Recurrent abortion is an important feature of?

NEET SS
#1

Recurrent abortion is an important feature of?

  1. SLE
  2. Antiphospholipid syndrome
  3. Systemic sclerosis
  4. Rheumatoid arthritis.
  5. Gonococcal arthritis

Answer: Anti-Phospholipid Syndrome

Description: Anti-phospholipid syndrome is characterized by a hypercoagulable state in which there is an increased risk of thrombosis. The thrombosis of placental vessels and subsequently placental infarction result in miscarriage

Study Notes:

What is a miscarriage and recurrent miscarriage?

Miscarriage: Miscarriage is spontaneously loss of pregnancy before 20 weeks of gestation.
Recurrent Miscarriage: it is the loss of two or more pregnancies occurring before 20 weeks of gestation

Loss of pregnancy after 20 weeks of gestation = Still Birth

Aetiology of Miscarriage:

  • Genetic causes (Most common cause)

    • Abnormal aneuploid

  • Immunological causes

    • Anti-phospholipid syndrome

  • Anatomic causes

    • Uterine defects

  • Environmental causes

    • Smoking
    • Excessive caffeine intake
    • Excessive alcohol intake

  • Endocrinological causes

    • Diabetes Mellitus
    • Thyroid dysfunction (anti-thyroid antibodies)
    • Luteal phase defects

  • Haematological causes:

    • Defective placentation
    • Formation of microthrombi in Placental vessels

What is anti-phospholipid Syndrome?

Anti-phospholipid syndrome is an autoimmune disorder in which antibodies are produced against the phospholipid components of the cell membrane. It may b primary or it may occur secondary to another autoimmune disease.

Formation of antibodies followed by deactivation of anticoagulatory protein (Protein C and S, antithrombin III) by formation of antibodies and anticoagulatorty protein complex and activation of platelets. This result in a hypercoagulable state that increases the risk of thrombosis

How a patient of Anti-phospholipid syndrome presents?

Patients of Anti-phospholipid syndrome presents with recurring events of thrombosis that may affect any organ. However, in this scenario, we are concerned with a female abortion which is also a form of presentation in the female.

Arterial Involvement causes:

  • Myocardial infarction (if organ arteries are occluded)
  • Ischemia –> gangrene (if arteries to extremities occluded)
  • Stroke and transient ischemic attacks

Venous Involvement Causes:

  • Deep venous thrombosis
  • Livedo reticularis
  • pulmonary embolism

Capillary involvement causes:

  • Splinter haemorrhage

Management of anti-Phospholipids?

For Acute Management:

  • Low-Molecular weight heparin
  • However in severe cases; high dose of glucocorticoids, immunoglobins or plasmapheresis can be used

Secondary Prophylaxis :

  • Low dose aspirin if the patient is a low risk
  • For High-risk Patients:
    • Oral warfarin in Female with no wish to have a pregnancy again
    • LMWH + Aspirin for a female having wish to have children