| Objective:By collecting the clinical data of 74 pregnant women with obstetric antiphospholipid syndrome(OAPS)in our hospital,the influencing factors of adverse maternal and fetal outcomes were explored,so as to provide clinical basis for maternal and fetal monitoring and clinicians’ guidance of pregnancy in this population,so as to reduce the occurrence of adverse pregnancy outcomes.Methods:A retrospective analysis was conducted on 74 OAPS pregnant women who delivered in the Department of Obstetrics of the First Hospital of Jilin University from January 2013 to January 2020,and 134 healthy pregnant women who were admitted to the Department of Obstetrics at the same time were randomly selected.According to the diagnostic criteria of OAPS,the 74 pregnant women were divided into the typical OAPS group(n = 26)and the non-criteria OAPS group(n = 48).First,women in the OAPS group were compared with healthy women,including their birth history,general laboratory examinations,fetal Doppler ultrasonography,and pregnancy outcomes.Further analysis of OAPS patients was conducted to analyze the influence of general information,pregnancy status and the existence of anti-phospholipid antibodies on the occurrence of adverse pregnancy outcomes,and to carry out multivariate analysis of pregnancy outcomes.Results:1.In this study,74 OAPS pregnant women ranged in gestational age from 23 to 42 years old,with 1-7 pregnancies,0-2 births and 0-6 miscarriages.A total of 134 normal and healthy pregnant women ranged in gestational age from 21 to 43 years old,with 1 to 5 pregnancies,0 to 2 births and 0 to 3 abortions.There were no statistically significant differences in age and BMI between the OAPS group and the healthy group(P > 0.05),but there were statistically significant differences in the number of pregnancies,number of births and number of miscarriages between the two groups(P < 0.05).2.There were no statistically significant differences in Hb,TT,PT,PTA,FBG and D-Dimer between the OAPS group and the healthy group(P > 0.05),but there were statistically significant differences in PLT and APTT between the two groups(P < 0.05).3.13 of the 208 subjects showed different types of umbilical artery blood flow abnormalities in the middle and late trimester.There were 9 cases(12.16%)in the OAPS group and 4 cases(2.99%)in the healthy group.The number of abnormal cases of umbilical artery blood flow was compared between the two groups,and the difference was statistically significant(P < 0.05).4.74 OAPS in pregnant women,duration of 0.17-8 years,has a history of thrombosis(3 cases),26 patients with typical OAPS,4 patients with secondary APS,9 cases of abnormal umbilical artery blood flow and 10 cases of thrombocytopenia,complement(C3 and C4)in early pregnancy decline in 8 cases,three single positive for antiphospholipid antibodies in 36 cases(48.65%),double and triple positive were 25 cases(33.78%)and 13 cases(17.57%).All OAPS patients were treated with LDA or LDA combined with LMWH during pregnancy,and the most patients were treated with multiple drugs,accounting for 62 cases(83.78%).5.There were 9 cases of pregnancy loss(12.16%)in the OAPS group,including 2 cases of spontaneous abortion(2.70%),2 cases of therapeutic abortion(2.70%),4 cases of stillbirth(5.41%),and 1 case of neonatal death(1.35%).There were 65 live births(87.84%),including 11 premature births(14.87%)and 54 full-term births(72.97%).There were 5 cases of pregnancy loss(3.73%)in 134 healthy pregnant women,including 1 case of spontaneous abortion(0.75%),2 cases of therapeutic abortion(1.49%),1 case of stillbirth(0.75%),and 1 case of neonatal death(0.75%).There were 129 live births(96.27%),including 8 premature births(5.97%)and 121 full-term births(90.30%).There was a significant difference in pregnancyoutcome between the two groups(P < 0.05).The proportion of pregnancy loss and premature delivery in OAPS group was higher than that in healthy group.6.Compare OAPS group and healthy group live births in Apgar1 minutes score,intrapartum blood loss,into the new pediatric cases,and differences in childbirth way,results indicate no statistical significance(P > 0.05),and compare the two groups of live births childbirth pregnant weeks and neonatal birth weight,and found OAPS delivery gestational age less than healthy group,and neonatal birth weight is lower than the healthy group,the differences were statistically significant(P < 0.05).7.Among maternal complications,there were 7 cases of oligohydramnios,34 cases of premature rupture of the membranes,6 cases of gestational hypertension,22 cases of eclampsia/preeclampsia,26 cases of gestational diabetes,3 cases of placental abruption,6 cases of HELLP syndrome,and 8 cases of thrombosis.There were 11 cases of fetal growth restriction,13 cases of fetal distress and 12 cases of neonatal asphyxia.There were significant differences in the incidence of eclampsia/ preeclampsia,thrombosis and fetal growth restriction(P < 0.05)between the OAPS group and the healthy pregnant women(P < 0.05),among which the occurrence risk of eclampsia/preeclampsia,thrombosis and fetal growth restriction was 3.4,5.4 and 4.8 times of the maternal and fetal complications of the healthy pregnant women.8.Among 65 live births in OAPS group,4 were low birth weight.Among 129 live births in healthy group,0 cases were low birth weight.Comparing the difference of low birth weight between the two groups,the proportion of full-term low birth weight babies in the OAPS group was higher than that in the healthy group,and the difference was statistically significant(P < 0.05).9.74 cases of OAPS pregnant women of different kinds of adverse pregnancy outcomes(pregnancy loss,premature pregnancy,preeclampsia/preeclampsia,thrombosis and FGR)between the single factor analysis,P < 0.2 variable into binary logistic regression model,the results show that the abnormal umbilical artery blood flow and triple positive for antiphospholipid antibody for OAPS pregnant women risk factor for pregnancy loss;Complement decrease was an independent risk factor for eclampsia/preeclampsia in OAPS patients.No independent risk factors associated with preterm delivery,thrombosis,or fetal growth restriction were found.10.Of the 74 patients with OAPS,32 had adverse maternal and fetal pregnancy outcomes.Regressive analysis showed that lupus anticoagulant positivity was an independent risk factor for adverse pregnancy outcomes in OAPS pregnant women,and the relative risk of adverse pregnancy outcomes in LA-positive OAPS patients was 3.389 times higher than that in lupus anticoagulant negative(P < 0.05).11.There were 48 patients with atypical OAPS and 26 patients with typical OAPS.The difference of thrombosis between the two groups was statistically significant(P < 0.05).Conclusion:1.Pregnant women in the OAPS group had significantly higher risks of eclampsia/preeclampsia and thrombosis during pregnancy than women in the healthy group,leading to higher risks of pregnancy loss,premature delivery,and fetal growth restriction.2.Previous history of thrombus and adverse pregnancy,abnormal fetal umbilical artery blood flow,triple antiphospholipid antibody and lupus anticoagulant positives,and decreased platelet and complement levels help identify high-risk patients who are at risk for adverse pregnancy outcomes despite standardized treatment.3.All OAPS patients before the planned pregnancy should undertake the pre-delivery and comprehensive assessment,suitable for pregnancy,pregnancy in obstetrics,pediatrics and rheumatology new multidisciplinary collaboration to strengthen disease surveillance,hierarchical management,formulate OAPS patients with individualized prenatal and postnatal management plan,to early identification of related complications,so as to improve the outcome. |
