title: Pregnancy-triggered antiphospholipid syndrome in a patient with multiple late miscarriages.
abstract: Antiphospholipid syndrome (APS) is a multisystemic disorder of coagulation-causing thrombosis in the arterial and venous system as well as pregnancy-related complications such as miscarriage, stillbirth, preterm delivery and pre-eclampsia. The disease is characterized by the autoimmune production of antibodies against phospholipid, a substance found in the cell membrane. We here report the case of a patient with four second trimester miscarriages, who apart from a heterozygous plasminogen activator-inhibitor-1 mutation, had no risk factors explaining her condition. In the subsequent pregnancy she was therefore put on low-molecular-weight heparin, aspirin and granulocyte colony-stimulating factor. Antiphospholipid antibodies (APL), which had been negative before gestation, increased and remained high throughout pregnancy, thus suggesting a pregnancy-induced or -aggravated APS. The patient was kept on the above-mentioned medication and delivered a healthy male baby by Caesarean section after an otherwise uneventful pregnancy. Thus, in order to diagnose and treat pregnancy-triggered APS in patients with unexplained recurrent miscarriage, screening for APL should also be performed at several time points after conception.
authors.affiliation: Department of OB/GYN, University of Wuerzburg, Wuerzburg, Germany. arnd_hoenig@hotmail.com
authors.forename: Arnd
authors.initials: A
authors.lastname: Honig
authors.forename: Joerg B
authors.initials: JB
authors.lastname: Engel
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Segerer
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
authors.forename: Sebastian
authors.initials: S
authors.lastname: Häusler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Würfel
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000032:analysis / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy / Q000209:etiology*; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*
chemical_list: D017152:Antibodies, Antiphospholipid; D006495:Heparin, Low-Molecular-Weight; D016179:Granulocyte Colony-Stimulating Factor; D001241:Aspirin