Antiphospholipid syndrome in obstetrics.

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Reproductive Medicine

Background:

• Antiphospholipid syndrome (APLS) in pregnancy is a serious condition characterized by autoantibodies and adverse pregnancy outcomes.
• Key serologic markers include lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2-glycoprotein 1 antibodies.
• Current standardization is lacking, and the link between antibody levels and specific clinical manifestations remains unclear.

Purpose of the Study:

• To review the current understanding of antiphospholipid syndrome (APLS) in pregnancy.
• To discuss diagnostic markers and their clinical significance.
• To evaluate current and alternative treatment strategies for improving pregnancy outcomes in APLS patients.

Main Methods:

• Review of experimental data on passive transfer of antiphospholipid antibodies.
• Analysis of evidence from prospective studies on treatment regimens.
• Examination of treatment outcomes, including fetal loss rates and complications.

Main Results:

• Experimental data suggest passive transfer of antiphospholipid antibodies can induce APLS manifestations like fetal loss and thrombocytopenia.
• Heparin and aspirin treatment demonstrated improved pregnancy outcomes in prospective studies.
• Despite treatment, preeclampsia and placental insufficiency occurred in 50% of patients, with a 30% failure rate for heparin/aspirin therapy.

Conclusions:

• Heparin and aspirin are supported by evidence for improving pregnancy outcomes in APLS.
• Intravenous immunoglobulin in combination with heparin and aspirin is a viable option for refractory cases.
• Further research is needed to address the substantial risks of preeclampsia and placental insufficiency and improve overall treatment efficacy.