Antiphospholipid Syndrome in Pregnancy | VSacharMD

VIKAS SACHAR

Posted on October 01 2017

 

Antiphospholipid Syndrome (APS) has been associated with a variety of medical problems in pregnancy; blood clots in arteries and veins (deep vein thrombosis), low platelets and bothearly (<12wks) and later fetal loss. This syndrome occurs secondary to the presence of maternal antiphospholipid antibodies:B2 glycoprotein1, Lupus anticoagulant, and anticardiolipin. There are blood tests that can check for the presence of the sematernal antibodies. Obstetric complications that have been associated with antiphospholipid antibodies include: preeclampsia (<34wks), intrauterine growth restriction, placental insufficiency, and preterm delivery.

Some patients have all three antibodies, some only have one. The diagnosis requires 2 positive tests at least 12 weeks apart (because sometimes the presence of these antibodies is transient).

The most common medical complication with APS is a blood clot and the most likely location is in the leg (calf). Recurrent pregnancy loss <10wks is also associated with APS.

Who​​ should​​ be​ ​tested​ ​for ​​APS?

  1. ​​​Women ​​with ​​any ​​history ​​of ​​a ​​blood​​ clot.
  2. ​​​Women​​ with ​​a ​​history ​​of ​​>3 ​​miscarriages ​​less ​​than ​​10​​ weeks, ​​consecutively ​​(not sporadic),​​ after​​ maternal​ ​hormonal​​ abnormalities, ​​​maternal ​​anatomical abnormalities, ​​and ​​abnormal ​​parental ​​chromosomes ​​were​ ​ruled​ ​out.
  3. ​​​Women​​ with ​​a​ ​history ​​of ​​a ​​fetal ​​loss​ ​after ​​10 ​​weeks ​​gestational ​​age.
  4. ​​​Women​​ with ​​a ​​history ​​of ​​preterm​ ​delivery​ ​<34​​ weeks ​​secondary ​​to​ ​severe preeclampsia ​​or ​​eclampsia,​​ or​​ placental ​​insufficiency.

 

How it Affects You

Pregnant women with APS are at risk for blood clots. Usually the blood clot occurs in the deep veins of the calf. This can present a painful swollen leg. If this occurs, there is a risk that the clot could spread to the lungs where it becomes a pulmonary embolus and is associated with maternal death. The purpose of the treatment of APS is to prevent clot formation.

How it Affects the Baby

Smaller clots occur in the placenta, and are associated with preeclampsia, growth restriction, and subsequent preterm delivery.

Treatment

Women with APS should be treated with both low-dose Aspirin and subcutaneous heparin injections. Third trimester fetal monitoring is recommended; discuss the timing of this with your physician. Treatment should continue through pregnancy and continue until 6weeks post-partum. Because women with APS are at a life long risk for thrombotic events and stroke, they should consult with their physician or a specialist regarding need for treatment after pregnancy.

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