Anaesthetic Considerations of Anti-Phospholipid Antibody Syndrome in Pregnancy

Abstract

Anti-phospholipid syndrome (APS) is a systemic autoimmune acquired disease characterised by vascular thrombosis or pregnancy complications with the presence of antiphospholipid antibodies. It is a rare disease affecting 40-50/100,000 population and 10%-15% of recurrent abortions. Perioperative management in obstetric APS undergoing caesarean section stresses on the management of anticoagulation and prior choice of anaesthetic technique. We report the case of 26 year old multigravida ,37 weeks of gestation diagnosed with APS since 8 weeks of gestation. She had previous three miscarriages with lupus anticoagulant(LAC) value of 45.6 (normal – 36.8), IgM and IgG anticardiolipin antibody values were 8.5µ/ml and 3.8µ/ml, respectively. She was prophylactically put on Aspirin 75mg orally and Enoxaparin 0.4IU subcutaneously every 24 hours. She presented to the obstetric department and was planned for emergency caesarean section . She received her usual dose of enoxaparin on the day of surgery but aspirin was omitted. Surgery was conducted under subarachnoid blockade. Anticoagulation resumed 12 hours after surgery .No maternal and fetal complications were noted