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Description of the condition

Antiphospholipid antibody syndrome (APS) is an illness that involve the immune system, and

causes increased clotting of the blood. Normally antibodies, chemicals made by the immune

system, are helpful in fighting germs or viral infections from outside the body. However in APS,

the immune system maes antibodies that cause blood to clot abnormally. !his may cause

problems with the pregnancy.

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Diagnosis

!he diagnosis of APS is very difficult, and also controversial among doctors.

!here are " blood tests that are commonly used, and accepted by most physicians.

As many as #$ blood tests for antiphospholipids are available% however, there is little evidence that patients

who are positive by the &e'tra& blood tests are at increased ris for pregnancy problems.

!he problem is that of all pregnant women have positive blood tests. *ost of these women never have

problems with abnormal pregnancy outcomes and treating them would e'pose them to the side effects of

the treatment without benefit.

!herefore, diagnosis involves more than blood tests.

!here must be &clinical signs& medical problems that have already occurred in addition to the abnormal

blood tests.

!he clinical signs are a history of blood clots in a large vein or in an artery, three or more consecutive

miscarriages, low platelet count, anemia caused by blood being broen down in the blood stream, stroe,

and still birth.

!he levels of antibody can go up and down, and even disappear, so to definitely say someone has APS, the

blood tests need to repeated at least + wees from the first and still be positive. !he decision on treatment at

a particular time (such as pregnancy) depends upon the levels and what the previous medical problems

were.

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Disease Impact on Pregnancy

!he manifestations of APS are variable. *ost people will not have more than one of these problems.

ecurring miscarriage

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7/25/2019 Description of the Condition aps

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Preeclampsia

-nsufficient function of the placenta causing poor growth of the baby andor inability of the baby to tolerate

labor

/lood clot in an artery or large vein either during the pregnancy, or up to si' wees after the baby is born

Stillbirth

A very rare APS condition e'ists of a severe postpartum illness with fever and heart, lung and idney

failure and multiple blood clots.

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Pregnancy Impact on Disease

Patients with APS are more prone to blood clots during pregnancy and up to 0 wees after pregnancy. !heblood clots may migrate to the lungs which is a very serious and life threatening event.

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Special Prenatal/Birth/Neonatal Considerations

-deally, one should see medical advice before becoming pregnant. 1hen you get pregnant it is important

to be referred to your 2bstetrician as early as possible to decide on the need for treatment with aspirin or

heparin.

2nce pregnancy is achieved, fre3uent office visits will be needed to4

Screen for preeclampsia,

*onitor the fetus with either nonstress test or biophysical profile

5ltrasound e'aminations every "67 wees to chec the growth of the baby.

8or patients on heparin, e'tra blood tests may be needed to ad9ust the dose depending on the type of

heparin being used, and the past history of the patient.

Patients on low molecular weight heparin may not be able to have epidural or spinal anesthesia.

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Treatment of APS During Pregnancy

!reatment of APS during pregnancy involves low dose aspirin andor heparin

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# baby aspirin (+: mg)day is usually started as soon as pregnancy is diagnosed

Heparin in9ections are usually started at + wees. Not all patients with APS need heparin.

Heparin is a blood thinner. -t can only be given by in9ection. !he needle is very thin, and is put 9ust under

the sin. *ost patients can do this by themselves.

!he effects of heparin depend on the dose given

o -n &therapeutic doses& the blood does not clot, and women will bruise and bleed easily.

o -n &prophylactic doses&, the blood clots normally and there is 9ust bruising at the site of in9ection.

o !he dose used depends on the clinical problems from APS.

!here are types of heparin

o ;ow molecular weight heparin

-s given once or twice a day.

-t is almost #: times as e'pensive as regular heparin.

-t lasts longer than regular heparin so epidural anesthesia cannot be used unless 7 hours

has elapsed since the last in9ection.

o 5nfractionated or regular heparin

-t is given " times a day.

-t costs much less than low molecular weight heparin.

-t has a higher chance of causing low platelets as a side effect than does low molecular

weight heparin.

-f only &prophylactic& doses are used, there is no problem with epidural anesthesia.

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esources

/oos4 &1hen Pregnancy -sn?t Perfect A ;ayperson?s @uide to omplications in Pregnancy& /y ;aurie

A. ich.

Also &Pregnancy /edrest a @uide for the Pregnant 1oman and Her 8amily&, by Susan H. Bohnston,

*.S.1. C Deborah A. Eraut, *.-.;..

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Sidelines at +::6+F06"#$# or http4www.sidelines.org 6 for full listings of esources for High6is Parents