A possible role for activated protein C resistance in patients with first and second trimester pregnancy failure.
Thrombophilia was recently suggested as a possible factor in recurrent pregnancy losses. We studied prospectively 125 patients (mean age 31.4 +/- 5.6 years) with one or more first or second trimester pregnancy losses for the prevalence of activated protein C resistance (APCR). Proteins C and S antigens, antithrombin III, anticardiolipin, and lupus anti-coagulant were also evaluated. Patients with uterine malformations, hormonal abnormalities, chromosomal translocations and infectious causes were excluded. A control group of 125 women with no past fetal loss were matched with the study group. Whenever the APC-sensitivity ratio (APC-SR) was </=2.2, polymerase chain reaction for factor V mutation (Leiden) was performed. Heterozygosity for the mutation was found in 18 patients (14.4%) compared with seven heterozygous among 125 control group (5. 6%; P < 0.05). Acquired APCR (APC-SR 1.8 and Leiden negative) was revealed in seven patients (5.6%) in the study group and in three of the controls (2.4%; not significant). The rate of preclinical pregnancy losses (17/48) and second trimester miscarriages (10/48) in mutation carriers was significantly higher than in patients with no APCR (25/214) and (14/214) respectively (P < 0.001 and P < 0.01 respectively). Live birth rate was not different between the two groups. Occurrence of APCR with any kind of pregnancy loss calculated per patient, in our study group, was approximately 1/7, 1/4 and 1/5 with one, two and three or more pregnancy losses respectively. These findings suggest that assessment of APCR should be considered in a more extended evaluation of such patients.
Tal
J
J
Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Rappaport Faculty of Medicine, Technion, 47 Golomb St, PO Box 4049, Haifa 31048, Israel.
Schliamser
L M
LM
Leibovitz
Z
Z
Ohel
G
G
Attias
D
D
D000022:Abortion, Spontaneous / Q000209:etiology*; D020016:Activated Protein C Resistance / Q000150:complications* / Q000235:genetics; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000990:Antithrombin III / Q000032:analysis; D002869:Chromosome Aberrations; D005165:Factor V / Q000032:analysis / Q000235:genetics; D005260:Female; D005865:Gestational Age; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D009154:Mutation; D011247:Pregnancy; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis
D017153:Antibodies, Anticardiolipin; D016682:Lupus Coagulation Inhibitor; D011486:Protein C; D017293:Protein S; C095381:factor V Leiden; D000990:Antithrombin III; D005165:Factor V