Histologic features of placentas and abortion specimens from women with antiphospholipid and antiphospholipid-like syndromes.

Placenta. 2004 Aug;25(7):642-8.
  
Histologic features of placentas and abortion specimens from women with 
antiphospholipid and antiphospholipid-like syndromes.

Van Horn JT, Craven C, Ward K, Branch DW, Silver RM.

University of Utah School of Medicine, Salt Lake City, UT 84132, USA.

OBJECTIVE: Antiphospholipid syndrome is characterized by recurrent pregnancy 
loss, thrombosis, and antiphospholipid antibodies. However, some women with 
clinical features of antiphospholipid syndrome test negative for antiphospholipid 
antibodies ("antiphospholipid-like syndrome"). Women with antiphospholipid and 
antiphospholipid-like syndromes have serum immunoglobulin G that harms murine 
pregnancy, suggesting that the mechanisms of fetal death may be similar in both 
groups. The objective of our study was to determine whether patients with 
antiphospholipid and antiphospholipid-like syndromes share pathophysiology by 
comparing the histology of gestational tissues from these groups. 

METHODS: Placenta and abortion specimens were obtained from 44 pregnancies in 26 
women with antiphospholipid syndrome and 37 pregnancies in 21 women with 
antiphospholipid-like syndrome. Of these, 16 pregnancies with antiphospholipid 
syndrome and 8 with antiphospholipid-like syndrome were treated with a variety 
of medications intended to improve pregnancy outcome. Placentas from 31 elective 
pregnancy terminations and 40 pregnancies complicated by idiopathic preterm 
delivery served as an additional control group. Twenty histologic parameters were 
systematically assessed by a single investigator who was blinded to the clinical 
status of the specimens. Histopathologic findings were compared among groups 
using multivariate logistic regression analysis. 

RESULTS: Antiphospholipid syndrome pregnancies included 15 spontaneous abortions, 
13 fetal deaths, and 16 live births. Pregnancies in the antiphospholipid-like 
syndrome group resulted in 5 spontaneous abortions, 30 fetal deaths, and one 
live birth. Gestational tissues from antiphospholipid and antiphospholipid-like 
syndrome pregnancies were similar for every histologic feature tested. Decidua 
from women with both antiphospholipid and antiphospholipid-like syndromes had 
more necrosis, acute and chronic inflammation, and vascular thrombus compared to 
controls. Placental tissue from antiphospholipid and antiphospholipid-like 
syndrome pregnancies showed more infarction, intravascular fibrin deposition, 
syncytial knot formation, and fibrosis than controls. Histologic features were 
variable within groups. There were no histologic differences in tissues from 
live births and pregnancy losses, or in treated and untreated pregnancies. 

CONCLUSIONS: Placental histopathology is similar in antiphospholipid and 
antiphospholipid-like syndrome pregnancies, suggesting that these disorders may 
share pathophysiology. Histologic findings in women with APS are non-specific 
and may not differentiate between women with APS and APS-like syndromes.

PMID: 15193871 [PubMed - in process]


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