Romero Arauz Juan Fernando, García Alonso López Angel, González Alma Lina Lara, Rivera Velásquez Patricia, Ayala Méndez José Antonio
Departamento de Medicina Perinatal, Hospital de Ginecología y Obstetricia Luis Castelazo Ayala, Instituto Mexicano del Seguro Social.
Ginecol Obstet Mex. 2006 Jul;74(7):367-75.
To assess the maternal and perinatal outcome of patients with antiphospholipid syndrome in pregnancy.
A descriptive and retrospective analysis of patients with antiphospholipid syndrome in pregnancy was made from January 2000 to June 2005.
We analyzed 35 patients. Primary and secondary antiphospholipid syndrome occurred in 25 (71%) and 10 (29%) women, respectively. Nine cases were associated with systemic lupus erythematosus and one with scleroderma. Approximately, 48% of women had history of thrombosis, 23% recurrent pregnancy loss, and 15% early onset preeclampsia in previous pregnancies. Twenty-seven patients had positive anticardiolipin antibodies, 6 lupus anticoagulant, and 2 both of them. About 80% of the patients were delivered by cesarean section. There was one spontaneous embryo loss before seven weeks. Eleven (32%) patients had preeclampsia. There were no maternal deaths. All women began treatment since the first trimester of pregnancy. Twenty-three patients (66%) received heparin and low dose aspirin, 8 cases (22%) heparin, low dose aspirin and prednisone, for presenting systemic lupus erythematosus, and the remaining 4 cases (12%) were treated with prednisone and aspirin. Ninety four percent of the cases got a live newborn. There were two neonatal deaths secondary to extreme prematurity and associated with preeclampsia. There was one fetal death related to maternal lupus renal activity. Fifty-eight percent of the newborns were premature. Intrauterine growth restriction was present in 20% of the cases.
Early treatment combined with close maternal-fetal surveillance was associated with a 90% chance of a live birth rate. However, prematurity, preeclampsia and intrauterine growth restriction were common.
评估妊娠合并抗磷脂综合征患者的母儿结局。
对2000年1月至2005年6月妊娠合并抗磷脂综合征的患者进行描述性回顾分析。
我们分析了35例患者。原发性抗磷脂综合征和继发性抗磷脂综合征分别发生在25例（71%）和10例（29%）女性中。9例与系统性红斑狼疮相关，1例与硬皮病相关。约48%的女性有血栓形成史，23%有复发性流产史，15%既往妊娠时有早发型子痫前期。27例患者抗心磷脂抗体阳性，6例狼疮抗凝物阳性，2例两者均阳性。约80%的患者通过剖宫产分娩。有1例在7周前自然胚胎丢失。11例（32%）患者发生子痫前期。无孕产妇死亡。所有女性自妊娠早期开始治疗。23例（66%）患者接受肝素和小剂量阿司匹林治疗，8例（22%）因合并系统性红斑狼疮接受肝素、小剂量阿司匹林和泼尼松治疗，其余4例（12%）接受泼尼松和阿司匹林治疗。94%的病例分娩出活产新生儿。有2例新生儿因极度早产并合并子痫前期死亡。有1例胎儿死亡与母体狼疮肾活动有关。58%的新生儿早产。20%的病例存在宫内生长受限。
早期治疗并加强母胎密切监测可使活产率达到90%。然而，早产、子痫前期和宫内生长受限较为常见。
