First-trimester repeated abortion is not associated with activated protein C resistance

• Published in: Human reproduction (Oxford) 1997-05, Vol.12 (5), p.1094-1097
• Main Authors: Balasch, J, Reverter, J C, Fábregues, F, Tàssies, D, Rafel, M, Creus, M, Vanrell, J A
• Format: Article
• Language: English
• Subjects: Abortion, Habitual - blood; Abortion, Habitual - genetics; Adult; Biological and medical sciences; Diseases of mother, fetus and pregnancy; Enzyme Activation; Factor V - analysis; Factor V - genetics; Female; Fibrinolytic Agents - analysis; Genotype; Gynecology. Andrology. Obstetrics; Heterozygote; Humans; Medical sciences; Mutation; Phenotype; Population; Pregnancy; Pregnancy Trimester, First; Pregnancy. Fetus. Placenta; Protein C - analysis
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/12.5.1094

The present study was undertaken to investigate the possible association between activated protein C resistance and first-trimester repeated abortion. Fifty-five consecutive patients with unexplained first-trimester repeated abortion and 50 healthy control women having at least one child but no previous abortion were included. Activated protein C resistance was measured in all subjects and factor V Leiden genotype testing was performed in those individuals with phenotypic activated protein C resistance. One patient with first-trimester repeated abortion and one control subject had phenotypic activated protein C resistance. Genotype analysis confirmed that both subjects were heterozygous for factor V Leiden. Our results indicate that first-trimester repeated abortion is not associated with activated protein C resistance. Factor V Leiden screening in first-trimester repeated abortion is not warranted.A case-control study failed to substantiate concerns that first-trimester repeated abortion is associated with activated protein C resistance. In its heterozygous form, activated protein C resistance creates a life-long hypercoagulable state and a 5- to 10-fold increased risk of venous thrombosis. Frozen blood samples from 55 consecutive patients with two or more (mean, 2.9; range, 2-7) consecutive first-trimester spontaneous abortions of unknown etiology were compared to those from 50 healthy blood donors with at least one child but no previous abortion. Mean activated protein C resistance ratio in the 55 cases was 3.2 in the direct test and 2.9 in the modified test. Only one case had phenotypic activated protein C resistance (ratio of 1.4 in the direct test and 1.5 after factor V depleted plasma dilution). Genotype analysis confirmed that this patient, who had two previous abortions at 10 and 8 weeks of gestation, was heterozygous for the factor V Leiden mutation. One woman in the control group had activated protein C resistance phenotype (ratios 1.9 and 1.8 in the direct and modified tests, respectively) that was confirmed as heterozygous for factor V Leiden mutation. The development of resistance to activated protein C is presumed to occur mainly after 14 weeks of gestation and is more evident at term. The findings of this study suggest that factor V Leiden screening in first-trimester repeated abortion is not warranted.