Management outcome of a cohort of Sri lankan women with antiphospholipid syndrome (APLS) and recurrent pregnancy loss

Abstract

BACKGROUND APLS is an autoimmune disease leading to recurrent pregnancy loss, the laboratory diagnosis being limited in Sri Lanka. OBJECTIVE We report the management outcomes of a series of affected women from a single tertiary care unit. METHOD Design: Observational case study DIAGNOSTIC CRITERIA International consensus guidelines for APLS (1999). Outcome measures: outcome of the last pregnancy managed with subcutaneous heparin and aspirin (international practice guidelines) versus previous obstetric outcome of pregnancies that did not receive treatment. RESULTS 111 women with APLS of whom 76 (68.47 percent) were pregnant and managed for APLS. Mean age 31.4 years, duration since marriage 6.1 years. 75(67.0 percent) were childless, 27(24.17 percent) had one child. Total gestations 493, mean gestations pre subject 4.4ñ 1.9(range 1-13) PREVIOUS PREGNANCY OUTCOMES 45 (9 percent) live births, 21(4.3 percent) stillbirths, miscarriages 111(22.5 percent) late (>10 weeks) 242(49.8 percent) early (<10 weeks) IMMUNOLOGICAL PROFILE Lupus anticoagulant/DRVVT positive 31, KCT positive 11, Anticardiolipin antibodies positive 11, ANF positive 8, dsDNA positive 4. Of 15 tested in a reference laboratory in UK all were positive for at least one antibody (AnnexinV, anti-_2-Glycoprotein, Phosphatidyliositol, Phosphatidylethanlamine). CO-MORBIDITIES pregnancy hypertension 45 (40.5 percent), gestational diabetes DM 19 (17. percent); cerebrovascular disease 13 (11.7 percent), deep vein thrombosis 5 (4.5 percent).. Outcomes with treatment (75) versus no treatment (418) Early miscarriage 2(2.7 percent) vs. 240(57.4 percent) (p=0.0001), late miscarriage 10(13.3 percent) vs. 101(24.2 percent) (p=0.03), still birth 0 vs. 21(5 percent) (p=0.04), live birth 51(68 percent) vs. 9(2.15 percent) (p=0.0001). Average birth weight of 2.7 ñ 0.6 kg (range 1.25-3.96); a mean period of gestation of 36.2ñ2.6 weeks. 8(15.68 percent) gestations on heparin have a future date of delivery but no foetal growth restriction; 5(9.8 percent) have defaulted. No postnatal thrombosis CONCLUSIONS AND RECOMMENDATIONS Women with APLS presenting with recurrent fatal loss managed with subcutaneous heparin and aspirin in a Sri Lankan tertiary setting have a significant improvement in pregnancy outcome, although with a high prevalence of maternal co-morbidities.