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Antiphospholipid Syndrome: Obstetric Diagnosis, Management, and Controversies

Branch, D. Ware MD; Khamashta, Munther A. MD, PhD


Antiphospholipid syndrome, a condition characterized by one or more thrombotic or pregnancy-related clinical features in association with medium to high levels of antiphospholipid antibodies, has emerged as an important diagnostic consideration in several medical fields. Antiphospholipid syndrome is one of the few treatable causes of pregnancy loss, and successful pregnancy rates of 70% or more can be achieved with appropriate treatment. Heparin, usually combined with low-dose aspirin, is used in patients at risk for thrombosis. Pregnancy in these women is associated with increased rates of preeclampsia, placental insufficiency, and preterm delivery, so that attentive clinical care is required for best outcomes. Recent studies indicate that women at low risk for thrombosis may be treated with low-dose aspirin. However, remaining controversies and unanswered questions in the field of antiphospholipid syndrome are a source of clinical confusion. This review highlights the most important controversies, taking into account the results of recent obstetric treatment trials and our own clinical experience.

Diagnosis and management of antiphospholipid syndrome in pregnancyrequire a full understanding of the maternal and fetal risks, as well as controversies raised by recent studies.

Department of Obstetrics and Gynecology, The University of Utah Health Sciences Center, Salt Lake City, Utah; and Lupus Research Unit, Rayne Institute, King's College, St Thomas’ Hospital, London, United Kingdom.

Address reprint requests to: D. Ware Branch, MD, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, 30 North 1900 East, Suite 2B200 MC, Salt Lake City, Utah 84132; E-mail:

DWB is supported by the H. A. and Edna Benning Presidential Endowed Chair at the University of Utah. MAK is supported by Lupus UK and The St. Thomas’ Lupus Trust.

We thank the following individuals who, in addition to members of our Editorial Board, will serve as referees for this series: Dwight P. Cruikshank, MD, Ronald S. Gibbs, MD, Gary D. V. Hankins, MD, Philip B. Mead, MD, Kenneth L. Noller, MD, Catherine Y. Spong, MD, and Edward E. Wallach, MD.

We have invited select authorities to present background information on challenging clinical problems and practical information on diagnosis and treatment for use by practitioners.

Received April 22, 2002. Received in revised form August 7, 2002. Accepted August 15, 2002.

© 2003 The American College of Obstetricians and Gynecologists