The Medical Management of Antiphospholipid Syndrome in Pregnancy

Wu, Clara Q.; Kustec, Vanessa E.; Brown, Richard N; Martin, Markus C.; Filion, Kristin B.

doi:10.1097/01.aog.0000447195.12926.b9

Cited by 12 publications

(3 citation statements)

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“…The protective role of LDA against preterm and severe pre-eclampsia has been established in non-autoimmune patients. 123 124 Accordingly, women with SLE at higher risk of pre-eclampsia including those with lupus nephritis or positive aPL will benefit from LDA, preferably given preconceptionally or no later than gestational week 16. 123 124 …”

Section: Resultsmentioning

confidence: 99%

EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome

Andréoli

Βertsias

Agmon‐Levin

et al. 2017

Annals of the Rheumatic Diseases

695

584

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ObjectivesDevelop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).MethodsSystematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.ResultsFamily planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.ConclusionsRecommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

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Section: Resultsmentioning

confidence: 99%

EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome

Andréoli

Βertsias

Agmon‐Levin

et al. 2017

Annals of the Rheumatic Diseases

695

584

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show abstract

“…57,58 However, all patients with positive titers should be stratified for the risk of maternal and fetal complications during pregnancy, and a combination therapy of low-dose aspirin and heparin should be considered.…”

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confidence: 99%

Pregnancy and menopause in patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: practical guide from EULAR

Vagelli¹,

Tani²,

Mosca³

2017

Polish Archives of Internal Medicine

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“…[40] There is limited evidence of benefit in other autoimmune vasculitides, or catastrophic antiphospholipid syndrome, and IV Ig is not currently recommended over less expensive therapy. [41] Large numbers of studies have examined the use of IV Ig and IgM-enriched immunoglobulin preparations for the treatment of severe bacterial sepsis and septic shock, and pooled data fail to show a mortality benefit. [42] In preterm (<37 weeks) and low-birthweight infants, IV Ig replacement can decrease sepsis and serious infection (by only 3 -4%), with no mortality benefit.…”

Section: Use In Other Disciplinesmentioning

confidence: 99%

Recommendations for the use of immunoglobulin therapy for immunomodulation and antibody replacement

2014

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The Medical Management of Antiphospholipid Syndrome in Pregnancy

Cited by 12 publications

References 0 publications

EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome

EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome

Pregnancy and menopause in patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: practical guide from EULAR

Recommendations for the use of immunoglobulin therapy for immunomodulation and antibody replacement

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