Obstetric APS

Abstract

Antiphospholipid syndrome (APS) was first described in patients with obstetric morbidity. In the frame of APS, several obstetrical problems have been identified: recurrent pregnancy loss, fetal death, preterm delivery, intrauterine growth restriction, early severe preeclampsia, and even HELLP syndrome. Nevertheless the association between pregnancy loss or complications and aPL antibodies has been differently reported in various studies because of the diverse inclusion criteria and the lack of standardization in the antibody detection methods. Another matter of controversies is the lack of uniform definitions for pregnancy loss that in many cases is outdated and not reflective of modern understanding of reproductive biology. Antiphospholipid antibody profile has also been investigated as possible risk factor for pregnancy loss recurrence: patients with triple antiphospholipid positivity seem to carry a higher risk for recurrency even in treated pregnancies. In contrast with what describe in thrombotic APS, low titer aPL (aCL and anti-β2GPI) and the presence of other “non-criteria” aPL (aPE, aPT, aPT/PS, anti-annexin 5) could be of significance in obstetric APS being associated with poor obstetric outcome. To achieve a successful outcome in APS pregnancy, an adequate pregnancy management is required and includes not only a proper treatment but also a coordinated medical–obstetrical care, a close follow-up protocol, and a good neonatal intensive care unit.