Journal Mobile

A Vashisht, L Regan
Journal Issue: 
Volume 35: Issue 4: 2005




The presence of aPL has been clearly shown to have an adverse effect on  pregnancy  outcome.  These  effects  may  be  apparent  in  the  first  trimester, presenting  as  recurrent  pregnancy  loss,  or  may  be  associated  with  the  later development of PET, IUGR, placental abruption, pre-term delivery, and intrauterine death. What appear to be most important in the aetiology, initially, are factors that disturb the vital interaction between the embryonic trophoblastic tissue and the host (maternal) endometrial tissue.  It seems that the presence of aPL may impair trophoblastic invasion, thus interfering with implantation and subsequent placental development. As the pregnancy advances, women are more prone to thrombosis in  the  uteroplacental  vasculature. Indeed, women  with  PAPS  suffer  from  a  live birth rate as low as 10% in the absence of pharmacological intervention.

Dramatic improvements in pregnancy outcome can be achieved by a combination of aspirin and heparin. However, although the live birth rate is increased sevenfold, it should be acknowledged that these births are associated with an increased rate of  prematurity  and  possible  neonatal  complications.  The  increased  incidence  of pregnancy-related  complications  necessitates  the  need  for  careful  antenatal surveillance, and for delivery to be conducted in a unit with facilities for operative delivery and neonatal intensive care.  For the women themselves, the significance of aPL outside pregnancy is far from clear, and the ideal management for optimising long-term health is yet to be determined.