Pregnancy by Antiphospholipid Antibody (APL) or Antiphospholipid Syndrome (APLS) 4.33/5 (3)

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Risk Pregnancy

Patients with APLS are followed up as "risk aversion" in gynecologist / obstetrician and hematologist (blood disorders) and / or rheumatoid arthritis (if also SLE, Sjögren's syndrome or other rheumatic disease) cooperate. When APL antibody is present without special disease, the need for action is considered individually.

  • About one in three with SLE has "secondary" APLS with associated risk factors
  • Lupus anticoagulant, cardiolipin antibody and beta-2 glycoprotein increase the risk of thrombosis and complications related to pregnancy
  • Those with high levels of antibodies, especially lupus anticoagulants or the presence of all three antibodies (triple positive) are most exposed
  • High levels of IgG antibodies are considered to be of greater importance than IgM levels and high levels are worse than low levels

Blood clot (thrombosis) risk

Risk of blood clot (Thromboembolism) is increased in pregnancy and in the weeks after birth. The pregnant woman may have blood clots (thromboembolisms) such as deep vein thrombosis (DVT), pulmonary embolism or stroke. The fetus may be affected by blood clots in the placenta (placenta) and thus increased risk of abortion or death.

  • In APLS (see above), drugs (anticoagulants) that reduce the risk of blood clots are given
  • Marevan must not used during pregnancy (increased risk of birth defects when used after week of pregnancy 6)
  • In pregnancy, acetylsalicylic acid (ASA, Albyl-E) is often used 75 mg / day (until pregnancy week 37) and Fragmin, Klexane or Heparin injections
  • Data suggest that Plaquenil (hydroxychlorokine) may also have some blood clotting protective effect (and may reduce the level of SSA / B antibody), also during pregnancy (reference: Sciascia S, 2015)
  • In all spontaneous abortions, other causes must also be considered and the department with special competence consulted. If "treatment-resistant" antiphospholipid syndrome is present, after careful consideration additional treatment with Prednisolone 10mg / day up to gestational age 14 may be considered. In special indications such as severe placental failure and preeclampsia, pravastatin 20mg / day and intravenous immunoglobulins (2g / kg per month) and / or plasma replacement (plasmapheresis) may be considered by a special department (Reference Uthman I, 2019)
  • Anticoagulants may limit the possibility of epidural anesthesia at birth
  • After birth, after 2-3 weeks, consider restarting Marevan (if used before pregnancy). NB INR levels can vary and create dosage problems shortly after birth. Alternatively, Fragmin or Klexane is used approximately 6 weeks after birth.

Miscarriages

Miscarriages. Studies have shown that recurrent abortions in 38-59% of patients occur among patients with combined SLE and APLS. For SLE without APL antibody, abortion risk is 16-20%. In recurrent abortions in the general population, 10-15% of women have APL antibodies.

Catasthrofic Antifosfolipid Syndrome (CAPS)

The condition is characterized by rapid development (within less than 1 week) and multiorgan infection.

  • CAPS can debut during pregnancy and is associated with an increased risk of death. In order to save the mother's life, it may be necessary in some cases to provide treatment even at the risk of damaging the fetus. Unusually high doses of Fragmin or Klexane, IVIG (intravenous immunoglobulins), corticosteroids and / or Plaquenil may be used. Some also provide plasma replacement (plasmapheresis).
  • Please read more about CAPS on the page here (Bindevevssykdommer.no)


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