Screening for Lupus Anticoagulant Antibody and Anticardiolipin Antibody in Recurrent Pregnancy Loss

The present study was a prospective study aimed at screening for the presence of lupus anticoagulant and anticardiolipin antibodies in 50 patients with history of recurrent pregnancy losses and 50 controls matched for age, gestational age at study, of proven good reproductive history. The distribution of study cases were 10% in first trimester, 76% in second trimester, and 14% in third trimester. The tests done were Activated Partial Thromboplastin Time and diluted Russell Viper Venom Time for lupus anticoagulants and ELISA for anticardiolipin antibodies. Five cases (10%) were positive for lupus anticoagulant, seven cases (14%) were positive for anticardiolipin antibodies. Hence the incidence of LAC and ACL in our study population was 10% and 14% respectively. The relative risk for pregnancy loss due to lupus anticoagulant was 1.4 and for anticardiolipin antibody, the relative risk was 1.8. Both APTT and dRVVT tests were sensitive in detecting lupus anticoagulant antibodies, but test for anticardiolipin had more specificity in our study. The outcome of LAC positive cases during previous pregnancy was as follows: 64.7% were abortions, 29.41% were fetal deaths, and 5.88% were live births. During present pregnancy 60% were abortions, 20% were fetal deaths, 20% were live birth. The outcome of ACL positive cases during previous pregnancy was as follows: 72.72% were abortions, 22.72% were fetal deaths and 4.5% were live birth. During present pregnancy 42.85% were abortions, 14.28% were fetal deaths, 42.85% were live births. Other pregnancy related complications noted were: a) Preeclampsia; 50% of cases had preeclampsia in their previous pregnancy, 40% of cases had during present pregnancy. b) IUFD: 22.72% of cases had intra uterine fetal death during previous pregnancy and 20% of cases had intrauterine fetal death during present pregnancy. c) IUGR: 9% of cases had growth retarded babies in previous pregnancy and one had growth retarded baby during present pregnancy. d) Preterm labour: 4.54% of cases had preterm labour during previous pregnancy and one had it during present pregnancy. e) Abruptio placenta: 9% of cases had abruption during previous pregnancy and none had abruption during present pregnancy. CONCLUSION: The presences of antiphospholipid antibodies [lupus anticoagulant and anticardiolipin] are associated with adverse pregnancy outcome. Patients with recurrent pregnancy loss need to be subjected to investigations for these antibodies. Identification of those patients early, with early institution of therapy will help in minimizing the associated complications and pregnancy losses, thus aiding the anxious mother in delivering a live child. The commonly used tests for detection of these antibodies are activated partial thromboplastin time and dilute Russell`s viper venom time for lupus anticoagulant and ELISA for anticardiolipin since performing more than one lupus anticoagulant screening test is important for optimal sensitivity. Moreover the predictive value of testing with anticardiolipin ELISA can be improved to an extent by concurrent lupus anticoagulant testing. In combination, these tests are sensitive, specific which can be used in conjunction to screen the patients with recurrent pregnancy loss and are mandatory in the investigation protocol for these patients in order to prevent further pregnancy wastages