Lymphocytic abnormalities in a mother suggesting transient antiphospholipid antibodies during a previous unsuccesful pregnancy

Abstract

Presence of antiphospholipid antibodies during a pregnancy represents a great challenge for the obstetrician. The appropriate medical measures usually result in significant improvement of the perinatal outcome. However, findings of routine diagnostics are sometimes normal and additional exercise is needed. Woman, 36 years old, in her third pregnancy, was admitted due to missing fetal movements. Fetus, 40 weeks of gestational age, had absent sounds and vaginal labor was augmented. A stillborn male neonate had weight of 4000 g, the umbilical cord was normal and it was not wrapped. However, after the pregnancy abnormalities of lymphocytic cell line were found. There was a lymphocytosis in which relative proportion of B lymphocytes was increased (range 40% to 44.8%), absolute number of T lymphocytes (CD3+) increased (range 1992/mm3 to 2081/mm3) and relative proportion of T lymphocytes (CD4+) increased in the range from 62% to 70.2%. After three years the woman was in her fourth pregnancy which was meticulously followed-up. Only subtle lymphocytic changes appeared, pregnancy course and labor were normal and healthy male neonate, weight of 3520 g, was finally born. Pattern of lymphocytic reaction between two consecutive pregnancies and during the last one with different clinical outcomes suggests development of transient antiphospholipid antibodies in the mother during her third pregnancy. It is likely that these antibodies triggered the chain of pathological events which finally contributed to the fetal demise.