Antiphospholipid Syndrome in Pregnancy V Sachar MD What is it?

Antiphospholipid Syndrome (APS) has been associated with a variety of medical

problems in pregnancy; blood clots in arteries and veins (deep vein thrombosis), low

platelets and both

early (<12wks) and

later fetal loss. This

syndrome occurs

secondary to the

presence of

maternal

antiphospholipid

antibodies: B2

glycoprotein 1,

Lupus anticoagulant,

and anticardiolipin.

There are blood

tests that can check

for the presence of these maternal antibodies. Obstetric complications that have

been associated with antiphospholipid antibodies include: preeclampsia (<34 wks),

intrauterine growth restriction, placental insufficiency, and preterm delivery. Some

patients have all three antibodies, some only have one. The diagnosis requires 2

positive tests at least 12 weeks apart (because sometimes the presence of these

antibodies is transient).

The most common medical complication with APS is a blood clot and the most likely

location is in the leg (calf). Recurrent pregnancy loss <10 wks is also associated

with APS.

Who should be tested for APS?

1. Women with any history of a

blood clot.

2. Women with a history of >3

miscarriages less than 10 wks,

consecutively (not sporadic),

after maternal hormonal

abnormalities, maternal

anatomical abnormalities, and

abnormal parental chromosomes

were ruled out.

3. Women with a history of a

fetal loss after 10 weeks

gestational age.

4. Women with a history of

preterm delivery <34 weeks

secondary to severe preeclampsia or eclampsia, or placental insufficiency.

How it Affects You

Pregnant women with APS are at risk for blood clots. Usually the blood clot occurs in

the deep veins of the calf. This can present as a painful swollen leg. If this occurs,

there is a risk that the clot could spread to the lungs where it becomes a pulmonary

embolus and is associated with maternal death. The purpose of the treatment of

APS is to prevent clot formation.

How it Affects the Baby

Smaller clots occur in the placenta, and are associated with preeclampsia, growth

restriction, and subsequent preterm delivery.

Treatment

Women with APS should be treated with both low-dose Aspirin and subcutaneous

heparin injections. Third trimester fetal monitoring is recommended; discuss the

timing of this with your physician. Treatment should continue through pregnancy and

continue until 6 weeks postpartum.

Because women with APS are at a lifelong risk for thrombotic events and stroke,

they should consult with their physician or a specialist regarding need for treatment

after pregnancy.

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