Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Both lupus anticoagulant and anticardiolipin antibody are groups of antiphospholipid antibodies associated with high frequency of thrombosis, fetal loss and thrombocytopenia. The hall marks of their identification is the prolongation of phospholipid-dependant coagulation tests. Much is written in literature about the successful management of lupus anticoagulant during pregnancy, via corticosteroid and acetyl salicylic acid (Aspirin) therapy; however, up to now only little has been mentioned about maternal and fetal complications associating lupus anticoagulant and its management. Here we present three cases with significant complications among patients with lupus anticoagulant managed in Sint Augustinus Hospital over the last 3 years. These complications were secondary to antiphospholipid syndrome or to therapy. Maternal complications included gastritis, atrophy of quadriceps muscle, resistant premature contractions and pre-eclampsia. One of our patients developed small lymphocytic lymphoma 1 year after her last labour. Fetal complications included: prematurity, suprarenal insufficiency (temporary) and delayed neuromuscular development found at the 2 year follow-up. As far as we know, some of these complications have never been mentioned in literature.
 ...
PMID:Maternal and fetal complications associating lupus anticoagulant and its management; three case reports. 211 27

Pregnancy loss, often recurrent, is one of the most important clinical manifestations associated with the primary antiphospholipid syndrome. In these cases, pregnancy wastage is related to the presence of antiphospholipid antibodies, namely lupus anticoagulant and anticardiolipin antibodies, but patients do not have features of systemic lupus erythematosus or any other well-defined autoimmune disease. We report here on the outcome of 21 consecutive pregnancies in 18 patients with the syndrome who were treated with low-dose aspirin (100 mg/day) from 1 month before attempting conception and throughout the pregnancy. Low-dose prednisone (15-30 mg/day) was added for potentially non-obstetric (autoimmune-related) reasons in six pregnancies. Patients were monitored as having high-risk pregnancies. Prior to therapy, the rate of live-born babies was 6.1% (46 previous fetal losses and three live-born babies), and after therapy, it was 90.5% (21 pregnancies and 19 live-born babies). Pre-term delivery due to maternal or fetal indications was required in 15% (3/20) of the viable pregnancies. Except for prematurity (20% of viable pregnancies) and its potential associated complications, there were no significant adverse effects to either mothers or babies. Our treatment modality is advocated for prevention of pregnancy losses in patients with the 'obstetric' primary antiphospholipid syndrome.
 ...
PMID:Low-dose aspirin for prevention of pregnancy losses in women with primary antiphospholipid syndrome. 796 50

A prospective study was performed to investigate the fetal and maternal outcome of 108 pregnancies in 90 lupus patients. The protocol was based on shared care of the patients by a rheumatologist and an obstetrician, with input from a hematologist, if necessary. Lupus flares were treated with low-dose prednisolone, azathioprine and hydroxychloroquine. The live birth rate was increased from 31 % in the patients' previous obstetric history to 82%. A high incidence of prematurity was observed (43%). Lupus patients with secondary antiphospholipid syndrome presented a higher risk for fetal loss (P = .006). Flares occurred in 57% of the pregnancies, but most were mild (skin and joints). Flare during pregnancy did not increase the risk of fetal loss. We believe that careful monitoring and management of the lupus pregnancy has substantially improved the fetal outcome.
 ...
PMID:Obstetric outcome in systemic lupus erythematosus. 865 May 88

Fertility is usually normal in systemic lupus erythematosus. However, cyclophosphamide therapy has been associated with an increased risk for sustained amenorrhea in these patients. There is still debate as to whether pregnancy increases systemic lupus erythematosus activity. We have known for decades that systemic lupus erythematosus is associated with an increased risk for pregnancy loss. Now we know that most excess fetal loss in women with systemic lupus erythematosus occurs in association with antiphospholipid antibodies, which also are associated with pregnancy loss in otherwise healthy women. Prematurity, intrauterine growth retardation, and preeclampsia are common features of lupus pregnancy, especially in women with antiphospholipid antibodies. Pregnancy complicated by antiphospholipid syndrome requires expert care and a team approach involving obstetricians, obstetric physicians, rheumatologists, and clinical hematologists. Treatment and close monitoring including uterine artery Doppler scans and timely delivery may improve fetal outcome in these cases. Although there is no evidence that maternal prednisone should be used prophylactically, fluorinated steroids may be efficacious after in utero identification of congenital heart block, especially in fetuses with associated myocarditis.
 ...
PMID:Pregnancy in systemic lupus erythematosus. 894 45

