title: [Pregnancy and antiphospholipid syndrome].
abstract: Antiphospholipid syndrome (APS) is associated with a risk of obstetrical complications, affecting both the mother and the fetus. Obstetrical APS is defined by a history of three consecutive spontaneous miscarriages before 10 weeks of gestation (WG), an intra-uterine fetal death after 10 WG, or a premature birth before 34 WG because of severe pre-eclampsia, eclampsia or placental adverse outcomes (intrauterine growth retardation, oligohydramnios). Pregnancy in women with a diagnosis of obstetric APS is at increased risk for placental abruption, HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome and thrombosis that may be part of a catastrophic antiphospholipid syndrome (CAPS). A previous thrombosis and the presence of a lupus anticoagulant are risk factors for pregnancy failure. A multidisciplinary approach, associating the internist, the anesthesiologist and the obstetrician, is recommended for these high-risk pregnancies. Preconception counseling is proposed to identify pregnancy contraindications, and to define and adapt the treatment prior and during the upcoming pregnancy. Heparin and low-dose aspirin are the main treatments. The choice between therapeutic or prophylactic doses of heparin will depend on the patient's medical history. The anticoagulant therapeutic window for delivery should be as narrow as possible and adapted to maternal thrombotic risk. There is a persistent maternal risk in the postpartum period (thrombosis, HELLP syndrome, CAPS) justifying an antithrombotic coverage during this period. We suggest a monthly clinical and biological monitoring which can be more frequent towards the end of pregnancy. The persistence of notches at the Doppler-ultrasound evaluation seems to be the best predictor for a higher risk of placental vascular complications. Treatment optimization and multidisciplinary antenatal care improve the prognosis of pregnancies in women with obstetric APS, leading to a favorable outcome most of the time.
authors.affiliation: Service de médecine interne, centre de référence national pour le lupus systémique et le syndrome des antiphospholipides, hôpital Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie Paris 6, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. nathalie.costedoat@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
authors.forename: G
authors.initials: G
authors.lastname: Guettrot-Imbert
authors.forename: V
authors.initials: V
authors.lastname: Leguern
authors.forename: G
authors.initials: G
authors.lastname: Leroux
authors.forename: D
authors.initials: D
authors.lastname: Le Thi Huong
authors.forename: B
authors.initials: B
authors.lastname: Wechsler
authors.forename: N
authors.initials: N
authors.lastname: Morel
authors.forename: D
authors.initials: D
authors.lastname: Vauthier-Brouzes
authors.forename: M
authors.initials: M
authors.lastname: Dommergues
authors.forename: A
authors.initials: A
authors.lastname: Cornet
authors.forename: O
authors.initials: O
authors.lastname: Aumaître
authors.forename: O
authors.initials: O
authors.lastname: Pourrat
authors.forename: J-C
authors.initials: JC
authors.lastname: Piette
authors.forename: J
authors.initials: J
authors.lastname: Nizard
mesh_terms: D000022:Abortion, Spontaneous / Q000276:immunology; D000037:Abruptio Placentae / Q000276:immunology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004461:Eclampsia / Q000276:immunology; D005260:Female; D005313:Fetal Death / Q000276:immunology; D005317:Fetal Growth Retardation / Q000276:immunology; D005500:Follow-Up Studies; D017359:HELLP Syndrome / Q000276:immunology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016104:Oligohydramnios / Q000276:immunology; D011225:Pre-Eclampsia / Q000276:immunology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D047928:Premature Birth / Q000209:etiology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D006493:Heparin