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10 results

  • Chapter 26 - Autoimmune Disease

  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Grace Lim, University of Pittsburgh
  • Book:
    Obstetric Anesthesia and Uncommon Disorders
    Published online:
    26 January 2024
    Print publication:
    01 February 2024, pp 421-442

  • Summary

    An autoimmune disease represents a pathological condition caused by an immune response directed against an antigen within the body of the host. The incidence and activity of autoimmune diseases are particularly high in young women and hence their occurrence in parturients is not uncommon. Autoimmune diseases often involve multiple systems and have a wide range of clinical manifestations and complications necessitating a multidisciplinary approach to management in the obstetric population, involving obstetricians, anesthesiologists, neonatologists, and rheumatologists. All affected organ systems should be evaluated and advice from appropriate medical specialties sought. The effect of autoimmune diseases and their treatment on pregnancy, and the effect of pregnancy on the disease itself varies between individual diseases. This chapter discusses the implications of the following autoimmune diseases in pregnancy: rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa, systemic sclerosis, antiphospholipid syndrome, and multiple sclerosis.

  • Chapter 12 - Recurrent Pregnancy Loss in the First and Second Trimesters

  • from Section 3 - Reproductive Endocrinology and Infertility
  • Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    24 November 2021
    Print publication:
    02 December 2021, pp 101-107

  • Summary

    Recurrent pregnancy loss (RPL) is defined as the consecutive or non-consecutive loss of two or more pregnancies before viability. Established, contributory and postulated causes for RPL include advanced maternal age, anti-TPO antibodies, antiphospholipid antibodies, Müllerian anomalies, parental chromosomal aberrations, inherited thrombophilia and alloimmunity. Recommended investigations include thyroid screening, testing for antiphospholipid antibodies and imaging of the uterus. A thorough reproductive history can guide investigation to include tailored tests (e.g. metabolic and genetic profile). Despite investigation, no cause is found in about 50% of RPL cases.

    Thyroid dysfunction should be treated, antiphospholipid antibodies are managed with low-dose aspirin and heparin in a subsequent pregnancy and an intrauterine septum should be resected.

    Maternal age and number of prior losses are the major determinants for the prognosis of a subsequent pregnancy. Pregnancies after RPL should be managed as high-risk.

  • Chapter 103 - Reflex epilepsy with higher-level processing

  • from Section 4 - Provoked epilepsies
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 720-722

  • Summary

    This chapter presents a brief description of some uncommon vascular disorders that can characteristically cause epilepsy and/or seizures. The epilepsy is usually not the main clinical problem. In cases with moyamoya syndrome, the prognosis depends upon identification and treatment of the underlying cause of the condition. A seizure, which results in recategorization as eclampsia, may occur before, during, and after delivery. The cerebral vascular changes most commonly occur in the posterior circulation and have features such as hypertensive encephalopathy, including cerebral edema. Thrombosis of the cerebral venous system is less common than in the arterial system. The autoimmune state, characterized by the presence of antiphospholipid antibodies, may cause thrombosis both in arteries and in veins. The isolated angiitis is probably an inflammatory reaction caused by a variety of disorders, such as infections, but also cerebral amyloid angiopathy. Treatment of the arteritis includes corticosteroids, often in combination with other immunosupressive drugs.

  • Chapter 19 - Implantation events

  • Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
  • Book:
    Early Pregnancy
    Published online:
    05 October 2010
    Print publication:
    09 September 2010, pp 199-212

  • Summary

    A thrombophilic defect is an abnormality in the coagulation system that predisposes an individual to thrombosis. This chapter examines the role that the acquired thrombophilic defects play in the magnitude of early pregnancy loss, with particular reference to Primary Antiphospholipid syndrome, hyperhomocysteinemia and Acquired protein C resistance. Antiphospholipid syndrome (APS) is now recognized to be the most important treatable cause of recurrent miscarriage. The potential of thromboelastography as a clinical tool to overcome many of the above limitations in hemostasis testing in our recurrent pregnancy-loss population is promising. The success of thromboprophylactic treatment for women with recurrent miscarriage associated with APS has resulted in women with unexplained recurrent miscarriage frequently demanding similar treatment. Recurrent miscarriage is a distressing condition that affects at least 1% of couples trying to achieve a successful pregnancy. Recurrent miscarriage is a heterogeneous condition and no single abnormality will account for all cases.

  • Chapter 20 - Recurrent implantation failure

  • Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
  • Book:
    Early Pregnancy
    Published online:
    05 October 2010
    Print publication:
    09 September 2010, pp 213-226

  • Summary

    This chapter focuses on the primary antiphospholipid syndrome, that is, in the absence of systemic lupus erythematodes. Women with thrombophilia have an increased baseline risk of venous thromboembolism. In antiphospholipid syndrome, lupus anticoagulant is more strongly related to venous thrombosis and pregnancy complications than antibodies against phospholipids. The chapter reviews the evidence regarding potential clinical implications of acquired and inherited thrombophilia for both venous thromboembolism and for pregnancy failure. Treatment guidelines vary with regard to the administration of heparin for antiphospholipid syndrome and recurrent miscarriage. For women with antiphospholipid syndrome, the evidence regarding the efficacy of aspirin with or without the addition of low-molecular-weight heparin is not solid, whereas two small trials have shown a clear benefit of unfractionated heparin. For women with inherited thrombophilia, low-molecular-weight heparin to prevent pregnancy loss is definitely experimental as solid evidence is not yet available.

