Obstetric outcome in antiphospholipid syndrome

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Hematology

Background:

• Recurrent pregnancy loss is often associated with antiphospholipid syndrome (APS).
• Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are key markers for APS.
• APS poses significant risks for both pregnancy and maternal health.

Purpose of the Study:

• To investigate the prevalence of LA and ACA in patients with recurrent miscarriage.
• To evaluate the live birth rates and outcomes in pregnancies complicated by APS.
• To assess the effectiveness of empirical treatments for APS during pregnancy.

Main Methods:

• A retrospective analysis of 387 patients at a Recurring Miscarriage Clinic over three years.
• Identification of patients positive for LA and/or ACA.
• Tracking of 53 subsequent pregnancies and their outcomes.
• Analysis of treatment strategies including low-dose aspirin and low molecular weight heparin (LMWH).

Main Results:

• 16% of patients (63/387) tested positive for LA and/or ACA, with 59 diagnosed with APS.
• An overall live birth rate of 70% was achieved in 53 pregnancies among these patients.
• Pregnancies with both LA and ACA showed lower success rates (53%) compared to single marker positivity (72-81%).
• Complications included Caesarean sections, intrauterine growth restriction, hypertension, deep vein thrombosis, and pulmonary embolism.

Conclusions:

• Antiphospholipid syndrome is a significant risk factor for recurrent pregnancy loss and maternal morbidity.
• Empirical treatment strategies yielded a 70% live birth rate.
• A randomized controlled trial is essential to determine optimal treatment for pregnancy conservation and thromboprophylaxis in APS patients.