Diagnosis and management of obstetrical antiphospholipid syndrome: where do we stand?

Abstract

Obstetrical antiphospholipid syndrome (APS) is defined by obstetrical complications and the presence of antiphospholipid antibodies (aPL). Although the incidence of APS is still poorly known, this thrombophilia is now recognized as one of the most common acquired causes of recurrent fetal loss. The diagnosis of APS during pregnancy can be challenging because of its various clinical features. Mothers with APS have an increased risk of thrombosis, thrombopenia, and specific pregnancy‑related complications such as preeclampsia, eclampsia, and hemolysis elevated liver enzyme and low‑platelet syndrome. aPL can also lead to recurrent, early miscarriages, stillbirths, and to intrauterine growth restriction. Clinicians should be aware of all these characteristics and a thorough differential diagnosis should be performed. Testing for aPL also requires skill due to the difficulty of standardization and interpretation of tests. To know when testing should be performed and when to repeat tests are still a matter of debate. While general management and first‑line treatment of APS during pregnancy now have clear guidelines, second‑line treatment is still required in 30% of the cases and new strategies are currently in development. In this review, we describe the clinical and biological aspects of obstetrical APS and its current management options. As APS pregnancies can be a real challenge for clinicians, we underline the necessity of multidisciplinary counselling and close follow‑up.