Chapter 9 Obstetric Manifestations of the Antiphospholipid Syndrome

Abstract

Abstract The antiphospholipid syndrome (APS) in pregnancy is characterized by the presence of autoantibodies in association with recurrent early miscarriages, fetal losses, and severe complications such as preeclampsia, placental insufficiency, or fetal growth restriction. Early-onset severe preeclampsia is sometimes complicated by the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, which is now grouped with the microangiopathic APS. The pathogenesis of pregnancy failures is related to the thrombophilic effect of antiphospholipid antibodies (aPL) and their direct effect on the uteroplacental unit. Pregnancy morbidity needs to be carefully investigated because it is part of the formal classification criteria for APS. In this respect the recently introduced uterine artery Doppler, performed at 24 weeks of gestation, seems to be a useful screening test for preeclampsia and small-for-gestational-age infants and should be applied to all the pregnant patients with aPL.