Catastrophic antiphospholipid syndrome during pregnancy: a case report and literature review

Abstract

Objective To summarize the diagnosis, management and prognosis of catastrophic antiphospholipid syndrome (CAPS) in pregnant and postpartum women through a case report and literature review. Methods The reported case was a gravida who had a history of antiphospholipid syndrome and was admitted to the Peking University First Hospital in July 2017 due to CAPS in the second trimester. She was fully recovered and discharged after effective management. Clinical data was collected and analyzed. Relevant literatures regarding the diagnosis, treatment and prognosis of pregnancy-related CAPS were reviewed. Results (1) Case report: The patient had taken warfarin after the diagnosis of antiphospholipid syndrome but stopped the medication six months before conception. She was admitted at 22 weeks of gestation due to severe upper abdominal pain accompanied by nausea and vomiting and diagnosed with CAPS based on severe low platelet count and remarkably elevated liver enzymes. After a series of treatment, including anticoagulation, glucocorticoid, plasma exchange and cesarean section, the patient became stable and was fully recovered. (2) Literature review: After searching all published literatures, 13 relevant literatures which including 35 patients were finally reviewed. It is found that CAPS was a rare and life-threatening condition with rapid progression and the mortality rate was 6/14 during gestation and 9% (2/21) after delivery. Anticoagulation, glucocorticoid, plasma exchange and immunoglobulin were the first-line treatment. Termination of pregnancy was required once CAPS was diagnosed. Conclusions CAPS is a rare but life-threatening disease. Early diagnosis and timely termination of pregnancy are crucial for gravidas with CAPS. Key words: Pregnancy complications; Antiphospholipid syndrome; Abortion, induced