POS0794 INCIDENCE AND PHENOTYPE OF ANTIPHOSPHOLIPID SYNDROME (APS) AFTER PREECLAMPSIA

Background:

Obstetric Antiphospholipid syndrom (oAPS) is induced by antiphospholipid antibodies (aPL) and associated with specific pregnancy complications. oAPS requires the combination of at least one obstetrical and one laboratory criteria (in 2 or more occasions at least 12 weeks apart). Multiple aPL positivity, lupus anticoagulant (LA) or persistently high aPL titers is defined as high risk aPL profile. “Non-criteria” oAPS are cases not fulfilling the clinical criteria.

Objectives:

To investigate the incidence of aPL after preeclampsia and the association of phenotypes of oAPS and pregnancy outcome.

Methods:

The present retrospective cohort analysis included women followed up after preeclampsia. Anti-PL (LA, aCL, anti-β2GBI of IgG and IgM isotype) are assessed 8 to 12 weeks after PE and if positive, again at least 12 weeks apart. According to the ISSHP PE is classified as severe if the blood pressure exceeds 160/110mmHg, or is associated with HELLP syndrome, or eclampsia. FGR is defined as estimated fetal weight <5th, and birth weight <10th percentile, and/or pathologic fetal Doppler.

Results:

Complete clinical and laboratory data were available for 99 women over a period of 6 years. 38.4% delivered <34 + 0 weeks. PE was severe in 63.6% of cases, and the incidence of FGR was 58.9%. HELLP syndrome was diagnosed in 34.3% and in 4 cases it was isolated. The prevalence of aPL was 35 (35.4%) at first evaluation, and 23 (23.2%) were still positive 12 weeks apart. 14/99 (14.1%) cases fulfilled the definition of classical oAPS, and 9/99 (9.1%) delivered >34 weeks (“non-criteria oAPS”). Of interest, the incidende og high risk aPL profiles was similar in both groups (64.3% vs. 77.8%; p=NS). The incidence of HELLP syndrome was higher in the presence of APS (APS: 9/23 [39.1%] vs. 21/76 [27.6%]; p=NS). 3 out of 4 cases with isolated HELLP syndrome were associated with high risk aPL profiles. Overall, aCL IgG was the dominant aPL. 32/35 (91.4%) and 22/23 (95.7%) had positive aCL at first and second investigation, respectively (p=NS). An aCL IgG titer >32.8CU at first assessment yield a LR of 10 for persistent aCL with a sensitivity and specificity of 91.3% and 90.9%, respectively.

Conclusion:

Classical and “non-criteria” obstetrical APS show a similar aPL pattern and distribution of aPL phenotypes regardless of gestational age at delivery. aCL IgG is the dominant aPL antibody and is highly predictive for aPL persistence at follow up. HELLP syndrome may be an additional feature of oAPS, in particular the isolated form. However, more studies are necessary to explore this possible association.

References:

[1]Tektonidou MG et al, EULAR recommendations for the management of antiphospholipid syndrome in adults Ann Rheum Dis. 2019 Oct;78(10):1296-1304. doi: 10.1136/annrheumdis-2019-215213. Epub 2019 May 15.

Disclosure of Interests:

None declared

Outcome of monochorionic twin pregnancy complicated by Type-III selective intrauterine growth restriction

OBJECTIVE

Type-III selective intrauterine growth restriction (sIUGR) is associated with a high and unpredictable risk of fetal death and fetal brain injury. The objective of this study was to describe the prospective risk of fetal death and the risk of adverse neonatal outcome in a cohort of twin pregnancies complicated by Type-III sIUGR and treated according to up-to-date guidelines.

METHODS

We reviewed retrospectively all monochorionic diamniotic twin pregnancies complicated by Type-III sIUGR managed at nine fetal centers over a 12-year period. Higher-order multiple gestations and pregnancies with major fetal anomalies or other monochorionicity-related complications at initial presentation were excluded. Data on fetal and neonatal outcomes were collected and management strategies reviewed. Composite adverse neonatal outcome was defined as neonatal death, invasive ventilation beyond the resuscitation period, culture-proven sepsis, necrotizing enterocolitis requiring treatment, intraventricular hemorrhage Grade > I, retinopathy of prematurity Stage > II or cystic periventricular leukomalacia. The prospective risk of intrauterine death (IUD) and the risk of neonatal complications according to gestational age were evaluated.

RESULTS

We collected data on 328 pregnancies (656 fetuses). After exclusion of pregnancies that underwent selective reduction (n = 18 (5.5%)), there were 51/620 (8.2%) non-iatrogenic IUDs in 35/310 (11.3%) pregnancies. Single IUD occurred in 19/328 (5.8%) pregnancies and double IUD in 16/328 (4.9%). The prospective risk of non-iatrogenic IUD per fetus declined from 8.1% (95% CI, 5.95-10.26%) at 16 weeks, to less than 2% (95% CI, 0.59-2.79%) after 28.4 weeks and to less than 1% (95% CI, -0.30 to 1.89%) beyond 32.6 weeks. In otherwise uncomplicated pregnancies with Type-III sIUGR, delivery was generally planned at 32 weeks, at which time the risk of composite adverse neonatal outcome was 29.0% (31/107 neonates). In twin pregnancies that continued to 34 weeks, there was a very low risk of IUD (0.7%) and a low risk of composite adverse neonatal outcome (11%).

CONCLUSIONS

In this cohort of twin pregnancies complicated by Type-III sIUGR and treated at several tertiary fetal centers, the risk of fetal death was lower than that reported previously. Further efforts should be directed at identifying predictors of fetal death and optimal antenatal surveillance strategies to select a cohort of pregnancies that can continue safely beyond 33 weeks' gestation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.