Antiphospholipid syndrome and pregnancy
- Authors: Gris J.1,2,3, Makatsariya A.D3, Bitsadze V.O3, Khizroeva D.K.3, Khamani N.M3
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Affiliations:
- University hospital, Nîmes
- University of Montpellier
- I.M. Sechenov First Moscow State Medical University
- Issue: No 10 (2018)
- Pages: 5-11
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/248253
- DOI: https://doi.org/10.18565/aig.2018.10.5-11
- ID: 248253
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Abstract
Antiphospholipid syndrome (APS) is a systemic process that affects all organs and tissues of the body and diagnosed upon fulfilment of clinical and biological criteria. The currently accepted clinical morbidities affect two organs: the vascular tree, leading to thrombotic manifestations, and the utero-placental unit, leading to pregnancy complications. Obstetric APS (oAPS) is an autoimmune disease leading to the synthesis of autoantibodies directly capable of activating key cells of vascular and/or placental pathophysiology. During pregnancy, placenta serves as the most important organ. Violations of the placenta function due to endothelial dysfunction, ischemia, and placenta microthrombosis are responsible for the development of obstetric complications: pre-eclampsia, HELLP-syndrome, placental abruption.This manuscript describes a data of a different clinical experience in the field of APS. APA directly or indirectly affects the implantation process and early embryonic stages. The thorough systematic review on histopathology in the placenta of oAPS women found, on the sincytiotrophoblast (sTB) side, a decreased trophoblast (TB) proliferation, increased TB death rates, a decreased syncytialisation process, an increased sTB death rate with increased cell debris, and areas of sTB denudation and of fibrin deposition. Experimental in vitro data confirmed that ab2GP1 Abs decrease fusion of TB cells, thus inhibiting sTB formation. Reduced eTB invasion was associated with decreased placenta anchorage, reduced transformation of maternal spiral arteries and reduced maternal flow to the placenta, mirroring the conditions in placenta-mediated late pregnancy complications such as preeclampsia. Our studies and over 20 years of clinical experience indicate the presence of etiopathogenetic relation between APS and obstetric complications and the high efficacy of prophylaxis with anticoagulants when it starts early, since the period of preconception.
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About the authors
Jean-Christophe Gris
University hospital, Nîmes; University of Montpellier; I.M. Sechenov First Moscow State Medical UniversityM.D., Ph.D., Professor of Department of Haematology; Professor of Obstetrics and Gynecology, Department of obstetrics and gynecology #2
A. D Makatsariya
I.M. Sechenov First Moscow State Medical University
Email: gemostasis@mail.ru
M.D, PhD, corresponding member of the Russian Academy of Sciences, Professor, Head of the Department of obstetrics and gynecology #2
V. O Bitsadze
I.M. Sechenov First Moscow State Medical University
Email: vikabits@mail.ru
MD, Professor of the Russian Academy of Sciences, Professor of the Department of obstetrics and gynecology #2
D. Kh Khizroeva
I.M. Sechenov First Moscow State Medical University
Email: jamatotu@gmail.com
MD, Professor of the Department of obstetrics and gynecology #2
N. M Khamani
I.M. Sechenov First Moscow State Medical University
Email: nadinka@list.ru
postgraduate student of the Department of Obstetrics and Gynecology #2
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