Antiphospholipid syndrome: laboratory concerns, fetal loss, and pregnancy management.

Abstract

Antiphospholipid antibodies are of interest to obstetrician-gynecologists because they are associated with fetal loss. We diagnosed our first patient with fetal loss associated with aPL in 1983. The same year, Lubbe et al reported that successful pregnancy could be achieved in women with aPL by treating the mother with corticosteroids and low-dose aspirin.’ By 1985 we had treated eight consecutive pregnancies complicated by aPL with the regimen proposed by Lubbe and others.2 In the meantime, a small international group of interested physicians and researchers was formed. Their third semi-annual meeting was held in Kingston, Jamaica in 1988; since then, the group has been known as the Kingston Antiphospholipid Study (KAPS) group. The seminal works of individuals in this group established the major clinical features (including pregnancy loss) associated with aPL. Graham Hughes3 and Nigel Harris4 suggested that these features should form the basis of a new autoimmune condition, now known as the antiphospholipid syndrome (APS). Numerous studies, reviews, and case reports have served to emphasize the important association between aPL and certain complications of pregnancy. This review focuses on the laboratory and clinical features of APS pertinent to the practicing obstetrician/ gynecologist. Areas of controversy will be emphasized.