A study of sixty pregnancies in patients with the antiphospholipid syndrome.
OBJECTIVE
To study the maternal and fetal outcome in treated antiphospholipid syndrome (APS) pregnancies.


METHODS
Sixty pregnancies in 47 APS patients (11 primary and 36 secondary) were followed in a multidisciplinary clinic. Patients testing antiphospholipid antibody positive and having a history of recurrent miscarriages were treated with low-dose aspirin (75 mg) daily. Patients with APS and a previous history of thrombotic events were treated with subcutaneous unfractionated or low molecular weight heparin and low-dose aspirin (75 mg) daily.


RESULTS
The live birth rate increased from 19% of their previous non-treated pregnancies to 70% despite a high incidence of obstetric and fetal complications: pre-eclampsia (18%), prematurity (43%), fetal distress (50%) and intrauterine growth retardation (31%). Two predictors of fetal outcome were observed: the previous obstetric history and the presence of thrombocytopenia. Seven pregnancies (12%) were complicated by thrombotic events during pregnancy or during the puerperium. There were no thrombotic events in those receiving a low molecular weight heparin regimen.


CONCLUSIONS
Close obstetric monitoring by a multidisciplinary team and the use of antithrombotic therapy was effective in reducing the fetal wastage in APS pregnancies despite a high incidence of obstetric and fetal complications.
Lima
F
F
Lupus Pregnancy Clinic, St. Thomas' Hospital, London, United Kingdom.
Khamashta
M A
MA
Buchanan
N M
NM
Kerslake
S
S
Hunt
B J
BJ
Hughes
G R
GR
D000026:Abortion, Habitual / Q000150:complications / Q000188:drug therapy; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000503:physiopathology*; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D011248:Pregnancy Complications; D011250:Pregnancy Complications, Hematologic; D011256:Pregnancy Outcome; D013921:Thrombocytopenia / Q000150:complications; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D001241:Aspirin