An association is described between women with lupus anticoagulant and abnormal prenatal serum screening results. Three cases of positive second-trimester serum screening for Down syndrome, with karyotypically normal fetuses, in women demonstrated to have lupus anticoagulant are presented. Serum screening positivity was principally due to a disproportionately elevated maternal serum human chorionic gonadotrophin (hCG) level. In each case, early, severe intrauterine growth restriction was documented, with only one fetus surviving the neonatal period. As maternal lupus anticoagulant may have a profoundly adverse effect on the course of pregnancy, we suggest that an elevated hCG level on prenatal screening prompt consideration of maternal lupus anticoagulant testing if ultrasonography demonstrates an otherwise normal singleton gestation and the fetal karyotype is normal.
EDITORIAL COMMENT: We accepted thispaper forpublication to encourage all our readers who practise obstetrics to examine the situation which obtains in the hospitals where they pmctise obstetrics to see if emergency Caesarean sections are performed within a reasonable time of the decision to deliver abdominally being made. Lance Townsend's favourite dictum that 'clinical scrutiny improves performance without the need for witch hunt' is supported by the findings in this papeE It may be noted that in the author's hospital the theatre was incorporated within the labour ward which unfortunately is not the case in many institutions, even level 3 hospitals. It seems obvious that Caesarean section when ordered can be performed quicker when the patient does not need to be shifted very far especially to another floor where a journey in a lijt and the availability of a theatre orderly is a requirement. Availability of anaesthetic equipment and staff in conventional operating theatres is often a factor since it is claimed that an effective service cannot additionally be provided within the labour ward environment. These considerations should be considered in all hospitals where obstetrics is practiked. Having visited a number of obstetric units in Australia and abroad in small and large hospitals it is the observation of the Editor that ironically the smaller the hospital the more likely it is to be able toperform a Caesarean section within the labour ward or in an operating theatre close-by.
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