  • Chapter 13 - Acquired thrombophilia and recurrent early pregnancy loss

  • Edited by Roy G. Farquharson, University of Liverpool, Mary D. Stephenson, University of Chicago
  • Book:
    Early Pregnancy
    Published online:
    05 October 2010
    Print publication:
    09 September 2010, pp 113-130

  • Summary

    Recurrent miscarriage (RM) affects between 1-2% of fertile couples and is a clinical condition of heterogeneous etiology. Parental structural chromosome rearrangements are reported in 3-8% of couples suffering recurrent miscarriage and testing of both partners is therefore recommended. Conventional cytogenetic analysis of miscarriage tissue from women with a history of RM has detected a 26-57% abnormality rate. In the RM population, the prevalence of reported uterine malformations range widely from between 1.8% to 37.6%. Diagnostic tools for detecting uterine anomalies include two- and three-dimensional ultrasound, hysteroscopy, laparoscopy and magnetic resonance imaging (MRI). The antiphospholipid syndrome (APS) remains entrenched as one of the most studied factors associated with RM. Natural killer (NK) cells are found in peripheral blood and within the endometrium and have been associated with RM. Presently, many of the RM investigations are controversial because of limited studies, inconsistent terminology and small and poorly designed treatment studies.

  • Chapter 19 - Myeloproliferative disorders

  • from Section 7 - Malignant conditions
  • Edited by Sue Pavord, Beverley Hunt
  • Book:
    The Obstetric Hematology Manual
    Published online:
    06 December 2010
    Print publication:
    15 April 2010, pp 229-242

  • Summary

    Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis and/or obstetric morbidity in the presence of persistent antiphospholipid antibodies (aPL) namely, lupus anticoagulant antibodies (LAC), anti-cardiolipin antibodies (aCL) and/or anti-β2-glycoprotein I antibodies. The syndrome produces a spectrum of disease, both in terms of clinical manifestations and the presence of other autoimmune conditions. The disease is classified as primary antiphospholipid syndrome (PAPS) when it occurs in the absence of any features of other autoimmune disease, and secondary where other autoimmune disease is present secondary antiphospholipid syndrome (SAPS). Upto 30% of patients with APS have minor valvular abnormalities, which usually do not cause hemodynamic disturbance. Individual treatment strategies for the management of the APS in pregnancy in part depend on the assessment of a number of different factors. The first treatment used and studied for pregnant patients with APS, was a combination of corticosteroids and low dose aspirin.

  • Nasal septal perforation and antiphospholipid syndrome (Hughes syndrome)

  • S S Banerjee, K Lammin, J de Carpentier
  • Journal:
    The Journal of Laryngology & Otology / Volume 121 / Issue 12 / December 2007
    Published online by Cambridge University Press:
    07 June 2007, pp. 1197-1200
    Print publication:
    December 2007

  • We present the case of a 19-year-old woman who developed a nasal septal perforation and atrophic rhinitis following septal surgery. During the subsequent five years, she also experienced intermittent episodes of swelling and ischaemia of the left foot, as well as livedo reticularis. Ultimately, haematological investigations revealed the presence of lupus anticoagulant and elevated antiphospholipid immunoglobulin M levels. A diagnosis of antiphospholipid syndrome (Hughes syndrome) was made.

    A search of the literature revealed that nasal septal perforation has been described in up to 0.8 per cent of patients with antiphospholipid syndrome. However, it is undescribed in the otorhinolaryngological literature. The impact of this syndrome on otorhinolaryngology practice is examined.

  • Sudden sensorineural hearing loss in a patient with primary antiphospholipid syndrome

  • K-T Kang, Y-H Young
  • Journal:
    The Journal of Laryngology & Otology / Volume 122 / Issue 2 / February 2008
    Published online by Cambridge University Press:
    10 April 2007, pp. 204-206
    Print publication:
    February 2008
  • Objective:

    Despite multiple systemic manifestations, sudden sensorineural hearing loss in a patient with antiphospholipid syndrome is rarely reported.

    Patient:

    A 46-year-old man with primary antiphospholipid syndrome had a sudden onset of hearing loss and tinnitus in the right ear in December 2005, because he discontinued use of warfarin and acetylsalicylic acid for a few days.

    Results:

    Audiometry revealed saucer-type sensorineural hearing loss with a pure tone average of 73 dB in the right ear, and flat-type hearing loss with a pure tone average of 25 dB in the left ear. Electronystagmography displayed multiple central signs and bilateral canal paresis, while a vestibular evoked myogenic potential test revealed bilateral delayed responses. After admission, the patient was re-treated with warfarin and acetylsalicylic acid. Follow-up audiometry showed recovery of right-sided hearing, with a pure tone average of 12 dB, three days after presentation.

    Conclusion:

    Consensus exists on the effectiveness of anticoagulant agents in aiding a favourable outcome of sudden sensorineural hearing loss in patients with antiphospholipid syndrome.

  • 8 - Genetic thrombophilias and antiphospholipid antibodies

  • Edited by Ann Harper
  • Book:
    Haemorrhage and Thrombosis for the MRCOG and Beyond
    Published online:
    05 October 2014
    Print publication:
    01 June 2005, pp 111-127

  • Summary

    Venous thromboembolism (VTE) is a common cause of morbidity and mortality and has been implicated in the pathophysiology of a number of obstetric complications. This chapter provides an overview of the more common genetic thrombophilias and the acquired thrombophilia associated with the presence of antiphospholipid antibodies. A limited number of genetic variants are proven to be independent risk factors for VTE. These include mutations in the genes controlling the function of both pro- and anticoagulant factors. The main benefit in screening thrombophilia is to prevent a first VTE in affected relatives rather than secondary prevention of recurrent VTE. Oral contraceptives increase the risk of VTE, particularly in the first year of use. Women with thrombophilic defects are at greater risk. Improved pregnancy outcomes in women with antiphospholipid syndrome can be achieved with the use of aspirin and low-dose heparin.