The presence of antiphospholipid antibodies (aPLs) is closely associated with thrombotic events and pregnancy complications such as recurrent pregnancy loss, preeclampsia and placental insufficiency. We investigated the presence of aPLs and its frequency among female patients with a history of fetal loss in a Malaysia population. Serum samples were collected from 108 patients who had (1) one or more unexplained deaths of morphologically normal fetuses at or beyond the 22nd week of gestation, or (2) one or more premature births of morphologically normal neonates at or before the 24th week of gestation due to eclampsia or preeclampsia, or recognized features of placental insufficiency, or (3) three or more unexplained, consecutive, spontaneous miscarriages before the 20th week of gestation. Serum was tested for aPLs subtypes: anticardiolipin (aCL), anti-beta-2- glycoprotein I (aβ2GPI), anti-beta-2-glycoprotein I dependent cardiolipin (aβ2GPI dependent CL), anti-phosphatidylcholine (aPC), anti-phosphatidylethanolamine (aPE), anti-phosphatidylinositol (aPI), anti-phosphatidylserine (aPS) and anti-sphingomyeline (aSph) by using the enzyme-linked immunosorbent assay (ELISA) method. The mean age of patients was 30±5. Four patients (3.7%) were found positive for at least one aPLs subtype. Four aPLs subtypes were detected. The most common subtypes was aβ2GPI dependent CL (3.7%), followed by aCL (2.7%), aβ2GPI (0.9%), and aPE(0.9%). In conclusion, frequency of aPLs among women with fetal loss (3.7%) in Malaysia was low with subtype aβ2GPI dependent CL being the most prevalent aPLs.
Early pregnancy failure is a common pregnancy complication. In clinical practice, the time delay to distinguish viable from nonviable pregnancy is often distressing to patients and doctors. A highly sensitive and specific biomarker that accurately discriminates between viable and nonviable pregnancy would be useful for early intervention. Progesterone has been shown as a biomarker of early pregnancy failure. However the usefulness is still questionable due to the different cutoff values used. A study was conducted to determine the role of progesterone as a marker of early pregnancy failure and to establish the cut-off value in discriminating between viable and nonviable pregnancy. The study was carried out in the Obstetric and Gynecology Patient Admission Centre (OBPAC), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for a period of twelve months. Ninety-five pregnant women of 13 weeks or less period of amenorrhoea (POA) were recruited. Fourteen normal pregnant women were controls. The patients with early pregnancy failure were classified according to types of abortion. Single measurement of serum progesterone was carried out during admission. The outcome of pregnancy was followed up until 22 weeks of POA to ascertain viability of the fetus. Median progesterone levels were significantly lower in women with nonviable pregnancies compared with viable pregnancy [10.7ng/ml (0.60-49.80) vs. 45.9ng/ml (15.40-127.20) respectively, p<0.001]. Progesterone levels were also significantly lower in threatened abortion patients with outcomes of nonviable pregnancy compared with pregnancies that progressed on to the viability period [23.3 +/- 12.0 vs. 89.7 +/- 33.2 respectively, p<0.001]. At cut-off value of 32.7ng/ ml, progesterone had 90% sensitivity with 75% negative predictive value and 92% specificity with 97% positive predictive value. The area under curve for progesterone was 0.95 (95% Confidence Interval, 0.903-0.990). In conclusion, these findings indicate that serum progesterone can be used as a marker for early pregnancy failure.
Five patients illustrate various aspects of obstetrical defibrination in West Malaysia, resulting from exaggeration of changes in fibrinolytic-coagulation equilibrium that occur at delivery. Hypofibrinogenaemia and fibrinolysis may occur in association or either feature predominate. These patients are from a population in which a variety of genetic and environmental factors may interact, e.g. abnormal haemoglobins, cold agglutinins, viral and other infections, introducing additional complications.