Obstetric management of antiphospholipid syndrome

The obstetric management of women with antiphospholipid (aPL) syndrome remains controversial. Despite recent advances, the controversies have been fueled by our limited understanding of the multi-factorial causes of aPL-associated pregnancy loss and the lack of data from randomized studies. We have escaped from the narrow confines of the concept of aPL pregnancy loss being purely thrombotic in aetiology and attention is now focused on the adverse effects of aPL on embryonic implantation and trophoblast invasion. Combined treatment with aspirin and heparin has been demonstrated in two randomized studies to lead to a high live birth rate in aPL pregnancies. However, successful pregnancies are characterized by a high rate of perinatal complications and some women are refractory to this treatment combination. In addition to addressing these issues, multi-centre studies, which should perhaps be internet based, are needed to identify those aPL that are causative of pregnancy complications and those that are not, the role of IVIG and the long-term follow-up of both mothers with aPL and their babies.