The association of antiphospholipid antibodies (aPLs) with a poor obstetric history and/or thrombotic event is typical of the antiphospholipid syndrome (APS). We report four cases of poor pregnancy outcome where a diagnostic label of APS resulted in delayed recognition of other causes of pregnancy loss. Pregnancy outcomes in these women were not improved with antithrombotic therapy alone. Successful outcomes were achieved only when other causes of recurrent miscarriage were considered and treated.
Wilson WA , Gharavi AE , Koike T et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome . Arthritis Rheum1999; 42: 1309–1311 .
2.
Langford K , Nelson-Piercy C . Antiphospholipid syndrome in pregnancy . Contemp Rev Obstet Gynaecol1999; 11: 93–97 .
3.
Harris EN , Spinnato JA . Should anticardiolipin tests be performed in otherwise healthy pregnant women?Am J Obstet Gynecol1991; 165: 1272–1277 .
4.
Greaves M . Antiphospholipidantibodies and thrombosis . Lancet1999; 353: 1348–1353 .
5.
Tan EM , Cohen AS , Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus (SLE) . Arthritis Rheum1982; 25: 1271–1277 .
6.
Backos M , Venkat-Raman N , Teoh TG , Regan L . Doppler ultrasound of the uterine artery in the early prediction of pregnancy complications in women with antiphospholipid syndrome . Hum Reprod1999; 14: 226-226 .
7.
Donohoe S , Geary M , Kingdom JCP , Jauniaux E , Purdy G , Mackie IJ . Maternal cardiolipin, β2-glycoprotein-I and prothrombin antibody expression in high-risk pregnancies with bilateral abnormal uterine artery Doppler waveforms . Ultrasound Obstet Gynecol1999; 13: 317–322 .
8.
Branch DW , Andres R , Digre KB , Rote NS , Scott JR . The association of antiphospholipid antibodies with severe preeclampsia . Obstet Gynecol1989; 73: 541–545 .
9.
Branch DW , Silver RM , Blackwell JL , Reading JC , Scott JR . Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience . Obstet Gynecol1992; 80: 614–620 .
10.
Lima F , Khamashta MA , Buchanan N , Kerslake S , Hunt BJ , Hughes GRV . A study of sixty pregnancies in patients with the antiphospholipid syndrome . Clin Exp Rheumatol1996; 14: 131–136 .
11.
De Wolf F , Carreras LO , Moerman P , Vermylen J , Van Assche A , Renaer M . Decidual vasculopathy and extensive placental infarction in a patient with repeated thromboembolic accidents, recurrent fetal loss, and a lupus anticoagulant . Am J Obstet Gynecol1982; 142: 829–834 .
12.
Lakasing L , Poston L . Adverse pregnancy outcome in the antiphospholipid syndrome: focus for future research . Lupus1997; 6: 681–684 .
13.
Rand JH , Wu X , Andree HAM et al. Pregnancy loss in the antiphospholipid-antibody syndrome— a possible thrombogenic mechanism . New Engl J Med1997; 337: 154–160 .
14.
Labarrere CA , Faulk WP . Fetal stem vessel endothelial changes in placentae from normal and abnormal pregnancies . Am J Reprod Immunol1992; 27: 97–100 .
15.
Hughes GRV . The antiphospholipid syndrome: ten years on . Lancet1993; 342: 341–344 .
16.
Rai RS , Cohen H , Dave M , Regan L . Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies) . Br Med J1997; 314: 253–256 .
17.
Kutteh WH . Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low dose aspirin is superior to low dose aspirin alone . Am J Obstet Gynecol1996; 174: 1584–1589 .
18.
Dahlman TC . Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin . Am J Obstet Gynecol1993; 168: 1265–1270 .
19.
Pattison NS , Chamley LW , Birdsall M , Zanderigo AM , Liddell HS , McDougall J . Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial . Am J Obstet Gynecol2000; 183: 1008–1012 .
20.
Farquharson RG , Quenby S , Greaves M . Antiphospholipid syndrome in pregnancy: a controlled treatment trial . J Obstet Gynaecol2001; 21: S22-S22 .
21.
Sanson B , Lensing AWA , Prins MH et al. Safety of low-molecularweight heparin in pregnancy: a systematic review . Thromb Haemost1999; 81: 668–672 .
22.
Backos M , Rai R , Thomas E , Murphy M , Dore C , Regan L . Bone density changes in pregnant women treated with heparin: a prospective longitudinal study . Hum Reprod1999; 14: 2876–2880 .
23.
Brudenell M . Gynaecological sequelae of induced abortion . Practitioner1980; 224: 893–898 .
