Antiphospholipid Syndrome

Antiphospholipid Syndrome (APS) is an autoimmune disorder that significantly impacts pregnancy outcomes. It is characterized by recurrent miscarriages, particularly in the first and second trimesters. Proper management and treatment can help in preventing future miscarriages in affected women.

Screening for Antiphospholipid Syndrome
Women who experience recurrent miscarriages (three or more in the first trimester or one or more in the second trimester) should be screened for antiphospholipid antibodies. The primary antibodies involved in APS include:

. Lupus anticoagulants
. Anti-cardiolipin antibodies
. Anti-β2 glycoprotein-1 antibodies

Pathophysiology
APS involves the immune system mistakenly attacking normal proteins in the blood, which leads to an increased risk of blood clots. These clots can obstruct blood flow to the placenta, leading to pregnancy complications and miscarriages.

Clinical Features

1. Recurrent Miscarriages: The hallmark of APS in pregnancy is recurrent miscarriages.
2. Blood Clots: Patients may experience deep vein thrombosis (DVT) or pulmonary embolism.
3. Other Symptoms: Thrombocytopenia and livedo reticularis are also common.

Diagnostic Criteria

Diagnosis is based on the presence of clinical and laboratory criteria:
i. Clinical Criteria: Vascular thrombosis and pregnancy morbidity (such as recurrent miscarriages).
ii. Laboratory Criteria: Presence of lupus anticoagulants, anti-cardiolipin antibodies, and anti-β2 glycoprotein-1 antibodies, confirmed on two or more occasions at least 12 weeks apart.

Management
The management of APS, particularly in pregnancy, involves a combination of medications aimed at reducing the risk of clot formation and improving pregnancy outcomes.

. Low-Dose Aspirin:
. Low Molecular Weight Heparin (LMWH):
. Combined Therapy: Aspirin + LMWH: This combination is more effective than either agent alone in preventing pregnancy loss in women with APS.

Treatment Plan

i. Preconception:

Start low-dose aspirin upon planning pregnancy or after confirmation of APS diagnosis.

ii. During Pregnancy
Continue low-dose aspirin.
Add LMWH upon confirmation of pregnancy.

iii. Postpartum:
Continue LMWH for 6 weeks postpartum to reduce the risk of thromboembolic events.

Monitoring
i. Regular Ultrasound: To monitor foetal growth and well-being.
ii. Blood Tests: To check for any signs of bleeding or clotting disorders.