ANTIPHOSPHOLIPID ANTIBODIES AND REPRODUCTIVE PROBLEMS: Foreword
By the late 1990s, I thought that the clinical and laboratory features of the antiphospholipid syndrome were clearly delineated and that the pathophysiologic mechanism of fetal loss would soon be found. I also believed treatment of the mother during pregnancy to improve fetal outcome was not only quite effective, but that ideal drug doses and standard protocols were just around corner. How foolish of me. To be sure, what Nigel Harris called the syndrome of the black swan in 1987 turned out to be a distinct and fascinating autoimmune syndrome now widely accepted as one of the few treatable causes of pregnancy loss. The issues that I thought would become crystal clear by the end of the millennium have instead been clouded by contrary scientific findings and legitimate controversies. The syndrome of the black swan is quite real, but much of its nature remains enigmatic.
In September 2000, the ninth International Symposium on Antiphospholipid Antibodies was held in Tours, France. The entire original cast was on hand, along with many newcomers. The topics featured in this edition of Clinical Obstetrics and Gynecology also featured prominently at the international meeting. By the end of the 4 days in Tours, one of the hottest topics was the still-problematic issue of testing for antiphospholipid antibodies. In this symposium, Silvia Pierangeli, PhD, who has years of experience in the field, provides us with her approach. Read her suggestions and have no doubt that changes in antiphospholipid assays are on the horizon. How do antiphospholipid antibodies cause pregnancy loss? Azzudin Gharavi, MD, a foremost investigator in the field and one of the most meticulous scientists I know, and his colleagues provide a complete overview. How should women with antiphospholipid syndrome and deep vein thrombosis be managed? Nitin Chandramouli, MD and George Rodgers, MD, PhD tender thoughtful answers for practicing physicians. What are the established as well as controversial obstetrical characteristics of antiphospholipid syndrome? William Geis, MD and I review the consensus and the controversies. How does one manage antiphospholipid syndrome during pregnancy? Sean Esplin, MD explains that management is not as straightforward as one may think. Finally, are antiphospholipid antibodies really associated with infertility? Flint Porter, MD dissects the literature and uncovers the facts and fallacies in this controversial area.
I thank the authors for their time and expertise in the preparation of the reviews included in this symposium. I hope the readers enjoy the symposium as much as I enjoy the friendship and collegiality of the experts involved in its creation.