Prevalence of Antiphospholipid Antibodies among Critically Ill Obstetric Patients with Bad Obstetric History Admitted to Intensive Care Unit of a Tertiary Care Centre

INTRODUCTION: Antiphospholipid syndrome is an autoimmune disorder characterized by high risk of obstetrical complications affecting both mother and fetus. The incidence of bad obstetrical history has been reported 5.27% in a tertiary care hospital study. Antiphospholipid antibodies, a group of autoantibodies that bind to negatively charged phospholipids, have clinical significance because of their association with thromboembolic events and adverse pregnancy outcome including recurrent miscarriages, stillbirths, preterm deliveries. Bad obstetric history implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous miscarriages, early neonatal deaths, intrauterine growth restriction and congenital anomalies. Bad obstetric history may result from multiple causes which include genetic factors (3.5-5%), anatomical abnormalities (12–16%), endocrine problems (17–20%), infections (0.5–5%), immunological factors such as APS (20–50%), and miscellaneous factors. The most important antiphospholipid antibody are anti-cardiolipin antibody, lupus anticoagulant, anti-β2 glycoprotein1 antibody. Complement mediated injury, reduced proliferation, syncytia formation trophoblastic apoptosis and reduced human chorionic gonadotrophin are the important underlying mechanism for APLA related adverse pregnancy event.. Critically ill obstetric patients with a bad obstetric history are at a higher risk of developing APS. OBJECTIVES: To determine the prevalence of antiphospholipid antibodies among critically ill obstetric patients with a bad obstetric history admitted to the intensive care unit (ICU) of a tertiary care centre. MATERIALS AND METHODS: This study is a prospective observational study that will be conducted in the ICU of tertiary care centre. All critically ill obstetric patients with age between 18 to 45 year with a bad obstetric history admitted to the ICU will be included in the study. Blood samples will be collected from these patients and tested for antiphospholipid antibody, including lupus anticoagulant, anticardiolipin antibodies, and anti-β2-glycoprotein antibodies. RESULTS: Till now we had collected 8 patient sample of which 3 (37.5%) came positive for antiphospholipid antibody. 1 patient came positive with both cardiolipin antibody and lupus anticoagulant. One patient came positive for cardiolipin antibody and another patient came positive for only lupus anticoagulant. DISCUSSIONS/CONCLUSIONS: This study will contribute to the existing literature on APS in obstetric patients and highlight the importance of screening for antiphospholipid antibody in critically ill obstetric patients with a bad obstetric history as this patient carries a high risk for developing antiphospholipid antibody syndrome. The findings of this study will have implications for the management of these patients and may improve obstetric outcomes.