Для всех, у кого выкидыш происходит между 8 и 9 нед. беременности

[Dr.Vad]

К сведению всех тестирующихся на антитела при выкидышах.
Недавнее публикация в журнале BLOOD показывает повышенный риск развития раннего выкидыша в зависимости от обнаружения антител или гипергомоцистеинемии: положительный тест на волчаночный антикоагулянт - в 2,6 раза, высокий титр антикардиолипиновых антител класса IgM - в 3.5 раза и антифосфатидилэтаноламиновых Ат того же класса в 4.7 раза, высокий титр антианнексиновых-V антител класса IgG в 3,2 раза, антитела к tPA - в 19.5 раз, повышенное содержание гомоцистеина в 4.1 раза.
Ссылка на оригинал:
Blood. 2003 Jul 17
Antiphospholipid/antiprotein antibodies, hemostasis-related autoantibodies, and plasma homocysteine as risk factors for a first early pregnancy loss: a matched case-control study.
Gris JC, Perneger TV, Quere I, Mercier E, Fabbro-Peray P, Lavigne-Lissalde G, Hoffet M, Dechaud H, Boyer JC, Ripart-Neveu S, Tailland ML, Daures JP, Mares P, Dauzat M.
Maternal hypercoagulability is a possible cause of miscarriage during the 8th and 9th week of pregnancy, when the placenta replaces the yolk sac. We thus examined associations between putative markers of an acquired hypercoagulable state and the risk of first miscarriage. We conducted a case-control study comparing 743 women who miscarried in weeks 8 and 9 with 743 women who underwent a first provoked abortion, matched for age, number of pregnancies and time elapsed since abortion. Levels of plasma homocysteine and of various antiphospholipid/antiprotein and hemostasis-related autoantibodies were categorized in four strata (percentiles 1-80, 81-95, 96-99, 100 among controls) and analyzed in conditional logistic regression models. Pregnancy loss was independently associated with positive lupus anticoagulant (matched odds ratio (OR) 2.6, 95% confidence interval (CI) 1.1-6.0), high levels of IgM antibodies against cardiolipin (OR for percentile 100 versus 0-80: 3.5, CI 1.2-10.1) and against phosphatidylethanolamine (OR 4.7, CI 1.9-12.1), high levels of IgG antibodies against annexin V (OR 3.2, CI 1.1-9.1) and against tissue-type plasminogen activator (OR 19.5, CI 7.9-48.0), and high homocysteinaemia (OR 4.1, CI 1.3-12.5). A first early pregnancy loss is associated with increased levels of several autoantibodies and of homocysteine.

[Dr.Vad]

Также немного по консенсусу о ведении беременных с АФС:

Lupus. 2003;12(7):524-9.

Treatment of pregnant patients with antiphospholipid syndrome.

Tincani A, Branch W, Levy RA, Piette JC, Carp H, Rai RS, Khamashta M, Shoenfeld Y.

Rheumatology Allergy and Clinical Immunology, Brescia Hospital, Brescia, Italy.

Antiphospholipid Syndrome (APS) has been widely recognized as a risk factor for the recurrence of both thrombosis and pregnancy losses; however the optimal treatment of patients is debatable. The aim of this paper was to establish a consensus among experts on the treatment of APS in pregnancy. A questionnaire that described possible different clinical situations was sent to the International Advisory Board of the 10th International Congress on Antiphospholipid Antibodies. Sixteen experts from different medical branches and different geographic areas sent their replies. The consensus was that treatment for APS pregnant patients should be low molecular weight heparin (LMWH) and low dose aspirin (LDA). The dosage, and frequency of LMWH depends on different situations, including the body weight and past history. Patients with previous thromboses usually receive two injections per day. Warfarin can also be used from 14 to 34 weeks, for patients with previous stroke or severe arterial thromboses. The use of intravenous immunoglobulin (IVIG) seems to be restricted to patients with pregnancy losses despite conventional treatment. The experts usually advised barrier methods of contraception, intrauterine device (if the patient is not taking corticosteroids) or progestins. Oral contraception with oestrogens was usually avoided.