Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, early neonatal deaths, stillbirths, intrauterine fetal deaths, intrauterine growth retardation and congenital anomalies. Thus, Modern laboratories offer BOH profile for such obstetric patients. The profile includes battery of tests for medical professional to evaluate the possible cause and solutions to support a patient with BOH. This becomes all the more crucial for patient with primary or secondary infertility, irregular menses and/or ovulation, history of uterine fibroid, advancing age, etc.
• BOH etiology may be genetic, hormonal, abnormal maternal immune response, and maternal infection. Immune related factors greatly affect pregnancy outcomes and relevant antibodies have been identified as biomarkers for BOH patients. These may be classified as autoimmune and alloimmune factors. Many of these antibodies test have been included in this profile. Further, primary infections caused by TORCH—Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), and Herpes simplex virus (HSV)—is another major cause of BOH.
• ANA
• ACL - IgG, IgM
• APA - IgG,IgM
• Lupus Anti
• TSH
• TORCH - 8
• ANA
Anti-nuclear antibodies or ANA comes under autoimmune factors along with others namely, anti-phospholipid antibodies and anti-thyroid antibodies. Women with history of complications during pregnancy without any autoimmune disorder may have raised numbers of autoimmune antibodies. The anti-nuclear antibodies have been found associated with pre-eclampsia, intrauterine growth retardation, fetal death and placental abruption. Studies suggest that Antinuclear antibodies may interfere with the formation and maturation of placenta which would eventually lead to an early fetal loss.
• ACL - IgG, IgM
Anticardiolipin (ACL or aCL) antibodies (IgG & IgM) are a type of anti-phopholipid antibodies which are autoimmune antibodies (other forms of autoimmune antibodies include anti-nuclear antibodies and anti-thyroid antibodies). Study show ACL antibodies concentrations have been positively correlated with bad obstetric history in women with three & more recurrent miscarrigages. Thus, testing levels of ACL can reduce the mortality in BOH patients.
• APA - IgG,IgM
As discussed antiphospholipid antibodies (APA) are autoimmune antibodies, that bind to negatively charged phospholipids. High APA levels causes thrombotic events resulting in health risk to both mother and baby eventually causing pregnancy loss and related complications.
• Anticardiolipin; antinuclear and lupus antibodies
- Lupus Anticoagulant
- Lupus Anticoagulant (LA) is a type of antiphospholipid antibodies, that is strongly associated with recurrent miscarriage before the 24th week of gestation. ACL and LA are reported to predict fetal loss, thus due to incomplete concordance both must be tested if antiphospholipid syndrome is suspected.
• TSH
Pregnancy induces various physiological changes to thyroid gland function with about 50% increase in production of thyroxin (T4) and tri-iodothyronine (T3) and iodine requirement. Maternal thyroid dysfunction if untreated can cause increased risk of miscarriage, intrauterine growth retardation, hypertensive disorders, preterm delivery, and a decreased child IQ. The actual values of the test varies with different trimester during pregnancy. Thus, evaluation of TSH value is crucial for management of thyroid dysfunction a common disorder that may become critical in patients with BOH.
• TORCH - 8
TORCH infections are associated with recurrent abortion, intrauterine growth retardation, intrauterine death, preterm labor, early neonatal death, and congenital malformation. The infection is more damaging to the foetus than the mother and the degree of severity depends on the gestational age of the fetus. The virulence can not only damage fetus but also increase severity of maternal infection. Serological evaluation of TORCH infection during pregnancy for early diagnosis is recommended so that appropriate intervention can help better manage cases with BOH.
Ref.
• Singh G, Sidhu K. Bad Obstetric History: A Prospective Study. Medical Journal, Armed Forces India. 2010;66(2):117-120.
• E Afman, I & Cronjé, Hendrik & Joubert, G & Badenhorst, Philip & G Schoon, M. (2004). Antinuclear antibody testing in obstetric patients. South African medical journal 93. 932-7.
• A ASAITHAMBI, M GUNASEKARAN, P NAINAR. ANTINUCLEAR ANTIBODIES IN PATIENTS WITH UNEXPLAINED RECURRENT ABORTIONS. Asian journal of Pharmaceutical and clinical research. Vol 10, Issue 8, 2017.
• TM DHASON; EL JAIRAJ; R SANKARALINGAM; B MAHENDREN; B CHILUKURI; S VENGUDUSAMY; M SEETHARAMAN. Role of anticardiolipin antibodies in bad obstetric history detected by ELISA test in a tertiary care centre. J Immunol Clin Microbiol. 2017; 2(2): 43-47.
• Nadia Mudher Al-Hilli and H Mohammad Al-Mosawi.The Prevalence of Anticardiolipin Antibodies in women with Bad Obstetric History International journal of current microbiology and applied science. .Volume 3 Number 2 (2014) pp. 547-553
• Di Prima FAF, Valenti O, Hyseni E, et al. Antiphospholipid Syndrome during pregnancy: the state of the art. Journal of Prenatal Medicine. 2011;5(2):41-53.
• Kumari N, Morris N, Dutta R. Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal. Journal of Health, Population, and Nutrition. 2011;29(1):77-80.
• Sadik, M.S. & Fatima, H & Jamil, Kaiser & Patil, C. (2012). Study of TORCH profile in patients with bad obstetric history. Biology and Medicine. 4. 95-101.
