Maternal and neonatal outcome in women with Antiphospholipid Syndrome and Systemic Lupus erythematodes (original) (raw)

2014, Gynaecologia Et Perinatologia

Despite the advances in obstetric and neonatal management, antiphospholipid syndrome (APS) and systemic lupus erythematodes (SLE) remain associated with significant maternal and fetal morbidity and mortality. The aim of this study was to analyse the maternal and fetal outcome in women with APS and SLE according to management. Additionally pregnancies with primary APS (group 1), APS and SLE (group 2) and isolated SLE (group 3) were compared. Overall, 42 pregnancies were included (15 in group 1; 12 in group 2; 15 in group 3). All women with APS and SLE were treated with low-molecular-weight heparin (LMWH) and low-dose-aspirin (LDA). Three women were treated with plasmapheresis. Overall, there were 13 cases of adverse obstetric outcome, consisting of catastrophic antiphospholipid syndrome (n=4 women in group 1), preeclampsia (n=2 women in group 1), HELLP-syndrome (n=1 woman in group 2), and isolated intrauterine growth restriction (n=3 women in group 2 and 3, respectively). The incidence of premature births was similar in all groups. Overall, there were 5 cases of impaired neonatal outcome (n=4 children in group 1 and n=1 child in group 2). The results show that women with primary APS are at highest risk to have an adverse obstetric outcome in later pregnancy, even when treated with LMWH and LDA. The use of alternative therapy, including plasmapheresis or a targeted complement inhibition with eculizumab seems to be an efficient approach in cases of refractory obstetric APS. It might be used for treatment of severe complications, as well as for prolongation of pregnancy.

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