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Placentation, antiphospholipid syndrome and pregnancy outcome

Lupus Pregnancy Clinic, St Thomas' Hospitals, London, UK; The Fetal and Maternal Health Research Group, St Thomas' Hospitals, London, UK; Maternal and Fetal Health Research Group, Department of Obstetrics and Gynaecology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK

M A Khamashta

Lupus Pregnancy Clinic, St Thomas' Hospitals, London, UK

L Poston

The Fetal and Maternal Health Research Group, St Thomas' Hospitals, London, UK

The antiphospholipid antibodies (aPLs) are a diverse group of autoantibodies associated with a pattern of disease known as antiphospholipid syndrome (APS). Pregnancy complications secondary to placental insufflciency are key features of this disease. The mechanisms underlying the placental pathology remain unclear. In this article the process of placentation in healthy and pathological pregnancies is reviewed. The evidence for defective placentation in APS pregnancies and involvement of aPLs in this process is summarized. Finally hypotheses based on the interpretation of these studies are discussed.

Key Words: antiphospholipid syndrome • placentation • trophoblast invasion • decidual vasculopathy • pregnancy outcome

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