Pregnancy outcomes of antiphospholipid syndrome: In a low resource South Asian setting

C N Wijeyaratne; Sla Galappaththi; E Palipane; Dbia Jayawardane; S H Dodampahala; M N Tudawe; L V Gooneratne; R de Silva; D Ratnayake; S L Seneviratne

doi:10.1177/1753495X16629300

Pregnancy outcomes of antiphospholipid syndrome: In a low resource South Asian setting

Obstet Med. 2016 Jun;9(2):83-9. doi: 10.1177/1753495X16629300. Epub 2016 Mar 17.

Authors

Affiliations

¹ Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
² Department of Haematology, National Hospital of Sri Lanka, Sri Lanka.
³ Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
⁴ Department of Immunology, Medical Research Institute, Colombo, Sri Lanka.
⁵ Royal Free Hospital and University College London, Centre for Immunodeficiency, London, UK.

Abstract

Problem: Antiphospholipid syndrome is associated with recurrent pregnancy loss, and specific treatment improves pregnancy outcome. Laboratory diagnosis is limited in South Asia. We assessed management outcomes of definite/probable antiphospholipid syndrome treated at a tertiary centre in Sri Lanka.

Method: Descriptive cross-sectional study of pregnancy outcomes with heparin and aspirin therapy.

Outcome measures: miscarriage, intrauterine death and live birth when compared to previous untreated pregnancies.

Results: Of 646 gestations in 145 women, 146 (22.6%) received specific treatment. In the preceding pregnancies without specific treatment, the rates of miscarriage, late fetal loss, stillbirth and live birth were 60%, 26%, 8% and 7%, respectively. Following specific treatment with low-dose aspirin ± low-molecular weight heparin in 146 pregnancies (145 women), the rates of miscarriage, late fetal loss, stillbirth and live birth were 14%, 10%, 3% and 74%, respectively. Mean birth weight was 2.54 ± 0.62 kg, preterm births complicated 32 (29.6%) with a mean gestational age at delivery 33.7 ± 2.6 weeks, with three neonatal deaths. Maternal complications were: pre-eclampsia 16 (10.9%), gestational diabetes 28 (19.2%), antepartum haemorrhage in 1 patient. Only 73/145 (50.3%) women had laboratory confirmation of antiphospholipid syndrome, while others were treated empirically. Live births in diagnosed vs. empiric treatment - 80.8% vs. 67.1%.

Conclusion: Pregnant women with clinical antiphospholipid syndrome when treated with low-dose aspirin and heparin, the live birth rate of 7% in the previous pregnancy resulted in live births of 74% in a resource limited South Asian setting.

Keywords: Heparin; Sri Lanka; low-dose aspirin; recurrent pregnancy loss.