Obstetric antiphospholipid syndrome.

Area of Science:

• Obstetrics and Gynecology
• Autoimmune Disorders
• Immunology

Background:

• Obstetric antiphospholipid syndrome (APS) is an acquired autoimmune condition linked to adverse pregnancy outcomes.
• It involves antiphospholipid antibodies (aPLs) targeting phospholipids, cofactors, or their complexes, often without a history of thrombosis.
• While aPLs' procoagulant effects are implicated, placental studies reveal their pro-inflammatory role via complement and cytokines.

Purpose of the Study:

• To review the pathophysiology and clinical manifestations of obstetric antiphospholipid syndrome.
• To discuss diagnostic challenges, particularly regarding the specific aPL profile conferring the highest obstetric risk.
• To evaluate current and potential therapeutic strategies for obstetric APS, including refractory cases.

Main Methods:

• Literature review of obstetric antiphospholipid syndrome.
• Analysis of pathological findings in human placenta related to aPLs.
• Examination of treatment outcomes for combined aspirin and heparin therapy.
• Review of therapeutic options for refractory cases and associated autoimmune conditions.

Main Results:

• Obstetric complications are associated with APS, potentially mediated by pro-inflammatory pathways involving complement and cytokines.
• Categories I and IIa aPL profiles are considered high-risk for obstetric complications.
• Combined low-dose aspirin and heparin therapy demonstrates efficacy in improving obstetric and maternal outcomes.
• Refractory cases require further investigation, though progression to other autoimmune diseases is uncommon.

Conclusions:

• Obstetric antiphospholipid syndrome presents significant pregnancy risks, influenced by both procoagulant and pro-inflammatory mechanisms.
• Accurate identification of high-risk aPL profiles is crucial for risk stratification.
• Standardized treatment with aspirin and heparin is effective for most patients.
• Management of refractory cases and incomplete APS warrants further research.