Pregnancy and its outcome in antiphospholipid syndrome after acute cerebral circulatory failure (clinical case study)
https://doi.org/10.47360/1995-4484-2024-325-330
Abstract
Obstetric pathology (pregnancy loss at different gestational ages; premature delivery of morphologically normal foetus due to pre-/eclampsia or placental insufficiency), along with thrombotic complications are the main clinical manifestations of antiphospholipid syndrome (APS). Among arterial thromboses in APS, cerebral vascular thromboses in the form of strokes or transient ischaemic attacks. Patients with APS have a well known increased risk of thrombosis associated with pregnancy or conditions accompanied by hyperestrogenemia. More than half of thrombotic complications in women with APS occur during gestation or hyperestrogenemia. Most studies of pregnancy in APS have focused on women with recurrent fetal loss, and data on pregnancy outcomes in patients with other clinical phenotypes of APS, such as thrombotic APS, are limited. We present a case report of a patient with reliable thrombotic APS (with recurrent ischaemic cerebral circulatory disorders) and highly positive levels of antiphosphrolipid antibodies with a favourable pregnancy outcome.
About the Authors
T. M. Reshetnyak
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Tatiana M. Reshetnyak
115522, Moscow, Kashirskoye Highway, 34A
F. A. Cheldieva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Fariza A. Cheldieva
115522, Moscow, Kashirskoye Highway, 34A
N. M. Kosheleva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Nadezhda M. Kosheleva
115522, Moscow, Kashirskoye Highway, 34A
A. A. Shumilova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Anastasiia A. Shumilova
115522, Moscow, Kashirskoye Highway, 34A
L. M. Blank
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Leonid M. Blank
115522, Moscow, Kashirskoye Highway, 34A
N. V. Seredavkina
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Nataliya V. Seredavkina
115522, Moscow, Kashirskoye Highway, 34A
References
1. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. doi: 10.1111/j.1538-7836.2006.01753.x
2. Petri M. Antiphospholipid syndrome. Transl Res. 2020;225:70-81. doi: 10.1016/j.trsl.2020.04.006
3. Suzumori N, Sugiura-Ogasawara M. Genetic factors as a cause of miscarriage. Curr Med Chem. 2010;17(29):3431-3437. doi: 10.2174/092986710793176302
4. Brigham SA, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. Hum Reprod. 1999;14(11):2868-2671. doi: 10.1093/humrep/14.11.2868
5. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al.; Lancet Ending Preventable Stillbirths Series study group; Lancet Stillbirth Epidemiology investigator group. Stillbirths: Rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587-603. doi: 10.1016/S0140-6736(15)00837-5
6. Liu L, Sun D. Pregnancy outcomes in patients with primary antiphospholipid syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(20):e15733. doi: 10.1097/MD.0000000000015733
7. Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, Sáez-Comet L, Lefkou E, Mekinian A, et al.; EUROAPS Study Group. The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases. Autoimmun Rev. 2019;18(4):406-414. doi: 10.1016/j.autrev.2018.12.006
8. Maynard S, Guerrier G, Duffy M. Pregnancy in women with systemic lupus and lupus nephritis. Adv Chronic Kidney Dis. 2019;26(5):330-337. doi: 10.1053/j.ackd.2019.08.013
9. Reshetnyak TM, Kosheleva NM, Nasonov EL. Systemic lupus erythematosus and pregnancy: Before gestation, during and after childbirth. Nauchno-Prakticheskaya Revmatologia = Rheumatology Science and Practice. 2023;61(3):292-297 (In Russ.). doi: 10.47360/1995-4484-2023-292-297
10. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, et al.; Euro-Phospholipid Project Group. Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46(4):1019-1027. doi: 10.1002/art.10187
11. Fischer-Betz R, Specker C, Brinks R, Schneider M. Pregnancy outcome in patients with antiphospholipid syndrome after cerebral ischaemic events: An observational study. Lupus. 2012;21(11):1183-1189. doi: 10.1177/0961203312451335
12. Levine SR, Brey RL, Joseph CL, Havstad S. Risk of recurrent thromboembolic events in patients with focal cerebral ischemia and antiphospholipid antibodies. The Antiphospholipid Antibodies in Stroke Study Group. Stroke. 1992;23(Suppl 2):I29-I32.
13. Lockshin MD, Qamar T, Levy RA, Druzin ML. Pregnancy in systemic lupus erythematosus. Clin Exp Rheumatol. 1989;7(Suppl 3):S195-S197.
14. Branch DW, Khamashta MA. Antiphospholipid syndrome: Obstetric diagnosis, management, and controversies. Obstet Gynecol. 2003;101(6):1333-1344. doi: 10.1016/s0029-7844(03)00363-6
15. Lima F, Khamashta MA, Buchanan NM, Kerslake S, Hunt BJ, Hughes GR. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol. 1996;14(2):131-136.
16. Ghembaza A, Saadoun D. Management of antiphospholipid syndrome. Biomedicines. 2020;8(11):508. doi: 10.3390/biomedicines8110508
17. Mahler M, Hanly JG, Fritzler MJ. Importance of the dense fine speckled pattern on Hep-2 cells and anti-DFS70 antibodies for the diagnosis of systemic autoimmune diseases. Autoimmun Rev. 2012;11(9):642-645. doi: 10.1016/j.autrev.2011.11.005
18. Reshetnyak TM, Shumilova AA, Kosheleva NM. Clinical value of antinuclear antibodies. Lechebnoe delo. 2021;4:96-103 (In Russ.). doi: 10.24412/2071-5315-2021-12398
Review
For citations:
Reshetnyak T.M., Cheldieva F.A., Kosheleva N.M., Shumilova A.A., Blank L.M., Seredavkina N.V. Pregnancy and its outcome in antiphospholipid syndrome after acute cerebral circulatory failure (clinical case study). Rheumatology Science and Practice. 2024;62(3):325-330. (In Russ.) https://doi.org/10.47360/1995-4484-2024-325-330
Views:
441
Email this article 