Comparison of placental vascular complications in patients with obstetric criteria and non criteria antiphospholipid syndrome

Abstract

Introduction. Placental vascular derived complications usually translate in high-risk pregnancies with fetal death or prematurity consequences. Antiphospholipid antibodies (APL) are the only thrombophilic disorder to be evaluated according to different guidelines. Sydney antiphospholipid criteria were intended for clinical trials. In daily practice we usually face women who do not fulfill these criteria but still are high risk cases and may be underrepresented. Objective. To compare clinical obstetric antiphospholipid syndrome (OAPS) versus non criteria obstetric antiphospholipid syndrome (NC-OAPS) in women with APL-related placental vasculopathy. Methods. This is a retrospective multicenter observational study. We analyzed and compared those complications that occur in late second and third trimester. Inclusion criteria: women 18-50 years old with a history of OAPS: stillbirth (SB), early and severe preeclampsia (EPE) < 34 weeks or prematurity due to placental insufficiency (PI) and NC-OAPS: late onset PE after 34 week (LPE), late intrauterine growth restriction (LIGR), preterm birth: > 34 < 37 weeks (PT), abruptio placentae (AP). Laboratory inclusion criteria: LA and/or aCL IgG, IgM and/or antiβ2GPI IgG / IgM positivity, tested at least twice, 12 weeks apart. Either Sydney or the 99th percentile was used. Data were analyzed with chi square. Results. 87 women, median age 33 years (22–50). OAPS:57 (65,5%): 47% EPE, 46% SB, 7% PI; NCOAPS: 30 (34,5%):37% PI/LIGR, 30% LPE, 23% AP. We did not find significant difference between clinical OAPS and NC-OAPS and placental infarcts/ villous thrombosis (p: 0,9); triple positive laboratory test (p: 0,87), positive lupus anticoagulant (p: 0,59). The live birth rate was similar in both groups (p: 0,82). Four OAPS women had a recurrent event in next pregnancy and interestingly it was a NC-OAPS (1 AP, 3IP/ LIGR). Conclusion. According to our results, we found no differences in terms of laboratory parameters or response to treatment in patients with criteria and non-criteria placental vascular complications. Considering the high risk that represent underrepresented cases, we recommend that NC-OAPS should be evaluated in prospective studies with a larger number of patients.