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The most efficacious strategy to manage pregnant patients with antiphospholipid syndrome (APS) refractory to conventional heparin/low-dose aspirin treatment or at high risk of adverse pregnancy outcomes has not been determined with any degree of certainty. The study set out to evaluate the efficacy and safety of the second-line treatments most frequently used in addition to conventional therapy, and the data were analyzed to identify which is/are associated to the best pregnancy outcomes. A systematic review of the literature on studies concerning second-line treatments for refractory and/or high risk pregnant APS women published between February 2006 and February 2020 was conducted. The records were retrieved by searching Medline via Pubmed, the Web of Science platform, the Cochrane library database and clinicaltrials.gov. Fourteen studies met the eligibility criteria of the review: six retrospective cohort studies, one case-control, one case-series and six case reports. The results of single treatment protocols based upon hydroxychloroquine (HCQ), low-dose steroids (LDS), intravenous immunoglobulins (IVIG), plasma exchange (PE) or pravastatin and of combination protocols based upon HCQ+LDS, IVIG+LDS, PE+LDS and PE+IVIG used during 313 pregnancies in 303 APS women were analyzed and compared. The second-line treatments produced 261/313 (83.4%) live births; severe pregnancy complications were registered in 75/313 (24%) pregnancies. Drug side-effects were observed in 3/313 (0.9%) pregnancies. Statistical analysis identified a significantly higher live birth rate and/or a significantly lower number of severe complications in the pregnancies treated with IVIG, HCQ, pravastatin, PE+IVIG and PE+LDS. Our results suggest using low-dose IVIG (< 2 g/Kg/month) or HCQ 400 mg/day starting before pregnancy in women with APS refractory to conventional therapy, while high-dose IVIG (2 g/Kg/month) associated with PE or alone in those with high risk±refractory APS. Image, graphical abstract [ABSTRACT FROM AUTHOR]

OBJECTIVE: The maternal syndrome of preeclampsia has been attributed to a systemic intravascular inflammatory response and endothelial cell dysfunction. The stimulus responsible for intravascular inflammation in preeclampsia has not been determined. The expression of CD45 isoforms on the surface of human T cells has been used to classify CD4[SUP+] T lymphocytes into naïve cells (CD45RA+) and memory T cells (CD45RO+). An increased percentage of CD45RO+ cells has been interpreted as consistent with previous exposure to microbial products or other antigens. The purpose of this study was to determine whether preeclampsia is associated with a change in the proportion of CD45RA+ and CD45RO+. STUDY DESIGN: A prospective study was conducted in patients with preeclampsia (n = 24) and normal pregnancy (n = 75). The percentage of CD45RA+ and CD45RO+ on CD4[SUP+] T lymphocytes in peripheral blood was determined using flow cytometry and monoclonal antibodies. Results were reported as a percentage of CD4[SUP+] lymphocytes. Parametric statistics were used for analysis. A probability value of <.05 was considered statistically significant. RESULTS: Patients with preeclampsia had a significantly higher percentage of CD45RO+ than normal pregnant women (P < .01). A significantly lower percentage of CD45RA+ was found in patients with preeclampsia than in normal pregnant women (P < .01). CONCLUSlON: Preeclampsia is associated with an increase in the percentage of CD45RO+ and a decrease in the CD45RA+ lymphocyte subpopulation. Therefore, patients with preeclampsia have evidence of previous antigenic exposure, the nature of which remains to be established. [ABSTRACT FROM AUTHOR]

Examines the characteristics of maternal monocytes and granulocytes in preterm labor with intact membranes in Detriot, Michigan. Impact of monoclonal antibodies on granulocyte and monocyte phenotype; Effect of white blood cells on inflammatory response; Evaluation of the results of flow cytometric analysis of patients.

Examines the phenotypic and metabolic characteristics of monocytes and granulocytes in normal pregnancy and maternal infection. Impact of gestational age on maternal peripheral blood; Correlation between leukocyte and cell activation; Symptoms of pyelonephritis.

Examines the metabolic characteristics of monocytes and granulocytes in women with preeclampsia in Detroit, Michigan. Use of flow cytometry for the study of intravascular inflammation; Application of monoclonal antibodies for selective cluster differentiation antigens; Assessment of peripheral venous blood.