination of antiphospholipid and torch syndromes
https://doi.org/10.23946/2500-0764-2021-6-2-41-50
Abstract
Aim. To study the features of gestation in women with a combination of antiphospholipid and TORCH syndromes in relation to preconception care.
Materials and Methods. We analyzed 137 medical records of women with a past medical history of pregnancy loss and antiphospholipid syndrome (APS), focusing on the presence or absence of plasmapheresis in the preconception period, and further ranking the patients into 2 subgroups (with and without TORCH syndrome). As a control group, we included 28 pregnant women without both syndromes.
Results. Gestation in women with combined APS and TORCH syndromes was accompanied by a 10-fold higher risk of threatened abortion in the first trimester and 3-fold higher risk of placental insufficiency as compared to those without both syndromes. Notably, the combination of the syndromes doubled the risk of placental insufficiency in comparison with APS alone. The lack of plasmapheresis in patients with APS and TORCH syndrome was associated with > 2-fold higher risk of threatened abortion. Further, in patients with APS and TORCH syndrome, lack of plasmapheresis increased the likelihood of developing fetal hypoxia by a factor of 2 and 3 in comparison with those diagnosed with APS alone or control patients.
Conclusions. TORCH syndrome is a major risk factor of adverse outcome in pregnant women with APS. Inclusion of plasmapheresis into the preconception care in women with APS and TORCH syndrome significantly reduced the development of pregnancy complications.
About the Authors
E. N. Kravchenko
Omsk State Medical University
Russian Federation
Russian Federation
MD, DSc, Professor, Department of Obstetrics and Gynecology #1,
12, Lenina Street, Omsk, 644043
A. A. Goncharova
City Clinical Perinatal Center
Russian Federation
Russian Federation
MD, Deputy Chief Physician,
69, Herzen Street, Omsk, 644007
References
1. Bitsadze VO, Khizroeva DKh, Makatsariya NA, Egorova ES, Baymuradova SM, Mashkova TYa. Antiphospholipid antibodies, their pathogenetic and diagnostic issues obstetric practice. Akusherstvo, Ginekologiya i Reproduktsiya (Obstetrics, Gynecology, and Reproduction). 2014;8(2):39-60.] (In Russ.).
2. Cervera R. Antiphospholipid syndrome. Thromb Res. 2017;151 Suppl 1:S43-S47. https://doi.org/10.1016/S0049-3848(17)30066-X
3. D'Ippolito S, Meroni PL, Koike T, Veglia M, Scambia G, Di Simone N. Obstetric antiphospholipid syndrome: a recent classification for an old defined disorder. Autoimmun Rev. 2014;13(9):901-908. https://doi.org/10.1016/j.autrev.2014.05.004
4. Menzhinskaya IV, Van'ko LV. Pathophysiological mechanisms of obstetric antiphospholipid syndrome. Obstetrics and Gynecology. 2018;1:5-12. (in Russ.). https://doi.org/10.18565/aig.2018.1.5-12
5. Menzhinskaya IV, Vanko LV. Antiphospholipid antibodies as diagnostic markers for obstetric antiphospholipid syndrome. Obstetrics and gynecology. 2019;2:5-12. (in Russ.). https://doi.org/10.18565/aig.2019.2.5-12
6. Fialová L, Petráčková M, Kuchař O. Comparison of different enzyme-linked immunosorbent assay methods for avidity determination of antiphospholipid antibodies. J Clin Lab Anal. 2017;31(6):e22121. https://doi.org/10.1002/jcla.22121
7. McDonnell T, Artim-Esen B, Wincup C, Ripoll VM, Isenberg D, Giles IP, Rahman A, Pericleous C. Antiphospholipid Antibodies to Domain I of Beta-2-Glycoprotein I Show Different Subclass Predominance in Comparison to Antibodies to Whole Beta-2-glycoprotein I. Front Immunol. 2018;9:2244. https://doi.org/10.3389/fimmu.2018.02244
8. Chepanov SV, Shlyakhtenko TN, Zainulina MS, Mirashvili MI, Sokolov DI, Selkov SA. Anti-annexin v antibodies in women with recurrent miscarriage. Obstetrics and Gynecology. 2014;7:29-32. (In Russ.).]
9. Bećarević M. The IgG and IgM isotypes of anti-annexin A5 antibodies: relevance for primary antiphospholipid syndrome. J Thromb Thrombolysis. 2016;42(4):552-557. https://doi.org/10.1007/s11239-016- 1389-5
10. Adamyan LV, Kuz'min VN, Arslanyan KN, Kaznacheeva TV, Kharchenko EI. Current approaches to diagnosis and treatment of intrauterine infections. Russian journal of human reproduction. 2015;21(5):115- 119. (In Russ.).
11. Kravchenko EN, Goncharova AA. Correlation between indicators of hemostasis system activity and antiphospholipid antibodies levels in women with miscarriage. Ginecology. 2019;5(21):53-58. (In Russ.). https://doi.org/10.26442/20795696.2019.5.190668
12. Kuzmin VN, Adamyan LV. The problem of intrauterine infection in modern obstetrics. Infectious diseases: news, views, education. 2017;3(20):32-36. (In Russ.).
13. Naumenko NS, Nikonov AP, Ascaturova OR, Belova AV. Structure of infectious screening of pregnants: russian and overall practice. VF Snegirev archives of obstetrics and gynecology. 2018;1(5):26-30. (In Russ.). https://doi.org/10.18821/2313-8726-2018-5-1-26-30
14. Tetruashvili NK. Recurrent abortion. Obstetrics and gynecology. news. views. Education. 2017;4(18):70-87. (In Russ.).
15. Kravchenko EN, Goncharova AA, Kropmaer KP. Features of the course of pregnancy in women with antiphospholipid syndrome, depending on the therapy and the presence of torch infection. Russian journal of human reproduction. 2020;26(1):83-89]. (In Russ.). https://doi.org/10.17116/repro20202601183
16. Martirosyan AA, Manukyan GP. Theories of antiphospholipid antibody origin: the role of infectious pathogenic agents. Theories of the originof antiphospholipid antibodies: the role of infectious pathogenic agents. Uspehi sovremennoj biologii. 2018;138(2):148-160. (In Russ.). https://doi.org/10.7868/S0042132418020047
17. Khizroeva J, Bitsadze V, Makatsariya A. Catastrophic antiphospholipid syndrome and pregnancy. Clinical report. J Matern Fetal Neonatal Med. 2019;32(12):2091-2094. https://doi.org/10.1080/14767058.2017.1422715
18. Shoenfeld Y, Blank M, Cervera R, Font J, Raschi E, Meroni PL. Infectious origin of the antiphospholipid syndrome. Ann Rheum Dis. 2006;65(1):2-6. https://doi.org/10.1136/ard.2005.045443
19. Abdel-Wahab N, Lopez-Olivo MA, Pinto-Patarroyo GP, Suarez-Almazor ME. Systematic review of case reports of antiphospholipid syndrome following infection. Lupus. 2016;25(14):1520-1531. https://doi.org/10.1177/0961203316640912
Review
For citations:
Kravchenko E.N., Goncharova A.A. Gestation in patients with a combination of antiphospholipid and torch syndromes. Fundamental and Clinical Medicine. 2021;6(2):41-50. (In Russ.) https://doi.org/10.23946/2500-0764-2021-6-2-41-50
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