Spontaneous abortion

Chief Complaint A 29 y/o 21 weeks pregnant female came for a regular checkup and she complains of swelling over the both arms. Pregnancy is going well according to her. No vaginal bleeding and abdominal cramps. Vitals Temperature was 36.7 °C BP 115/75 mmHg HR 83 beats/ min. Investigations Ultrasound shows no fetal movement which suggests spontaneous abortion. Lab tests are given below. Treatment Induced labor was done. What is your opinion here?

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NEITHER APLA NOR DRUG INDUCED LUPUS : 1. DRVVT is a non specific test APLA. Anticardiolipin antibody and Anti beta 2 glycoprotein antibody tests are negative which rule out APLA SYNDROME. 2. Anti Ds DNA, Anti Sm and RNP positive which rule out DRUG INDUCED LUPUS. IT'S A CASE OF SLE : -Positive ANA with Anti Ds DNA, Anti Sm positivity indicate SLE. -Organ involved to be diagnosed with proper history and further investigations like ECG, CXR, Diect coomb's test, Kidney biopsy, Anti glutamate antibody tests etc as history suggests. Specially r/o Lupus cerebritis and Lupus nephritis. -Treatment :- (i) Systemic gluvocorticoids 0.5 - 1 mg /kg /day PO or 1000 mg of methylprednisolone sodium succinate IV daily for 3 days f/b 0.5-1 mg/kg of daily Prednisolone. (ii) DOC for Lupus nephritis is Cyclophosphamide and for Lupus cerebritis is Dexamethasone. (iii) In pregnancy steroids or Hydroquinone chloroquine is preferred. REGARDING THE PRESENT PREGNANCY LOSS : -The patient was asymptomatic probably due to decrease level of Oestrogen in pregnancy. -Recurrence of abortion is less likely as there is no evidence of APLA. -Ro antibody is an IgG antibody so size is small which may cross placenta and affect the AV node of the foetus causing complete heart block. This is the reason of foetal death here.

Also get Torch test done

Increase in Lupus anticoagulant value increase the possibility of Spontaneous abortion and Fetal death. Small blood clots caused by LAs can complicate a pregnancy and induce miscarriage. Multiple miscarriages may be a sign of LAs, especially if they occur after the first trimester.. Antiicardiolipin antibody test ....Kaolin clotting time. ......Coagulation factor ...... Assays dilute Russell viper venom test (DRVVT) LA-sensitive .....PTTbeta-2 glycoprotein 1 antibody test. These all are required to be tested. Lupus anticoagulants (LAs) are a type of antibody produced by your body’s immune system. While most antibodies attack disease in the body, LAs attack healthy cells and cell proteins. They attack phospholipids, which are essential components of cell membranes. LAs are associated with an immune system disorder known as antiphospholipid syndrome.

Combination of SLE and Mixed Connective Tissue disorder. Needs Rheumatoligist opinion . When Lupus anticoagulants are present, spontaneous abortions and fetal death are common . Aspirin, LMWH could have been started earlier ,if diagnosis were available earlier.

Autoimmune disorder - SLE causing spontaneous abortion Multiple Antibody positive indicate severity She will need immunosuppression medication for treatment of autoimmune disorder Rheumatologist opinion for same

Lupus anticoagulant value increase Spontaneous abortion and fetal death are common

LUPUS ANTICOAGULANTS AND.. COMPLICATIONS.. OF PREGNANCY..

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