Update on the management of the pregnant patient with antiphospholipid antibody

Abstract

Management of the pregnant patient with antiphospholipid antibody (aPL) is reviewed, with emphasis on recent randomized controlled clinical trials. These support the use of subcutaneous heparin and low dose aspirin, current standard therapy for women with aPL and a history of fetal loss. Prednisone is rarely used due to high risk of maternal and fetal morbidity. Intravenous immunoglobulin may represent an important additional therapy for women who fail aspirin and heparin. Patients with a history of thrombosis require full, therapeutic anticoagulation during pregnancy. Recommendations are less clear for newly described antibodies to phospholipid-binding protein, for low titer antibodies, and for infertility treatment in the setting of aPL.

Primary Antiphospholipid Syndrome Presenting as HELLP Syndrome

“…The rate of pregnancy loss in untreated APS is 80–90% [11, 12]. Approximately 10–15% of healthy women with recurrent pregnancy losses have aPL [13], therefore establishing that the correct cause of pregnancy morbidity is important to optimize management. Other etiologies of early pregnancy loss should be first excluded, even in the presence aPL because embryonic pregnancy losses are common in the general population.…”