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Recurrent miscarriages (Thrombophilias in pregnancy (Indications for…

- - - - antinuclear (ANA)
        antithyroid (ATA)
        antiplacental (APA)
      - Antiphospholipid antibodies (APL)
        
        binding free phospholipids or phospholipid bound with proteins participating in coagulation process:
        anticardiolipin (ACL)
        lupus anticoagulant (LA)
        
        Against phospholipids of cellular walls:
        phosphatydyloserin (PS), phosphatydylocholin (PC),
        phosphatydyloinozytol (PI), phosphatydyloetanolamin (PE).
        
        Antiphospholipid syndrome (APS)
        
        Coincidence of obstetric complications in patients with antiphospholipid antibodies without symptoms of autoimmunologic disease
        
        Obstetrical complications
        
        Intrauterine growth restriction
        Preterm placental abruption
        PIH, PROM
        Conduction disorders – atrio-ventricular block in the fetus and neonate
        
        Diagnosis
        
        At least one clinical symptom & at least one laboratory symptom
        
        Clinical symptoms
        
        One or more episode of thrombosis of arteries, deep veins or capillars (excluding superficial veins) confirmed by diagnostic imaging, Doppler or pathological examination
        
        At least one demise of morphologically normal fetus after 10 weeks of gestation
        
        At least 3 sponataneous abortions before 10 weeks without anatomic reasons, hormonal disorders in the mother and chromosomal abnormalities in parents
        
        At least one preterm delivery before 34 weeks related to preeclampsia, eclampsia or severe placental insufficiency
        
        Laboratory symptoms
        
        Lupus anticoagulant
        
        Anticardiolipin antibodies IgG and/or IgM (titer >40MPL)
        
        Anti beta2-glicoprotein antibodies
        
        Every antibody has to be confirmed twice at 12 weeks interval
        
        Organs involved
        
        Skin (livedo reticularis, maculopapular lesions, lower leg ulcers, skin vessels infarcts, fingers’ necrosis, atrophie blanche, purpura fulminans).
        
        Brain (migraine, strokes, epilepsia).
        
        Eyes (optic neuritis, retinal thrombosis).
        
        Ears (hearing loss).
        
        Bones (necrosis).
        
        Heart (aseptic endocarditis, valves invovlvement).
        
        Lungs (lung hypertension, ARDS).
        
        Kidneys (renal arteries stenosis).
        
        Circulatory system (hypertension).
        
        Vessels (atherosclerosis).
        
        Suprarenal glands (insufficiency, infarct).
        
        Indications for APS diagnosis
        
        Clinical symptoms of APS
        
        Lupus erythomatosus or lupus-like disease
        
        Idiopathic thombosis or thrombosis during pregnancy
        
        Positive VDRL
        
        Increased APTT
        
        Thrombocytopenia of unknown origin
        
        aPL in family history
        
        ANA presence
      - Possible reasons of antibodies production
        
        Infections:
        bacterial (syphilis, leprosy, tuberculosis, boreliosis, streptococcus B, Staphylococcus aureus, Helicobacter pyroli, Mycoplasma)
        viral (HCV, Hepatitis A, herpes, adenoviruses, parvoviruses, mumps, rubella, CMV, Ebola)
        
        Drugs (contraception, COX2 inhibitors, cholorpromazin, phenothiazin, phenytoin, hydralazin, procainamid, chinidine, streptomycin)
        
        Hematologic disorders (Waldenstrom macroglobulinemia, polycythemia, Von Willebrandt disease)
        
        Neoplasms (solid tumors, leukemia, Hodgkin’s lymphoma, multiple myeloma)
        
        Other (homocysteinemia)
  - - - Lack of maternal answer for fetal antigens or improper answer for foreign antigens of gesational sac:
        Change of prevailing immune answer from type Th2 to Th1;
        Disturbance of progesteron function in immmunoregulation in the region of contact of maternal and fetal tissue
        Lack or deficiency of blocking antibodies
    - - There is no laboratory test to diagnose this reason of abortions. They are classified as idiopathic and many tests have to be performed to exclude all other, known reasons of miscarriages.