title: Management of women with recurrent pregnancy losses and antiphospholipid antibody syndrome.
abstract: Antiphospholipid antibodies (aPL) have been associated with recurrent pregnancy losses (RPL) and other obstetrical complications. The diagnostic criteria for the classical antiphospholipid antibody syndrome (APS) have been utilized for the detection of obstetrical APS in women with RPL. However, laboratory findings and immunopathology of obstetrical APS are significantly different from those of classical APS. In addition, many women with RPL who have positive aPL do not have symptoms consistent with the current APS criteria. The induction of a proinflammatory immune response from trophoblasts and complement activation by aPL rather than thromboembolic changes has been reported as a major immunopathological feature of obstetrical APS. Heparin treatment has been reported to be effective in prevention of early pregnancy loss with APS but not for the late pregnancy loss or complications. The complex effects of heparin may explain the limited efficacy of heparin treatment in RPL. New diagnostic criteria for obstetrical APS are needed urgently, and new therapeutic approaches should be explored further.
authors.affiliation: Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL 60061, USA. joanne.kwakkim@rosalindfranklin.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: Kwak-Kim
authors.forename: Maria Socorro L
authors.initials: MS
authors.lastname: Agcaoili
authors.forename: Lara
authors.initials: L
authors.lastname: Aleta
authors.forename: Aihua
authors.initials: A
authors.lastname: Liao
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ota
authors.forename: Svetlana
authors.initials: S
authors.lastname: Dambaeva
authors.forename: Kenneth
authors.initials: K
authors.lastname: Beaman
authors.forename: Joon Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Alice
authors.initials: A
authors.lastname: Gilman-Sachs
mesh_terms: D000026:Abortion, Habitual / Q000097:blood / Q000276:immunology* / Q000517:prevention & control; D000818:Animals; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D015415:Biomarkers; D005343:Fibrinolytic Agents; D018836:Inflammation Mediators; D006493:Heparin; D001241:Aspirin