This protocol addresses the management of antiphospholipid syndrome in women who experienced a prior delivery before 34 weeks of gestation due to eclampsia, severe pre-eclampsia, or recognised features of placental insufficiency, and who have no history of thrombotic events.
Obstetric antiphospholipid syndrome presenting with severe placenta-mediated complications — including eclampsia, severe pre-eclampsia, or placental insufficiency leading to very preterm delivery — defines a distinct and clinically significant risk group. The individual's overall risk profile informs the selection and intensity of treatment in subsequent pregnancies.
Management in this scenario may involve modification of the anticoagulant regimen and, in selected cases, the addition of an adjunctive agent. The full structured protocol specifies the options, their sequencing, and the clinical conditions under which each applies.
DOI: 10.1136/annrheumdis-2019-215213
With a history of delivery <34 weeks of gestation due to eclampsia or severe pre-eclampsia or due to recognised features of placental insufficiency, treatment with LDA or LDA and heparin at prophylactic dosage is recommended considering the individual’s risk profile.
In women with ‘criteria’ obstetric APS with recurrent pregnancy complications despite combination treatment with LDA and heparin at prophylactic dosage, increasing heparin dose to therapeutic dose or addition of HCQ or low-dose prednisolone in the first trimester may be considered.
Use of intravenous immunoglobulin might be considered in highly selected cases.
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