gynecology and obstetrics
Autoimmune Disorders in Pregnancy
Antiphospholipid Syndrome in Pregnancy
 Antiphospholipid Syndrome (APS) (APS) is an autoimmune disorder that predisposes patients to thrombosis and, during pregnancy, increases risk of Small-for-Gestational-Age (SGA) Infant None Stillbirth None Hypertension in Pregnancy None Preeclampsia and Eclampsia None APS is caused by autoantibodies to certain phospholipid-binding proteins that would otherwise protect against excessive coagulation activation. Measurement of circulating antiphospholipid antibodies Clinical criteria Antiphospholipid syndrome is suspected in women with a history of any of the following: ≥ 3 unexplained embryonic losses (before 10 weeks gestation) or ≥ 1 unexplained fetal losses (after 10 weeks) Prior unexplained arterial or venous thromboembolism New arterial or venous thromboembolism during pregnancy Antiphospholipid syndrome is diagnosed by measuring levels of circulating antiphospholipid antibodies (anticardiolipin, beta-2 glycoprotein I, lupus anticoagulant) with positive results on ≥ 2 occasions 12 weeks apart. Diagnosis of antiphospholipid syndrome requires ≥ 1 clinical criterion in addition to ≥ 1 of the laboratory criteria above. Clinical criteria can be vascular (prior unexplained arterial or venous thromboembolism in any tissue) or pregnancy-related. Pregnancy-related criteria include the following ( Diagnosis reference ): ≥ 1 unexplained deaths of a morphologically normal (via ultrasonography or direct examination) fetus at ≥ 10 weeks gestation ≥ 1 premature births of a morphologically normal neonate at ≤ 34 weeks gestation because of eclampsia or severe preeclampsia or with features of placental insufficiency ≥ 3 unexplained consecutive spontaneous pregnancy losses at < 10 weeks gestation, with maternal anatomic and hormonal abnormalities and paternal and maternal chromosomal causes excluded 1.Miyakis S, Lockshin MD, Atsumi T, et al: International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).J Thromb Haemost4(2):295-306, 2006. doi:10.1111/j.1538-7836.2006.01753.x Prophylaxis with anticoagulants and low-doseaspirin Women with antiphospholipid syndrome are usually treated prophylactically with anticoagulants and with low-doseaspirinduring pregnancy and for 6 weeks postpartum. Patients should be monitored closely and referred to a maternal-fetal medicine specialist as needed. 