PREGNANCY OUTCOME IN RELATION TO UTERINE ARTERY FLOW VELOCITY WAVE-FORMS AND CLINICAL CHARACTERISTICS IN WOMEN WITH ANTIPHOSPHOLIPID SYNDROME

Objective: To determine whether uterine artery velocimetry is a useful tool for identifying pregnancies with antiphospholipid syndrome at ri sk for adverse outcome. Methods: Twenty-four women with antiphospholip id syndrome, who had experienced 56 fetal losses in 63 previous pregna ncies (88.9%), were treated with prednisone (40 mg/day) and aspirin (1 00 mg/day) during 28 pregnancies. Color Doppler ultrasound was perform ed at 18-24 weeks' gestation to investigate the resistance index of th e uterine arteries. Results: Treated women delivered 23 live infants i n the 28 pregnancies (82.1%). Three infants weighed less than the tent h percentile (13%). Five pregnancies were complicated by preeclampsia and ten by nonproteinuric gestational hypertension. Positive results f or all three assays for antiphospholipid antibodies (anticardiolipin a ntibodies, lupus anticoagulant, VDRL) at conception identified pregnan cies destined to have poor fetal outcome and a significantly lower bir th weight compared to pregnancies not having all three assays positive . An abnormal resistance index of the uterine arteries predicted pregn ancies with poor fetal outcome in terms of week of delivery, birth wei ght, and birth percentile, as well as four of five cases of preeclamps ia. Conclusions: Three assays positive for antiphospholipid antibodies at conception and an abnormal resistance index of the uterine arterie s at 18-24 weeks' gestation predicted pregnancies at major risk for ob stetric complications. Future studies should determine whether treatme nt can be modulated based on the Doppler findings.