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Obstetric antiphospholipid syndrome.

E Esteve-Valverde1, R Ferrer-Oliveras2, J Alijotas-Reig3

  • 1Servicio de Medicina Interna, Althaia, Xarxa Assistencial de Manresa, Barcelona, España; Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitari Vall d'Hebrón, Universitat Autònoma, Barcelona, España.

Revista Clinica Espanola
|November 26, 2015
PubMed
Summary
This summary is machine-generated.

Obstetric antiphospholipid syndrome, an autoimmune disorder, causes pregnancy complications. Combined aspirin and heparin treatment improves outcomes for affected mothers and babies.

Keywords:
Abortos recurrentesAnticuerpos antifosfolipídicosAntiphospholipid antibodiesEmbarazoFetal lossObstetric antiphospholipid syndromePreeclampsiaPregnancyPérdidas fetalesRecurrent miscarriagesSíndrome antifosfolipídico obstétrico

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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.