Antiphospholipid syndrome and pregnancy

To assess the maternal and perinatal outcome of patients with antiphospholipid syndrome in pregnancy. A descriptive and retrospective analysis of patients with antiphospholipid syndrome in pregnancy was made from January 2000 to June 2005. We analyzed 35 patients. Primary and secondary antiphospholipid syndrome occurred in 25 (71%) and 10 (29%) women, respectively. Nine cases were associated with systemic lupus erythematosus and one with scleroderma. Approximately, 48% of women had history of thrombosis, 23% recurrent pregnancy loss, and 15% early onset preeclampsia in previous pregnancies. Twenty-seven patients had positive anticardiolipin antibodies, 6 lupus anticoagulant, and 2 both of them. About 80% of the patients were delivered by cesarean section. There was one spontaneous embryo loss before seven weeks. Eleven (32%) patients had preeclampsia. There were no maternal deaths. All women began treatment since the first trimester of pregnancy. Twenty-three patients (66%) received heparin and low dose aspirin, 8 cases (22%) heparin, low dose aspirin and prednisone, for presenting systemic lupus erythematosus, and the remaining 4 cases (12%) were treated with prednisone and aspirin. Ninety four percent of the cases got a live newborn. There were two neonatal deaths secondary to extreme prematurity and associated with preeclampsia. There was one fetal death related to maternal lupus renal activity. Fifty-eight percent of the newborns were premature. Intrauterine growth restriction was present in 20% of the cases. Early treatment combined with close maternal-fetal surveillance was associated with a 90% chance of a live birth rate. However, prematurity, preeclampsia and intrauterine growth restriction were common.