Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study
Abstract Background The potential role of antinuclear antibodies (ANA) in recurrent pregnancy loss (RPL) pathogenesis is still debated, although some evidences suggest that they could affect pregnancy outcome, leading to a higher miscarriage rate in these patients. A hypothesized mechanism is throug...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-01-01
|
| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-020-2724-6 |
| _version_ | 1818561981169270784 |
|---|---|
| author | Valentina Bruno Carlo Ticconi Federica Martelli Marzia Nuccetelli Maria Vittoria Capogna Roberto Sorge Emilio Piccione Adalgisa Pietropolli |
| author_facet | Valentina Bruno Carlo Ticconi Federica Martelli Marzia Nuccetelli Maria Vittoria Capogna Roberto Sorge Emilio Piccione Adalgisa Pietropolli |
| author_sort | Valentina Bruno |
| collection | DOAJ |
| description | Abstract Background The potential role of antinuclear antibodies (ANA) in recurrent pregnancy loss (RPL) pathogenesis is still debated, although some evidences suggest that they could affect pregnancy outcome, leading to a higher miscarriage rate in these patients. A hypothesized mechanism is through changes in uterine flow in pre-conceptional stage, by modifying endometrial receptivity in RPL. However, scant data are available, in pregnancy, about their role in RPL placental perfusion, also in relation to its potential treatments, such as low molecular weight heparin (LMWH). The aim of this study is to retrospectively further investigate the correlation between two-dimensional (2D) and three-dimensional (3D) uterine and placental flow indexes and the presence or the absence of ANA in women with unexplained RPL (uRPL), treated or not treated with LMWH. Methods 2D Doppler measurement of pulsatility index (PI) of the uterine arteries and 3D ultrasonography determination of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) was carried out with the aid of the virtual organ computer-aided analysis (VOCAL) technique in LMWH treated (n 24) and not treated-uRPL patients (n 20) and in the relative control group (n 27), each group divided in ANA+ and ANA- subgroups. Serum assay for the presence of ANA was performed in all women. Results No differences were found in PI, VFI and VI values, by comparing the different groups. A difference in VI values was found for ANA- patients between RPL women not treated with LMWH and the treated ones (p = 0,01), which have lower VI values and similar to controls. By considering only ANA- treated and not treated RPL patients, the ROC curve shows an area of 0,80 and at the VI cut-off of 11,08 a sensitivity of 85% and a specificity of 67%. Conclusions LMWH could exert a potential beneficial effect in restoring the physiological blood flow supply in terms of VI in uRPL ANA- status, suggesting to include ANA and VI investigations in the RPL diagnostic algorithm in a research context, since further studies are needed to clarify this challenging hypothesis in order to try to ameliorate ANA and abnormal placental vascularization negative influence on RPL pregnancy outcome . |
| first_indexed | 2024-12-14T00:57:48Z |
| format | Article |
| id | doaj.art-4e9ab71334434e96bfd91a601c043844 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-14T00:57:48Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-4e9ab71334434e96bfd91a601c0438442022-12-21T23:23:27ZengBMCBMC Pregnancy and Childbirth1471-23932020-01-012011910.1186/s12884-020-2724-6Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective studyValentina Bruno0Carlo Ticconi1Federica Martelli2Marzia Nuccetelli3Maria Vittoria Capogna4Roberto Sorge5Emilio Piccione6Adalgisa Pietropolli7Academic Department of Biomedicine and Prevention, Section of Gynecology, University of Rome “Tor Vergata”Academic Department of Surgical Sciences, Section of Gynecology, Tor Vergata University HospitalAcademic Department of Biomedicine and Prevention, Section of Gynecology, University of Rome “Tor Vergata”Department of Experimental Medicine and Surgery, Tor Vergata University HospitalAcademic Department of Surgical Sciences, Section of Gynecology, Tor Vergata University HospitalDepartment of Systems Medicine, Laboratory of Biometry, University of Rome “Tor Vergata”Academic Department of Surgical Sciences, Section of Gynecology, Tor Vergata University HospitalAcademic Department of Systems Medicine, Section of Gynecology, University of Rome “Tor Vergata”Abstract Background The potential role of antinuclear antibodies (ANA) in recurrent pregnancy loss (RPL) pathogenesis is still debated, although some evidences suggest that they could affect pregnancy outcome, leading to a higher miscarriage rate in these patients. A hypothesized mechanism is through changes in uterine flow in pre-conceptional stage, by modifying endometrial receptivity in RPL. However, scant data are available, in pregnancy, about their role in RPL placental perfusion, also in relation to its potential treatments, such as low molecular weight heparin (LMWH). The aim of this study is to retrospectively further investigate the correlation between two-dimensional (2D) and three-dimensional (3D) uterine and placental flow indexes and the presence or the absence of ANA in women with unexplained RPL (uRPL), treated or not treated with LMWH. Methods 2D Doppler measurement of pulsatility index (PI) of the uterine arteries and 3D ultrasonography determination of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) was carried out with the aid of the virtual organ computer-aided analysis (VOCAL) technique in LMWH treated (n 24) and not treated-uRPL patients (n 20) and in the relative control group (n 27), each group divided in ANA+ and ANA- subgroups. Serum assay for the presence of ANA was performed in all women. Results No differences were found in PI, VFI and VI values, by comparing the different groups. A difference in VI values was found for ANA- patients between RPL women not treated with LMWH and the treated ones (p = 0,01), which have lower VI values and similar to controls. By considering only ANA- treated and not treated RPL patients, the ROC curve shows an area of 0,80 and at the VI cut-off of 11,08 a sensitivity of 85% and a specificity of 67%. Conclusions LMWH could exert a potential beneficial effect in restoring the physiological blood flow supply in terms of VI in uRPL ANA- status, suggesting to include ANA and VI investigations in the RPL diagnostic algorithm in a research context, since further studies are needed to clarify this challenging hypothesis in order to try to ameliorate ANA and abnormal placental vascularization negative influence on RPL pregnancy outcome .https://doi.org/10.1186/s12884-020-2724-6uRPLANAVOCALPlacental blood flow supplyLMWH |
| spellingShingle | Valentina Bruno Carlo Ticconi Federica Martelli Marzia Nuccetelli Maria Vittoria Capogna Roberto Sorge Emilio Piccione Adalgisa Pietropolli Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study BMC Pregnancy and Childbirth uRPL ANA VOCAL Placental blood flow supply LMWH |
| title | Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study |
| title_full | Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study |
| title_fullStr | Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study |
| title_full_unstemmed | Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study |
| title_short | Uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss: should they be investigated in pregnancy as correlated potential factors? A retrospective study |
| title_sort | uterine and placental blood flow indexes and antinuclear autoantibodies in unexplained recurrent pregnancy loss should they be investigated in pregnancy as correlated potential factors a retrospective study |
| topic | uRPL ANA VOCAL Placental blood flow supply LMWH |
| url | https://doi.org/10.1186/s12884-020-2724-6 |
| work_keys_str_mv | AT valentinabruno uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT carloticconi uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT federicamartelli uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT marzianuccetelli uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT mariavittoriacapogna uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT robertosorge uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT emiliopiccione uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy AT adalgisapietropolli uterineandplacentalbloodflowindexesandantinuclearautoantibodiesinunexplainedrecurrentpregnancylossshouldtheybeinvestigatedinpregnancyascorrelatedpotentialfactorsaretrospectivestudy |