WB Saunders, 2000.
Antiphospholipid syndrome is associated with thrombophilia and recurrent pregnancy loss. Antiphospholipid antibodies are found in 2% to 5% of the general healthy population, but they also may be associated with systemic lupus erythematosus and other rheumatic diseases. Obstetric complications arise from the prothrombotic effects of the antiphospholipid antibodies on placental function. Vasculopathy, infarction, and thrombosis have been identified in mothers with antiphospholipid syndrome. Antiphospholipid syndrome can include fetal growth impairment, placental insufficiency, maternal preeclampsia, and premature birth.
Idiopathic thrombocytopenic purpura (ITP) is seen in approximately 1 to 2 per 1000 live births and is an immune process in which antibodies are directed against platelets. Platelet-associated IgG antibodies can cross the placenta and cause thrombocytopenia in the fetus and newborn. The severely thrombocytopenic fetus is at increased risk for intracranial hemorrhage. ITP during pregnancy requires close maternal and fetal management to reduce the risks of life-threatening maternal hemorrhage and trauma to the fetus at delivery. Postnatal management involves observation of the infant’s platelet count. For infants who have evidence of hemorrhage, sin-gle-donor irradiated platelets may be administered to control the bleeding. The infant may benefit from an infusion of intravenous immunoglobulin. Neonatal thrombocytopenia usually resolves within 4 to 6 weeks.
Immune abnormalities in systemic lupus erythematosus (SLE)can lead to the production of anti-Ro (SS-A) and anti-La (SS-B)antibodies that can cross the placenta and injure fetal tissue.The most serious complication is damage to the cardiac conducting system, which results in congenital heart block. The heart block observed in association with maternal SLE tends to be complete (third degree), although less advanced blocks havebeen observed. The mortality rate is approximately 20%; mostsurviving infants require pacing. Neonatal lupus may occur and is characterized by skin lesions (sharply demarcated erythematous plaques or central atrophic macules with peripheralscaling with predilection for the eyes, face, and scalp), thrombocytopenia, autoimmune hemolysis, and hepatic involvement.
Birth asphyxia Birth injury (macrosomia, shoulder dystocia) Congenital anomalies (lumbosacral dysgenesis—caudal regression) Congenital heart disease (ventricular and atrial septal defects, transposition of the great arteries, truncus arteriosus, double-outlet right ventricle, coarctation of the aorta) Hyperbilirubinemia (unconjugated) Hypocalcemia Hypoglycemia Hypomagnesemia Neurologic disorders (neural tube defects, holoprosencephaly) Organomegaly
Polycythemia (hyperviscosity) Renal disorders (double ureter, renal vein thrombosis, hydronephrosis, renal agenesis)
Respiratory distress syndrome Small left colon syndrome Transient tachypnea of the newborn