Antiphospholipid syndrome and recurrent miscarriages

Sixty percent of recurrent spontaneous abortions are unexplained. Antiphosp holipid syndrome is a multisystem disease with the predominant features of venous and arterial thrombosis. recurrent pregnancy loss, foetal death and the presence of antiphospholipid antibodies. Many epidemiological studies f ocus on antiphospholipid autoantibodies syndrome (APS) as a cause of recurr ent spontaneous abortion (RSA). It is found that 7-25% of RSA would have AP S as the main risk factor. 'Association not being synonymous with cause'. t he proportion of abortions due to the APS is difficult to estimate for seve ral reasons: definition of recurrent abortion is variable, the assays for a ntiphospholipid antibodies are not well standardised. inclusion of patients in the study group according to the antibodies titre is author dependant. Recent studies suggest association of antiphospholipid antibodies syndrome not only with recurrent abortions but also with infertility. New mechanisms are described by which antiphospholipid antibodies could cause placental t hrombosis and infarction, acting directly on the surface anticoagulant expr essed on trophoblastic cells. Only lupus anticoagulant (LA) and anticardiol ipin antibodies (aCL) assays are sufficiently standardised to be usable in routine. Testing Tur other antiphospholipid antibodies (aPLs) should remain investigational. Several treatments have been proposed: low doses of aspir in. low or immunosuppressive doses of corticosteroids. and preventive or ef fective dose of heparin, intravenous immunoglobulin. (C) 2001 Elsevier Scie nce Ireland Ltd. All rights reserved.