[Circulating anticoagulants and pregnancy: a risky combination]

In the last ten years the relationship between the presence of lupus type anticoagulants in the blood and some obstetrical complications, in particular spontaneous abortions, repeated fetal deaths in utero and intra-uterine growth retardation, has been well documented. A study of the literature shows that there were only twenty live-born children out of 280 pregnancies in 71 women who had the lupus type anticoagulant factor. The presence of the factor in high levels in a pregnant woman was seen to be of poor prognostic significance for the obstetric outcome. Biologically the lupus type circulating anticoagulant should be suspected when there is a five to six seconds prolongation of clotting time and it is highly suspicious if the time is prolonged by more than seven seconds. Its presence should equally be suspected by testing for the activated partial thromboplastin time (APTT). It has been shown that early treatment directed to lessen the activity of the lupus type factor (the use of corticoid-immunosuppressors) and forestalling as far as possible placental insufficiency (by giving heparin, aspirin and dipyridamole) could help, thus enabling some women to have live children who would not otherwise be able to do so.