A STUDY OF 60 PREGNANCIES IN PATIENTS WITH THE ANTIPHOSPHOLIPID SYNDROME

Objective. To study the maternal and fetal outcome in treated antiphos pholipid syndrome (APS) pregnancies. Methods. Sixty pregnancies in 47 APS patients (11 primary and 36 secondary) were followed in a multidis ciplinary clinic. Patients testing antiphospholipid antibody positive and having a history of recurrent miscarriages were treated with low-d ose aspirin (75 mg) daily. Patients with APS and a previous history of thrombotic events were treated with subcutaneous unfractionated or lo w molecular weight heparin and low-dose aspirin (75 mg) daily. Results . The live birth rate increased from 19% of their previous non-treated pregnancies to 70% despite a high incidence of obstetric and fetal co mplications: pre-eclampsia (18%), prematurity (43%), fetal distress (5 0%) and intra-uterine growth retardation (31%). Two predictors of feta l outcome were observed: the previous obstetric history and the presen ce of thrombocytopenia. Seven pregnancies (12%) were complicated by th rombotic events during pregnancy or during the puerperium. There were no thrombotic events in those receiving a low molecular weight heparin regimen. Conclusion. Close obstetric monitoring by a multidisciplinar y team and the use of antithrombotic therapy was effective in reducing the fetal wastage in ASP pregnancies despite a high incidence of obst etric and fetal complications.