title: Pregnancy outcomes of antiphospholipid syndrome: In a low resource South Asian setting.
abstract: OBJECTIVE
  Antiphospholipid syndrome is associated with recurrent pregnancy loss, and specific treatment improves pregnancy outcome. Laboratory diagnosis is limited in South Asia. We assessed management outcomes of definite/probable antiphospholipid syndrome treated at a tertiary centre in Sri Lanka.
  
  
  METHODS
  Descriptive cross-sectional study of pregnancy outcomes with heparin and aspirin therapy.
  
  
  METHODS
  miscarriage, intrauterine death and live birth when compared to previous untreated pregnancies.
  
  
  RESULTS
  Of 646 gestations in 145 women, 146 (22.6%) received specific treatment. In the preceding pregnancies without specific treatment, the rates of miscarriage, late fetal loss, stillbirth and live birth were 60%, 26%, 8% and 7%, respectively. Following specific treatment with low-dose aspirin ± low-molecular weight heparin in 146 pregnancies (145 women), the rates of miscarriage, late fetal loss, stillbirth and live birth were 14%, 10%, 3% and 74%, respectively. Mean birth weight was 2.54 ± 0.62 kg, preterm births complicated 32 (29.6%) with a mean gestational age at delivery 33.7 ± 2.6 weeks, with three neonatal deaths. Maternal complications were: pre-eclampsia 16 (10.9%), gestational diabetes 28 (19.2%), antepartum haemorrhage in 1 patient. Only 73/145 (50.3%) women had laboratory confirmation of antiphospholipid syndrome, while others were treated empirically. Live births in diagnosed vs. empiric treatment - 80.8% vs. 67.1%.
  
  
  CONCLUSIONS
  Pregnant women with clinical antiphospholipid syndrome when treated with low-dose aspirin and heparin, the live birth rate of 7% in the previous pregnancy resulted in live births of 74% in a resource limited South Asian setting.
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors: C N
authors: CN
authors: Wijeyaratne
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors: Sla
authors: S
authors: Galappaththi
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors: E
authors: E
authors: Palipane
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors: Dbia
authors: D
authors: Jayawardane
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors: S H
authors: SH
authors: Dodampahala
authors: Department of Haematology, National Hospital of Sri Lanka, Sri Lanka.
authors: M N
authors: MN
authors: Tudawe
authors: Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors: L V
authors: LV
authors: Gooneratne
authors: Department of Immunology, Medical Research Institute, Colombo, Sri Lanka.
authors: R
authors: R
authors: de Silva
authors: Department of Immunology, Medical Research Institute, Colombo, Sri Lanka.
authors: D
authors: D
authors: Ratnayake
authors: Royal Free Hospital and University College London, Centre for Immunodeficiency, London, UK.
authors: S L
authors: SL
authors: Seneviratne
keywords: Heparin; Sri Lanka; low-dose aspirin; recurrent pregnancy loss