Human Reproduction, Vol. 16, No. 2, 395,
February 2001
© 2001 European Society of Human Reproduction and Embryology
Letters to the editor |
Thrombophilias and adverse pregnancy outcome
Department of Histopathology, St. Mary's Hospital, Paddington, London W2, UK
Dear Sir,
Mousa and Alfirevic (2000) recently reported on the relationship between histological placental lesions and thrombophilia status in women with adverse pregnancy outcomes. Their results are interesting (with apparently thorough thrombophilia testing performed), but their conclusion, that the results do not support an association between thrombophilias and adverse pregnancy outcome, is misleading.
Firstly, this study only examined pregnancies complicated by intrauterine growth restriction, stillbirth, pre-eclampsia (PET) or abruption. If certain thrombophilias do indeed result in increased likelihood of pregnancy complications (e.g. PET), then the common mechanism would be expected to be related to trophoblastic invasion defects, just as in any other population complicated by this disorder. Therefore, examining the end result (i.e. the placenta), would be expected to show features of PET, not the underlying cause. Analogously, a head computerized tomography (CT) scan could diagnose, e.g. a thrombotic cerebrovascular accident, but the scan would not reveal much information about the underlying aetiology; however, this does not reduce the usefulness of the examination.
Secondly, the results themselves may not be as clear cut as presented and certain histological features may indeed be more common with certain thrombophilias. For example, massive perivillus fibrin deposition was present in six out of 11 cases which were anticardiolipin antibody (ACA)-positive compared with only six out of 36 from the thrombophilia-negative group (z = 1.97, P < 0.05). In fact, it is highly likely that the relative prevalence of the types of pregnancy complications and certain associated histological features will vary according to the type of thrombophilia and only larger future studies will provide such data. Nevertheless, this study highlights the importance of systematic examination of placental pathology in relation to high-risk pregnancy groups and provides some data on which further studies may be based.
References
Mousa, H.A. and Alfirevic, Z. (2000) Do placental lesions reflect thrombophilia state in women with adverse pregnancy outcome? Hum. Reprod., 15, 1830–1833.
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