PLACENTAL PATHOLOGY IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A PROSPECTIVE-STUDY

OBJECTIVES: Systemic lupus erythematosus and antiphospholipid antibody , often identified in patients with systemic lupus erythematosus, are associated with poor pregnancy outcome. This study distinguishes betwe en the effect of each of these factors on gestational outcome and plac ental pathologic conditions in pregnant patients with systemic lupus e rythematosus. STUDY DESIGN: Thirty-seven pregnancies and 40 placentas from 33 women with systemic lupus erythematosus were studied prospecti vely. RESULTS: Systemic lupus erythematosus alone, but not systemic lu pus erythematosus activity, was associated with increased spontaneous abortions, preterm gestations, and fetal growth restriction. Placental correlates were ischemic-hypoxic change, decidual vasculopathy, decid ual and fetal thrombi, chronic villitis, and decreased placental weigh t. Extensive infarction and fetal death were important antiphospholipi d antibody-related findings. CONCLUSIONS: Decidual vasculopathy/coagul opathy appears to mediate the antiphospholipid antibody-related and mu ch of the systemic lupus erythematosus-related deleterious effect on t he placenta and gestational outcome. The presence of antiphospholipid antibody largely, but not invariably, predicts fetal death. Antiphosph olipid antibody-independent chronic villitis may represent a second me chanism of systemic lupus erythematosus-related change.