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Belhocine M, Coutte L, Martin Silva N, Morel N, Guettrot-Imbert G, Paule R, Le Jeunne C, Fredi M, Dreyfus M, Piette JC, Souchaud-Debouverie O, Deneux-Tharaux C, Tsatsaris V, Pannier E, Le Guern V, Costedoat-Chalumeau N. Intrauterine fetal deaths related to antiphospholipid syndrome: a descriptive study of 65 women. Arthritis Res Ther 2018; 20:249. [PMID: 30400982 PMCID: PMC6235231 DOI: 10.1186/s13075-018-1745-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Although one of the three obstetric manifestations of antiphospholipid syndrome (APS) is intrauterine fetal death (IUFD), little is known about it in this context. We report the first large series of patients with APS and IUFD. Methods We retrospectively analyzed the history and clinical data of women at four French hospitals. All had (1) APS diagnosis (Sydney criteria) and (2) IUFD at or after 10 weeks of gestation (weeks) between 2000 and 2016. Results The study included 65 women. Their median age at the index IUFD was 29 years (IQR 26–33); 38 (58%) were primigravidas. The index IUFD was the first APS clinical manifestation in 48 women (74%). Overall, 35% had a triple-positive antibody profile. IUFD occurred at a median gestational age of 24 weeks (IQR 18–27) and was associated with maternal obstetric complications in 16 women (25%), namely, preeclampsia (n = 12), hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) (n = 6), and/or placental abruption (n = 5). Half of the 50 women with available data had a small-for-gestational-age fetus. Overall, including during the follow-up period of 4 years (IQR 2–9), 28 women (43%) had at least one thrombosis, and 29% were diagnosed with systemic lupus erythematosus (SLE). Ultimately, 54 women (83%) had at least one live birth. Only one woman had three consecutive early miscarriages. Conclusion IUFD was most often the inaugural sign of APS. Of the APS classification criteria, IUFD, preeclampsia, and thromboses were common in this cohort, while the “3 consecutive early miscarriages” criterion was met only once. With treatment, most of the women successfully had at least one live birth.
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Affiliation(s)
- Mériem Belhocine
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Laetitia Coutte
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | | | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Gaëlle Guettrot-Imbert
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Romain Paule
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Claire Le Jeunne
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Micaela Fredi
- Spedali Civili di Brescia, Rheumatology and Clinical Immunology Department, Brescia, Italy
| | - Michel Dreyfus
- Caen University Hospital, Gynecology and Obstetrics Department, Caen, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpétrière University Hospital, Internal Medicine and Clinical Immunology Department, Centre de référence maladies auto-immunes et systémiques rares de l'île de France, Université Paris 6, Paris, France
| | | | - Catherine Deneux-Tharaux
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Université Paris Descartes, Paris, France
| | - Vassilis Tsatsaris
- AP-HP, Cochin Hospital, Port-Royal maternity, Gynecology and Obstetrics Department, DHU Risks in Pregnancy, INSERM U1139, Paris, France
| | - Emmanuelle Pannier
- AP-HP, Cochin Hospital, Port-Royal maternity, Gynecology and Obstetrics Department, DHU Risks in Pregnancy, INSERM U1139, Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France. .,INSERM U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
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