Management of the controversial aspects of the antiphospholipid syndrome pregnancies: a guide for clinicians and researchers.
BACKGROUND
Recommendations for the treatment of aPL-positive patients with pregnancy morbidity are based on a limited number of well-designed clinical trials. However, the management of pregnant aPL-positive women still displays several open questions.


OBJECTIVE
To determine the practice patterns of experienced physicians in the management of the controversial aspects of aPL pregnancies.


METHODS
A questionnaire reproducing debated conditions was initially sent to the Advisory Board members (ABMs) of the 12th Congress of aPL and the Fifth Conference on Sex Hormones, Pregnancy and Rheumatic Diseases (Florence, Italy, April 2007), and then the same questionnaire was posted at the Hospital for Special Surgery (www.hss.edu) website and all attendees (ATS) of the above meetings were invited to participate via e-mail. Answers have been collected and analysed in a descriptive fashion and responses of the two groups evaluated by Chi-square or Fisher's exact test.


RESULTS
As a whole 75 responses from the ABMs and ATS were included in the analysis. In general, there was no significant difference between the opinions of two groups.


CONCLUSIONS
Management recommendations displayed reasonable consistence: (i) for the use of low-dose aspirin and low-molecular weight heparin during pregnancy and during ovarian stimulation for in vitro fertilization; (ii) against oestrogen-containing oral contraceptives; and (iii) for the use of anticoagulants in the post-partum period.
Erkan
D
D
Division of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, NY 10021, USA. erkand@hss.edu
Patel
S
S
Nuzzo
M
M
Gerosa
M
M
Meroni
P L
PL
Tincani
A
A
Lockshin
M D
MD
D000026:Abortion, Habitual; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D001779:Blood Coagulation Factors / Q000032:analysis; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011644:Puerperal Disorders / Q000188:drug therapy; D012219:Rheumatology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D015415:Biomarkers; D001779:Blood Coagulation Factors; D006493:Heparin; D001241:Aspirin