Galindo GCG, Bernárdez ZFJ, Hernández MI, Ayala AR

Language: Spanish
References: 14
Page: 277-285
PDF size: 246.18 Kb.

ABSTRACT

Recurrent pregnancy loss is secondary to multiple illnesses. An important cause sometimes undiagnosed is the antiphospholipid syndrome, an autoimmune disease with various clinical alterations (miscarriage, hypertensive disorders, preterm delivery, vascular thrombosis, intrauterine retard growth, death intrauterine, abruption placentae). There are major and minor clinical criteria and precise indications that guide the physician to its recognition. Antibodies related with the syndrome are anticardiolipin and lupic anticoagulant, but other phospholipids seems to be implicated on this pathology and its participation on trombotic events is even unknown. Opportune diagnosis is of vital importance for fetomaternal morbidity and mortality. The repercussions are important during gestational stage, but their effects can persist or even appear during the puerperium, predisposing to trombotic events. The antiphospholipid syndrome that accompanies gestation, requires of efficient valuation and a special treatment, with a narrow prenatal surveillance. The best therapy for reproductive future which has less undesirable effects, is with heparin and acetylsalicylic acid administration; prednisone (steroids) is used in cases of active illness. The current knowledge about this disease makes possible that a pregnancy at term can be achieved with the least as possible number of complications.

REFERENCES

1. Shehata H, Nelson-Piercy C, Khamashta M. Management of pregnancy in antiphospholipid syndrome. Rheum Dis Clin North Am 2003;203-17.

2. Gharavi A, Pierangeli S, Levy R, Harris E. Mechanisms of pregnancy loss in antiphospholipid syndrome. Clin Obstet Gynecol 2001;44:11-19.

3. Quilligan E, Zuspan F. Current therapy in obstetrics and gynecology. 5th ed. Philadelphia: W.B. Saunders Company, 2000;pp:8-12.

4. Branch DW, Khamashta MA. Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol 2003;101(6):1333-42.

5. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Management of recurrent pregnancy loss. Number 24, February 2001. (Replaces technical bulletin number 212, September 1995). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002;78(2):179-90.

6. Levine, Branch, Rauch. Antiphospholipid syndrome. N Engl J Med 2002;346(10):988-93.

7. Merkel P, Chang Y, Pierangeli S. Comparison between the standard anticardiolipin antibody test and a new phospholipids test in patients with connective tissue. J Dis Rheumatol 1999;26:591-6.

8. Luzzana C, Gerosa M, Riboldi P, Meroni P. Update on the antiphospholipid syndrome. J Neprhol 2002;15:342-8.

9. Lockshin E. Treatment of the antiphospholipid syndrome. N Engl J Med 2003;349(12):1177-9.

10. Sean M. Management of antiphospholipid syndrome during pregnancy. Clin Obstet Gynecol 2001;44(1):20-28.

11. Guerin J, Sheng Y, Reddel S, Iverson GM, et al. Heparin inhibits the binding of beta 2-glycoprotein I to phospholipid and promotes the plasmin-mediated inactivation of this blood protein. Elucidation of the consequences of the two biological events in patients with the antiphospholipid syndrome. J Biol Chem 2002;227:2644-9.

12. Pattison N, Chamley L, Birdsall M. Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol 2000;183:1008-12.

13. Branch D, Peaceman A, Druzin A. A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. The pregnancy loss study group. Am J Obstet Gynecol 2000;182:122-7.

14. Crowther MA, Ginsberg JS, Julian J, Math J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome. N Engl J Med 2003;349(12):1133-8.