Antiphospholipid Syndrome And Pregnancy PdfBy Alarico O. In and pdf 25.01.2021 at 21:26 5 min read
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Guidelines for the treatment of antiphospholipid syndrome. Levy VIII. The antiphospholipid syndrome APS is a systemic autoimmune disease characterized by arterial and venous thrombosis, gestational morbidity and presence of elevated and persistently positive serum titers of antiphospholipid antibodies.
Antiphospholipid syndrome is associated with various conditions, including arterial and venous thromboses, autoimmune thrombocytopenia, fetal loss, preeclampsia, intrauterine growth restriction, placental insufficiency, and preterm delivery. Diagnosis of antiphospholipid syndrome is based on a combination of clinical history and laboratory testing. Initial diagnosis requires testing for lupus anticoagulant and anticardiolipin antibodies; patients should be diagnosed if lupus anticoagulant is present or if medium to high levels i. Positive test results must be confirmed by a second test after several weeks. Testing for antiphospholipid antibodies should be limited to women with appropriate medical or obstetric histories.
The Management of Antiphospholipid Syndrome in Pregnancy
Hughes Syndrome pp Cite as. Antiphospholipid syndrome APS predominantly affects young women and there has been a growing awareness of this condition amongst obstetricians and gynecologists over the last decade. In this chapter we discuss the association between APS and recurrent pregnancy loss, and present some of the dilemmas in the management of on-going pregnancies in women with APS. Knowledge of the pathogenesis of adverse pregnancy outcome in APS is incomplete and some of the numerous hypotheses and areas of research in this rapidly evolving field are outlined. Unable to display preview. Download preview PDF. Skip to main content.
Read terms. Diagnosis requires that at least one clinical and one laboratory criterion are met. Antiphospholipid antibodies are a diverse group of antibodies with specificity for binding to negatively charged phospholipids on cell surfaces. Despite the prevalence and clinical significance of APS, there is controversy about the indications for and types of antiphospholipid tests that should be performed in order to diagnose the condition. Much of the debate results from a lack of well-designed and controlled studies on the diagnosis and management of APS. The purpose of this document is to evaluate the data for diagnosis and treatment of APS. ACOG Clinical is designed for easy and convenient access to the latest clinical guidance for patient care.
Marchetti, M. Cohen, P. Antiphospholipid syndrome APS is an acquired thrombophilia with clinical manifestations associated with the presence of antiphospholipid antibodies aPL in patient plasma. Obstetrical APS is a complex entity that may affect both mother and fetus throughout the entire pregnancy with high morbidity. Clinical complications are as various as recurrent fetal losses, stillbirth, intrauterine growth restriction IUGR , and preeclampsia. Pathogenesis of aPL targets trophoblastic cells directly, mainly via proapoptotic, proinflammatory mechanisms, and uncontrolled immunomodulatory responses.
PDF version. ABSTRACT : This retrospective review of hospital records analysed pregnancy outcome with 2 different treatments for women with recurrent miscarriage diagnosed with antiphospholipid syndrome in the index pregnancy. Of 64 women, 29 had received aspirin and 35 aspirin plus heparin. Pregnancy-induced hypertension, prematurity, intrauterine growth restriction and neonatal death were considered as maternal and fetal complications. There were no significant differences in antenatal and maternal complications between the groups.
Antiphospholipid antibody syndrome commonly called antiphospholipid syndrome or APS is an autoimmune disease present mostly in young women. Those with APS make abnormal proteins called antiphospholipid autoantibodies in the blood. This causes blood to flow improperly and can lead to dangerous clotting in arteries and veins, problems for a developing fetus and pregnancy miscarriage.
Blood ; 3 : — Among women with pure obstetric APS, late pregnancy complications are more frequent in cases of prior fetal loss. Late pregnancy complications are more frequent among women treated for pure obstetric APS than among nontreated controls. The incidence of pregnancy outcomes for women with the purely obstetric form of antiphospholipid syndrome APS treated with prophylactic low-molecular-weight heparin LMWH plus low-dose aspirin LDA has not been documented. We observed women without a history of thrombosis who had experienced 3 consecutive spontaneous abortions before the 10th week of gestation or 1 fetal loss at or beyond the 10th week. Among APS women, prior fetal loss was a risk factor for fetal loss, preeclampsia PE , premature birth, and the occurrence of any placenta-mediated complication.
Professional Reference articles are designed for health professionals to use. You may find the Antiphospholipid Syndrome Hughes' Syndrome article more useful, or one of our other health articles. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Antiphospholipid syndrome APS is an autoimmune disorder characterised by arterial and venous thrombosis, adverse pregnancy outcomes for mother and fetus , and raised levels of antiphospholipid aPL antibodies [ 1 ]. The aPL antibody syndrome is present if at least one of the clinical criteria and one of the laboratory criteria are present [ 2 , 3 ].
Purely obstetric APS oAPS is an APS clinical presentation characterized by precisely defined morbidities occurring during pregnancy in women with no history of thrombosis. This causes aberrant placental angiogenesis and vasculogenesis. This study focuses on a subgroup of patients included in the NOH-APS cohort: those with an oAPS diagnosis who were treated for a new pregnancy during the 18 months individual observational period after diagnosis. The time window for recruitment was January 1 to January 1 Clinical follow up started on July 1 and ended on September 1 None of the observed treated pregnant oAPS women was lost to follow up.
What is antiphospholipid syndrome (APS)?
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If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. The antiphospholipid syndrome APS is characterized by the presence of specific autoantibodies in association with certain clinical conditions, most notably arterial and venous thrombosis and adverse pregnancy outcomes. In addition to these clinical features, laboratory criteria include the identification of at least one of the following three antiphospholipid antibodies: 1 anticardiolipin antibodies, 2 anti-betaglycoprotein I antibodies, or 3 the lupus anticoagulant see Chapter The optimal treatment for APS in pregnancy is unclear but generally involves administration of a heparin compound unfractionated or LMWH in prophylactic amounts —10, units subcutaneously twice per day for the former and low-dose aspirin 81 mg.