WRITE UPS - RECURRENT PREGNANCY LOSS - Obstetric Consequences Of Anti Phospholipid Antibody Syndrome (APA)


The issue of obstetric consequences of APA syndrome is now well settled in the obstetric academics. It is pertinent now to take it from the realms of academic world to day to day practice.

APA syndrome is basically an autoimmune disorder. Its origin was in some medical conditions like deep vein thrombosis. However, it is now implicated conclusively in obstetric conditions like recurrent missed abortions, pre-eclampsia remote from term, I.U.G.R., accidental hemorrhage and the like. Decidual vasculopathy generated by accumulation of these antibodies is the current explanation provided for its effects.

We got working in this field about 15 years ago. Initially we investigated only recurrent missed abortions of late I-trimester and II trimester. Nearly 80% of such carefully selected cases tested positive. We then enlarged the scope of these investigations to other areas as well.  We found association of APA syndrome with other obstetric conditions notable amongst these was pre-eclampsia remote from term. Treatment protocol established in these cases was according to the degree of positivity. We classified <10 GPL as negative, 10-20 as weakly positive, 20 to 100 as moderately positive and more than 100 as strongly positive. For weak and moderate positive cases, we gave low dose aspirin 1.2 mg/kg./day in the interval period. Than allowed a conception. We restarted aspirin at 12 weeks and went on to give for 36 weeks. In strong positive cases we gave prednisolone in a dose of 10-20 mg/day for three months in the interval period allowed a conception and then started aspirin in the some dose from 12 weeks to 36 wks. Our published data showed very satisfactory results in the otherwise furious looking conditions.



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