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Diagnosis and management of obstetrical antiphospholipid syndrome: where do we stand?
Insights
Obstetrical antiphospholipid syndrome (APS) is a leading cause of recurrent pregnancy loss. Early diagnosis and multidisciplinary care are crucial for managing this condition and improving outcomes for mothers and infants.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Immunology
Background:
- Obstetrical antiphospholipid syndrome (APS) is characterized by pregnancy complications and antiphospholipid antibodies (aPL).
- It is a significant acquired cause of recurrent fetal loss, though its incidence is not well-established.
- Diagnosis during pregnancy presents challenges due to diverse clinical manifestations.
Purpose of the Study:
- To review the clinical and biological aspects of obstetrical APS.
- To discuss current management strategies, including first-line and emerging second-line treatments.
- To emphasize the need for multidisciplinary care and close monitoring in APS pregnancies.
Main Methods:
- Literature review of obstetrical antiphospholipid syndrome.
- Analysis of diagnostic challenges and clinical features.
- Overview of current and developing treatment guidelines.
Main Results:
- Mothers with APS face increased risks of thrombosis, thrombocytopenia, preeclampsia, eclampsia, and HELLP syndrome.
- aPL is associated with recurrent miscarriages, stillbirths, and intrauterine growth restriction.
- Standardization and interpretation of aPL testing require expertise, and optimal testing protocols are debated.
Conclusions:
- Obstetrical APS requires a high index of suspicion and thorough differential diagnosis.
- While first-line treatments are established, 30% of cases necessitate second-line therapies, with new strategies under development.
- Multidisciplinary counseling and vigilant follow-up are essential for managing challenging APS pregnancies.
Abstract:
Obstetrical antiphospholipid syndrome (APS) is defined by obstetrical complications and the presence of antiphospholipid antibodies (aPL). Although the incidence of APS is still poorly known, this thrombophilia is now recognized as one of the most common acquired causes of recurrent fetal loss. The diagnosis of APS during pregnancy can be challenging because of its various clinical features. Mothers with APS have an increased risk of thrombosis, thrombopenia, and specific pregnancy‑related complications such as preeclampsia, eclampsia, and hemolysis elevated liver enzyme and low‑platelet syndrome. aPL can also lead to recurrent, early miscarriages, stillbirths, and to intrauterine growth restriction. Clinicians should be aware of all these characteristics and a thorough differential diagnosis should be performed. Testing for aPL also requires skill due to the difficulty of standardization and interpretation of tests. To know when testing should be performed and when to repeat tests are still a matter of debate. While general management and first‑line treatment of APS during pregnancy now have clear guidelines, second‑line treatment is still required in 30% of the cases and new strategies are currently in development. In this review, we describe the clinical and biological aspects of obstetrical APS and its current management options. As APS pregnancies can be a real challenge for clinicians, we underline the necessity of multidisciplinary counselling and close follow‑up.
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