A successful pregnancy after 8 consecutive miscarriages of a young woman with antisynthetase syndrome

Abstract

Antisynthetase Syndrome is an autoimmune inflammatory condition which, due to its rarity, has not been well studied in pregnancy. The literature that does exist has shown affected patients are at significant risk of obstetric complications. We herein report the pregnancy of a 25-year-old gravida-9 para-0 woman who was referred to our regional obstetric unit at fifteen weeks gestation with her first ongoing pregnancy following eight previous first trimester losses. She had known Antisynthetase Syndrome with active disease at the time of conception. An ultrasound scan at 24+4 weeks gestation showed a fetus that was asymmetrically growth restricted with abnormal umbilical and middle cerebral artery dopplers. This triggered urgent transfer to a tertiary unit where she delivered a live baby male at 24+6 weeks gestation by classical caesarean section. The placenta showed evidence of maternal vascular malperfusion. Despite delivery at a periviable gestation her son is now four months of age. Reflecting on our own practice we present a management approach for future pregnancies with particular focus on fetal surveillance.