Treatment of Antiphospholipid Syndrome in Women with Recurrent Pregnancy Loss
This protocol covers the management of antiphospholipid syndrome (APS) in female patients with a history of three or more recurrent spontaneous miscarriages before the 10th week of gestation, or fetal loss at or after the 10th week of gestation, in the absence of any prior thrombotic events.
Clinical Scenario
This is the obstetric presentation of APS in women — recurrent pregnancy loss without accompanying thrombosis. The qualifying history includes three or more early spontaneous miscarriages (before 10 weeks of gestation) or one or more fetal losses at or beyond 10 weeks. No history of thrombotic events is present in this population.
Treatment Approach (Partial)
Management in this setting may involve adjustments to anticoagulant therapy or the addition of immunomodulatory agents, with particular attention to the first trimester of pregnancy.
The complete regimen — all options, clinical decision points, and sequencing — is available in the full protocol.
References
DOI: 10.1136/annrheumdis-2019-215213
- With a history of ≥3 recurrent spontaneous miscarriages <10th week of gestation and in those with a history of fetal loss (≥10th week of gestation), combination treatment with LDA and heparin at prophylactic dosage during pregnancy is recommended.
- 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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