Publication:

To study the association of antiphospholipid syndrome in patients with bad obstetric history

Background Antiphospholipid syndrome is an autoimmune condition characterized by vascular thrombosis and /or pregnancy morbidity in the presence of antiphospholipid antibodies. A failure or significant delay in recognizing APS as the underlying disease entity may leave to the loss of an opportunity to prevent serious consequences of the disease and the associated pregnancy complications. Aim of the study was to study the association of Antiphospholipid Syndrome (APS) in patients with bad obstetric history (BOH).

Methods Patients registered in Obstetrics and Gynecology Department SAT Hospital, Medical College, Trivandrum, Kerala with bad obstetric history (BOH) meeting the inclusion and exclusion criteria were recruited for the study. They were followed up in the postnatal ward after abortion and preterm delivery as per protocol for bad obstetrics outcome evaluation. They were offered lab test in standard labs for APL Syndrome especially LAC and anti-cardiolipin antibodies IgM and IgG. Those tested positive were retested 12 weeks later also to confirm the test. Then the various adverse pregnancy outcomes were studied in both APLA positive and negative groups.

Results The association of APLA with bad obstetric history (BOH) in the present study are as follows- Late miscarriages-16%, miscarriages less than 10 weeks-12%, Preterm- 10.8%, unexplained death-14%, Severe Pre-eclampsia-12.3%, IUGR-11.8%, Abruption-11.1% of which late miscarriages more than10 weeks was the commonest association.

Conclusions The study shows that women with bad obstetric history (BOH) and those cases where miscarriage occurred after the appearance of foetal cardiac activity should be investigated for APLA in the preconceptional period itself in the next pregnancy earlier and if positive should be given prophylaxis for the same to prevent a miscarriage in future pregnancy.