The importance of detecting impaired uteroplacental circulation for the diagnosis of an antiphospholipid-antibody syndrome - a case report

Introduction: The antiphospholipid antibody syndrome (APA) is a potentially life-threatening disease in pregnancy. associated with spontaneous abortio n, intrauterine growth retardation (IUGR), preeclampsia and foetal death in utero. One of the sequelae of the antiphospholipid-antibodies is an impair ed utero-placental circulation. We present a case where we diagnosed an ant iphospholipid antibody syndrome (APA) on the basis of a highly pathological Doppler Row in both uterine arteries. Case report: A 35-year-old G2P0 with a history of intrauterine foetal death in the 24th week was seen at 15 weeks in her second pregnancy for an ultra sound scan. The Doppler study of both uterine arteries showed highly pathol ogical resistance indices and bilateral notching. Laboratory studies reveal ed elevated levels of antibodies against Cardiolipin and phospholipids. The rapy trials with low-dose aspirin, heparin, corticosteroids, hemodilution t herapy and immunoglobulin remained unsuccessful. The foetus developed sever e IUGR, anhydramnios and foetal distress. In the 26th week the parents insi sted on a caesarean section because of a pathological heart rate pattern. T he birth weight was 365 grams and the infant died immediately. Discussion: There are several mechanisms which impair the uteroplacental ci rculation in an APA syndrome. Therefore it is essential to perform laborato ry tests when detecting a pathological blood flow in both uterine arteries. In this case all therapies failed, and the preterm infant died due to seve re IUGR and distress. The diagnosis, however, facilitated the introduction of early anticoagulation therapy for the mother, the exclusion of systemic lupus erythematodes and the counselling of the parents with regard to furth er pregnancies.