Lima F, Khamashta M A, Buchanan N M, Kerslake S, Hunt B J, Hughes G R
Lupus Pregnancy Clinic, St. Thomas' Hospital, London, United Kingdom.
Clin Exp Rheumatol. 1996 Mar-Apr;14(2):131-6.
To study the maternal and fetal outcome in treated antiphospholipid syndrome (APS) pregnancies.
Sixty pregnancies in 47 APS patients (11 primary and 36 secondary) were followed in a multidisciplinary clinic. Patients testing antiphospholipid antibody positive and having a history of recurrent miscarriages were treated with low-dose aspirin (75 mg) daily. Patients with APS and a previous history of thrombotic events were treated with subcutaneous unfractionated or low molecular weight heparin and low-dose aspirin (75 mg) daily.
The live birth rate increased from 19% of their previous non-treated pregnancies to 70% despite a high incidence of obstetric and fetal complications: pre-eclampsia (18%), prematurity (43%), fetal distress (50%) and intrauterine growth retardation (31%). Two predictors of fetal outcome were observed: the previous obstetric history and the presence of thrombocytopenia. Seven pregnancies (12%) were complicated by thrombotic events during pregnancy or during the puerperium. There were no thrombotic events in those receiving a low molecular weight heparin regimen.
Close obstetric monitoring by a multidisciplinary team and the use of antithrombotic therapy was effective in reducing the fetal wastage in APS pregnancies despite a high incidence of obstetric and fetal complications.
研究接受治疗的抗磷脂综合征（APS）孕妇的母婴结局。
在一个多学科诊所对47例APS患者（11例原发性和36例继发性）的60次妊娠进行随访。抗磷脂抗体检测呈阳性且有复发性流产史的患者每天接受低剂量阿司匹林（75毫克）治疗。有APS病史且既往有血栓形成事件的患者每天接受皮下普通肝素或低分子肝素以及低剂量阿司匹林（75毫克）治疗。
尽管产科和胎儿并发症发生率较高，如先兆子痫（18%）、早产（43%）、胎儿窘迫（50%）和宫内生长受限（31%），但活产率从之前未治疗妊娠时的19%提高到了70%。观察到两个胎儿结局的预测因素：既往产科病史和血小板减少症的存在。7次妊娠（12%）在孕期或产褥期并发血栓形成事件。接受低分子肝素治疗方案的患者未发生血栓形成事件。
尽管产科和胎儿并发症发生率较高，但由多学科团队进行密切的产科监测并使用抗血栓治疗可有效减少APS妊娠中的胎儿丢失。
