Obstetrical

Antiphospolipid Syndrome
Hello!
APS is an autoimmune thrombophilic
disease characterized by occurrence
of vascular events and/or pregnancy
complications, in association with
persistenly positive antiphospholipid
antibodies.
 Antiphospholipid
antibodies

Lupus anticoagulant Anticardiolipin Anti b2GP1

(LA) antibodies (aCL)

Are antibodies againt They are antibodies Seems the main antigen
substances in the that form in for APL, are now
lining of cells. These response to considered amongst
subtances prevent cardiolipins, the the principal
blood clotting. They levels of these antibodies of the
are called antibodies are often syndrome
phospholipid. high on people with
abnormal blood
clotting
The most common LA tests are aPTT and the
dilute Russell viper venom time (dRVVT)

A positive result occurs when: 1) coagulation is

prolonged instead; 2) adding normal serum fails
to correct this;
22 Cervera R, Piette JC, Font J, et al. Antiphospholipid
syndrome: clini cal and immunologic manifestations and
patterns of disease expression in a cohort of 1,000 patients.
Arthritis Rheum. 2002; 46: 10191027
When to test antiphospholipid antibodies in
obstetrics?

APS patient when planning to get pregnant

pregnant patient with systemic lupus
erythematous other autoimmune diseases
patient with a history of:
23 fetal losses <10 WG not due to causes
described in
stillbirth
prematurity <34 WG, due to preeclampsia or
eclampsia or placental insufficiency
intrauterine growth restriction
abruptio placentae
EPIDEMIOLOGY

Women are more commonly affected by APS than men, in

primary ratio (3,5:1) as well as in secondary APS (7:1)

aPL is commonly found in 15% of women with recurrent

pregnancy losses, suggesting that APS in one of the most
frequent acquired etiology for RPL
 Antiphospholipid
syndrome
Antibodies usually help defend the body against infections. In
APS, the body makes antibodies that mistakenly attack
phospholipid- a type of fat.
When antibodies attack phospholipid, cells are damaged. This
damaged cause blood clots to form in the bodys arteries and
veins.
In APS, too much blood clots can block blood flow and damage
the bodys organs.
 Pathogenesis

Pathogenesis of aPL in pregnancy include :

1. Thrombotic mechanisms,
2. Inflammation,
3. Apoptosis
4. Immunomodulatory molecules impairments in
trophoblast.
Mechanism of thrombosis
Obstetrical manifesatations of APS (on Mothers Side)

Recurrent thrombotic events (RTEs)

Thrombocytopenia
Livedo reticularis
Severe preeclampsia
On the fetuss side

Miscarriages
Stillbirth
IUGR (Intrauterine growth restriction )
Prematurity
On the infants side
These studies focused on the
effectiveness of therapy :

Low
Low dose
molecular
Low- dose - unfractioned
weight
aspirin heparin
heparin
(UFH)
(LMWH)
 Infections in APS patients should always be treated carefully
When surgery is needed, APS patients should receive parenteral anticoagulation
During pospartum, women should continue anticoagulant for 6 weeks
Thank You