Antiphospholipid syndrome and pregnancy

Antiphospholipid syndrome (APS) is an autoimmune thrombophilic condition characterized by the onset of venous and/or arterial thrombosis, often multiple, and pregnancy morbidity in a background of antiphospholipid antibodies (aPL) positivity. Some patients can be carrier of aPL with no clinical symptoms, in other cases clinical manifestation can range from the classical presentation to an acute life-threatening condition named catastrophic APS. APS can be considered as primary or associated to other disease, however pregnancy acts as a triggering factor on a susceptible background that lead to the clinical manifestations through immunological and non-immunological mechanism. APS is characterized by thrombotic manifestation involving both venous and arterial vessels of different size, in any part of the body the clinical presentation can be extremely polymorphic. Livedo reticularis is the most common cutaneous finding, however it is not specific for APS and other cutaneous manifestation such as ulcers or purpura can be the only presentation of APS. Diagnosis is established by clinical and laboratory criteria. Counselling, pregnancy plan and monitoring during pregnancy is mandatory in APS patients. Treatment can be challenging, and it is mainly based on the use of anticoagulant and antiaggregant medications. A literature review on PubMed about APS and pregnancy was performed, and the significant information in conjunction with our clinical experience lead to the drafting of this paper. We present a review of APS and its management in pregnancy, with a special focus on the dermatological presentation and the role of the dermatologists in diagnosing and managing this potential life-threatening condition.