The aim of this study was to determine the neonatal outcome in women with well-characterized antiphospholipid syndrome treated during pregnancy with low-dose aspirin. We compared 38 babies born after 36 pregnancies of 33 women diagnosed as having antiphospholipid syndrome with a group of 38 control infants matched for the same gestational age at birth. In all 76 newborns we studied the maternal events associated with the antiphospholipid syndrome, mothers' treatment and neonatal data. All mothers with antiphospholipid syndrome were treated with low-dense aspirin. Prednisone was only prescribed due to maternal complications and heparin in a case of thrombosis. No significant relation was found between maternal treatment and neonatal complications. The prematurity rate in these newborns was high 14% and the neonatal mortality (5.8%) was only associated with extreme prematurity (p < 0.001). In our population the overall rate of neonatal complications was higher than in the general population, but when compared with a similar group of newborns no significant differences were found. Our results suggest that primary antiphospholipid syndrome appears to be improved by low-dose aspirin treatment, with a high rate of neonatal survival (95%). Except for prematurity and its potential associated complications, fetal and neonatal outcome is very favourable and no significant relation between maternal treatment and neonatal pathology has been detected.
 ...
PMID:Neonatal outcome in women treated for the antiphospholipid syndrome during pregnancy. 918 40

We conducted a prospective study in order to determine planned pregnancy outcome in systemic lupus erythematosus followed in a tertiary referral centre. Pregnancy was authorized if disease was inactive on 20 mg/day prednisone or less for at least 1 yr. Upon the diagnosis of pregnancy, systematic corticosteroids consisting of 10 mg/day prednisone or more were started. In the case of antiphospholipid antibodies, 100 mg/day aspirin was added, replaced by heparin in the pre-partum period. In the case of antiphospholipid syndrome complicated by previous thrombotic events or fetal losses despite aspirin, heparin was prescribed. One woman with a history of atrioventricular block was treated with dexamethasone. Patients were monitored by medical and obstetrical examination, and laboratory tests carried out at least monthly and a quarterly echography. Among 62 pregnancies in 38 women, lupus flare was observed in 27% of the cases, 6% of which occurred in the post-partum period. Flares were moderate except in one renal involvement in a woman with prior diffuse proliferative glomerulonephritis. Therapy was not modified in half of the cases. Pregnancy ended in early spontaneous abortion not related to lupus flare (n = 10), stillbirth (n = 2). induced abortion (n = 2), preterm birth (n = 29) and full-term birth (n = 19). Caesarean section was performed in nine cases. A severe infection occurred in two premature neonates. Another premature neonate was growth retarded. Two children had cutaneous neonatal lupus. No child died, neither had atrioventricular block. Stillbirth and severe prematurity were more common in mothers with antiphospholipid syndrome. After exclusion of early spontaneous and induced abortions, the live birth rate was 96%, that is close to the French general population. The main problem remains a high rate of prematurity, but without maternal or neonatal death.
 ...
PMID:Outcome of planned pregnancies in systemic lupus erythematosus: a prospective study on 62 pregnancies. 925 12

Although experience is still limited, intravenous immunoglobulin therapy for recurrent pregnancy loss in the Antiphospholipid Syndrome (APS) may represent a significant advance. APS was widely recognized only fifteen years ago. Pregnancy loss and thrombosis are the prominent clinical features. Initially, prednisone was used for treatment of pregnancy loss, but matemal and fetal complications stimulated searches for alternative therapy. Subcutaneous heparin and low dose aspirin was next utilized, but although efficacious, there is still a 30% failure rate, and intrauterine growth retardation, prematurity, and pre-eclampsia are relatively frequent. In the late 1980's, there were a number of case reports of successful pregnancy outcomes after treatment with intravenous immunoglobulin (IVIg) but regimens differed. Series from two centers have confirmed these initial findings and treatment regimens have become more consistent. Both centers have reported success with doses of 400 mg/kg/day for 5 days or 1 g/kg/day for two days each month initiated during the first or early second trimester. Success rates of 70-100% have been reported, and complications such as pre-eclampsia, intrauterine growth retardation, and premature births appear reduced, when compared to prednisone and low dose aspirin or heparin and low dose aspirin. Several patients who were treated with IVIg also received heparin, making it uncertain whether heparin may also need to be added to IVIg. Intravenous immunoglobulin is safe, but expensive. Despite its expense, if IVIG is shown to markedly decrease matemal and fetal morbidity, it may be the logical treatment of choice to prevent pregnancy loss in APS.
 ...
PMID:Utilization of intravenous immunoglobulin therapy to treat recurrent pregnancy loss in the antiphospholipid syndrome: a review. 975 43

