Lupus anticoagulant. Implications for obstetric anaesthetists

Circulating lupus anticoagulant occurs in 5-37% of all patients with systemic lupus erythematosus. Its occurrence is not restricted to collagen vascular disease states. Lupus anticoagulant causes a prolongation of certain laboratory coagulation studies yet it is associated in vivo with a history of systemic intravascular thromboses. Placental vessels are also affected. Less than one in six pregnancies complicated by the presence of this auto-antibody is successful. Treatment of afflicted parturients with anti-platelet therapy has increased perinatal survival rates. Derangements in the coagulation profile and concomitant anti-platelet therapy confound the rational use of regional anaesthesia in the management of labour and delivery in these high-risk pregnancies.