Lupus anticoagulant: Its significance in first trimester habitual abortion

206

P 307 LUPUS

ANTICOAGULANT~

ITS SIGNIFICANCE HABITUAL ABORTION.

IN

FIRST

TRIMESTER

HJA. C A R P , Y. M E N A S H E , A. M A N Y , V. T O D E R , S. M A S H I A C H , DM. SERR, L. NEBEL. D e p t s . O b s t e t r i c s . & G y n e c o l o g y , & H a e m a t o l o g y , S h e b a M e d i c a l C e n t e r , Tel Hashomer, and Dept. Embryology & Teratology University of Tel Aviv, Israel

Lupus Anticoagulant (LA) has been widely reported to be a cause of fetal d e a t h . Most reports claim that 50-60% of,fetal losses occurr in the st no 1 t r i m e s t e r in p a t i e n t s w i t h LA, 30% in the 2 t r i m e s t e r and 10-20% in r~ the 3 t r i m e s t e r . In our series of 899 fetal losses in an unse~ected group of 186 h a b i t u a l aborters, 800 a b o r t i o n s (89%) occurred in the i st trimester and 9 9 (ii % ) in the 2 no trimester. As good results have been reported from therapy w i t h s t e r o i d s and asprin, 25 p a t i e n t s w i t h 97 p r e v i o u s fetal l o s s e s w e r e t r e a t e d . 34 p r e g n a n c i e s ensued, 17 of which resulted in live births (50%). P a t i e n t s w e r e classified as habitual aborters, lupus patients, and unexplained second and third t r i m e s t e r fetal l o s s e s . The lupus p a t i e n t s had 71% live b i r t h s . In h a b i t u a l ~ a b o r t e r ~ o n l y 7 of 21 (33%) of pregnancies terminated in live b i r t h s . The 2 n° and 3 r~ t r i m e s t e r l o s s e s had an 83% s u c c e s s rate. In our control g r o u p of u n t r e a t e d h a b i t u a l a b o r t e r s . l l of 29 p a t i e n t s h a d subsequent live births (38%). As the results of treatment are no bette~ than the control 9 r o u p a n d the d i s p r o p o r t i o n a l l y l a r g e n u m b e r of 2 n e a n d 3r= t r i m e s t e r fetal losses, we suggest that lupus anticoagulant is not a cause of st i trlmester abortion and that t r e a t m e n t by s t e r o i d s w i t h the a t t e n d a n t risks maj be unnecessar F. Keywords:

Lupus

Anticoagulant,

Abortion,

P 308 PREDICTION OF THE OUTCOME OF PREGNANCY AFTER PATERNAL LEUCOCYTE IMMUNISATION HJA. CARP, E. BACHAR, M. ZIGRIL, A. FEIN, E. GAZIT, V. TODER, S. MASHIACH, DM. SERR, L. NEBEL. Depts. Obstetrics. & Gynecology, & Transplant Ir~nunology, Sheba Medical Center, Tel Hashomer, Dept. Embryology & Teratology University of Tel Aviv, Israel Paternal Leucocyte immunisation has been shown to be an effective means of preventing further miscarriages in habitual aborters. However, the mechanism remains unclear. In our series, the production of anti paternal complement dependant antibody (APCA) is associated with a 75% success rate in the subsequent pregnancy. Only 43% of APCA negative patients had successful pregnancies after i ~ u n i s a t i o n . As APCA itself is not essential for pregnancy to develop normally, further investigations were carried out to determine its possible role. Five patients so far have been found to have an anti-idiotypic antibody to paternal HLA antigens prior to i~mlunisation. This antibody inhibited the cross match between maternal serum and paternal lymphocytes. Its effect was neutralised when APCA was produced. Sera of habitual aborters were also tested on mouse blastocyst development in vitro. Pre-immunisation serum inhibited bl~stocyst spreading. This effect was neutralised when APCA was produced. Therefore habitual aborters may produce an anti-idiotypic antibody to fetal HLA antigens which causes early embryonic demise in vivo. This antibody may be associated with toxicity to the blastocyst in vitro.

Keywords:

Anti-idiotypic antibody, APCA Habitual abortion.