Recurrent fetal loss occurs in approximately 1% of women. Autoimmune causes have been suggested as a factor in some of these cases. High rates of intrauterine fetal growth retardation and increased incidence of prematurity is associated with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). We found in previous studies that sera from SLE/APS patients when used as a culture medium for rat embryos were found to reduce embryonic growth and development, induce a high rate of embryonic anomalies and death and damage the yolk sac morphologically and functionally. In order to investigate the direct effect of IgG purified from women with SLE/APS on the growth and viability of embryos, we cultured 11.5-day-old rat embryos in their yolk sacs in the presence of IgG purified from SLE/APS patients with recurrent pregnancy loss (RPL). The IgG affected directly the embryo and yolk sac, reducing their growth. The purified IgG positive for anticardiolipin/anti-DNA antibodies reduced yolk sac and embryonic growth more than sera negative for these antibodies but positive for antiphosphatydilserine and for antilaminin. Monoclonal antiphosphatydilserine reduced yolk sac growth but the embryos remained intact. Following the observed damage to the yolk sac we cultured human placental explants at 5.5-8 weeks of pregnancy in sera from SLE/APS patients for 96 hours and found that these sera reduced placental trophoblastic cell growth, reduced their proliferation rate and increased their rate of apoptosis. Successful treatment of the women resulted in a correction of the damage induced in the cultured rat embryos and in the cultured placental explants.
 ...
PMID:The effects of antiphospholipid antibodies obtained from women with SLE/APS and associated pregnancy loss on rat embryos and placental explants in culture. 1289 2

Among connective tissue diseases, systemic lupus erythematosus is the illness that is most concerned by hormonal life events. The sex ratio is 9/1, and symptoms begin mostly during the third decade, sometimes during birth pill contraception or during pregnancy. As soon as systemic lupus is under control of an efficient treatment, pregnancy is no longer contra-indicated. A medical multidisciplinary surveillance is required. Complicated pregnancy concerns mother and baby. Lupus flares are more frequent during the second and third trimesters as well as during the post-partum period. Usually the intensity is moderate. Severe flares concern patients with renal involvement, hypertension and renal insufficiency and are mostly seen in patients with unplanified pregnancy and yet with still active lupus. Foetal death occurs in 10-30% of the cases, depending on the lupus activity and severity (renal lupus). Prematurity remains an important cause of morbidity (30% of live births). Foetal deaths and prematurity are even more frequent if the patient has an antiphospholipid syndrome. Neonatal cutaneous lupus and auriculo-ventricular congenital heart block is infrequent (1% of SLE patients with anti-Ro/SSA antibodies). Among other connective tissue diseases, polymyositis has a very severe obstetrical prognosis for both mother and foetus. Among primary vasculitis, polyarteritis nodosa, as found during pregnancy, can herald a very bad prognosis.
 ...
PMID:[Hormonal life in systemic lupus and other connective tissue diseases]. 1449 21

Antibodies directed against protein S (anti-ProtS) may be involved in the development of thrombosis in patients with the antiphospholipid syndrome. We assessed the prevalence and clinical significance of anti-ProtS and evaluated their immunological characteristics in 184 patients with SLE and 99 healthy donors. All patients were tested for IgG anti-ProtS by an in-house ELISA. Plasma levels and functional activity of protein S were also tested. Anti-ProtS were found in 57 patients (31%) and 4 healthy controls (4%). Patients with thrombosis had anti-ProtS more frequently than controls (29% vs 4%, OR 9.5 [95% CI 3.07-29.3], p<0.0001). Anti-ProtS were more frequent in patients with venous thrombosis and in those with arterial thrombosis, than in controls (41% vs. 4%, OR 16.5 [95% CI 5-54], p<0.0001 and 23% vs. 4%, OR 7 [95%CI 2.1-23.5], p=0.0008, respectively). Patients with prematurity, preeclampsia and intrauterine growth restriction had anti-ProtS more frequently than the control group (36%, 47% and 44% vs. 4%; OR 13.6 [95% CI 2.8-66], p=0.003, OR 21 [95% CI 5-86], p<0.0001 and OR 19 [95% CI 4-99], p=0.0014, respectively). Plasma levels of free protein S were not statistically different between patients with and without anti-ProtS and controls (77.9% [20.7-100] vs. 83.7% [52.7-100] vs. 89% [62-101], respectively). Free protein S functional activity was no different between subgroups (105% [48-230] in anti-ProtS positive vs. 123% [95-283] in anti-ProtS negative vs. 136% [60-174] in controls). Anti-ProtS are frequent in SLE patients with thrombosis and pregnancy morbidity. These antibodies do not interfere with free protein S in plasma since its level and/or functional activity are not impaired.
 ...
PMID:Antibodies directed to protein S in patients with systemic lupus erythematosus: prevalence and clinical significance. 1451 84


1 2 3 Next >>