Antiphospholipid syndrome in obstetrics.
Antiphospholipid syndrome (APLS) in pregnancy is characterized by the presence of autoantibodies in association with recurrent fetal loss and severe complications such as preeclampsia, fetal growth retardation, or placental insufficiency. The most clinically important serologic markers are lupus anticoagulant, anticardiolipin antibodies, and recently anti-beta-2-glycoprotein 1 antibodies. At present, standardization does not exist and a definitive association between specific clinical manifestation and antibody level is not yet known. Experimental data gave evidence that passive transfer of antiphospholipid antibodies result in clinical manifestation of APLS, that is, fetal loss and thrombocytopenia. Treatment with heparin, aspirin, or intravenous immunoglobulins decreased the fetal loss rate. Treatment regimens in human are very difficult to interpret. Evidence from two prospective studies supported treatment with heparin and aspirin to improve pregnancy outcome. The risk of preeclampsia and placental insufficiency was substantial and occurred in 50% of patients. The general failure rate of heparin/aspirin treatment is approximately 30%. In such cases intravenous immunoglobulin in combination with heparin and aspirin has been used to treat APLS.
Heilmann
Lothar
L
Department of Obstetrics and Gynecology, City Hospital Ruesselsheim, Germany. dr.lothar.heilmann@t-online.de
von Tempelhoff
Georg-Friedrich
GF
Pollow
Kunhard
K
D000026:Abortion, Habitual / Q000209:etiology / Q000517:prevention & control; D000022:Abortion, Spontaneous / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D017304:Annexin A5 / Q000032:analysis / Q000502:physiology; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology / Q000517:prevention & control; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007112:Immunity, Maternally-Acquired; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D016682:Lupus Coagulation Inhibitor / Q000032:analysis; D010927:Placental Insufficiency / Q000209:etiology / Q000517:prevention & control; D011225:Pre-Eclampsia / Q000209:etiology / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000276:immunology / Q000628:therapy; D015995:Prevalence; D013921:Thrombocytopenia / Q000151:congenital; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology
D017304:Annexin A5; D017153:Antibodies, Anticardiolipin; D000925:Anticoagulants; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016682:Lupus Coagulation Inhibitor; D006493:Heparin; D001241:Aspirin; D011241:Prednisone