[Antiphospholipid syndrome in obstetrics--a new version of criteria, pathomechanism and the prophylaxis].
The paper surveys literature referring to criteria of the antiphospholipid syndrome in obstetrics as well as to the pathomechanism and prophylactic treatment. Criteria of that syndrome were modified in 1999. Generally accepted are two clinical criteria--thromboembolic complications and recurrent pregnancy loss, as well as two laboratory criteria--presence of lupus anticoagulant and/or anticardiolipin antibodies in the medium or high titer. Thrombocytopenia is no longer treated as a criterion. Diagnosis is formulated on the basis of at least one clinical and one laboratory criterion. It is assumed that obstetric complications are the result of immunological reaction of antiphospholipid antibodies with antigen located in trophoblast or vascular endothelium of the spiral arteries. The elimination of the activity of placental anticoagulant--annexin V--is the main mechanism of local thrombosis and infractions in placenta. Improvement in the results of obstetrics care can be achieved through prophylactic treatment: from the beginning of pregnancy until delivery, acetylosalicylic acid (aspirin) is applied in low doses, i.e. 80 mg/24 h and low molecular weight heparin or standard heparin in low-doses. It is recommended that for 6 weeks after delivery oral anticoagulants should be used in prophylactic doses in cases of primary syndrome, and in the secondary syndrome even constant antithrombotic prophylaxis is advised.
Uszyński
Mieczysław
M
Katedry i Zakładu Propedeutyki Medycyny Akademii Medycznej im. Ludwika Rydygiera w Bydgoszczy.
Uszyński
Waldemar
W
D016736:Antiphospholipid Syndrome / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy