Anti-phopsholipid syndrome and IVIG – pro

The thrombophilias are a group of disorders that promote blood clotting. Most women with a thrombophilia have healthy pregnancies. However, pregnant women with a thrombophilia may be more likely than other pregnant women to develop a Venous thrombosis or certain pregnancy complications. This is particularly true of the anti-phospholipid sydrome that this member has. Fetal loss may occur late in the first trimester (miscarriage) or in the second or third trimesters (stillbirth). Some pregnant women with a thrombophilia are treated with low moecular weight heparins(LMWH), such as Lovenox. ASA has not been shown to add to LMWH.

An American Society for Reproductive Medicine (2002) Committee Opinion concluded: “IVIG as a treatment for recurrent pregnancy loss should be evaluated in patients who are informed, consenting participants in an institutional review board approved randomized clinical trial. For the management of recurrent spontaneous pregnancy loss IVIG is an experimental treatment.”

However, this may not be true if a diagnosis of anti-phospholipid (APL) syndrome is made. A prospective, two-center trial study evaluated the pregnancy outcomes in recurrent spontaneous abortion associated with antiphospholipid antibodies: and compared treatment outcomes of intravenous immunoglobulin versus prednisone plus low-dose aspirin. The two-center trial study included 82 recurrent aborters with aPL syndrome. Twenty-nine were treated with prednisone and low-dose aspirin (LDA) in one center, 53 received IVIG in the other center. Maternal and fetal outcomes and pregnancy complications were compared between groups. The results showed that live-birth rates were equivalent between groups (78 vs. 76%). Mean birth weight was higher in the IVIG group than in the prednisone plus LDA group. In the prednisone-plus LDA-treated patients, gestational hypertension and gestational diabetes were found significantly more often than in the IVIG-treated group (14 vs. 5% and 14 vs. 5%, respectively). In conclusion, in patients with aPL syndrome, IVIG treatment improved pregnancy outcomes, with significantly lower pregnancy complication rates, when compared with prednisone plus LDA therapy.

Several review articles were consulted and recommend IVIG in refractory cases.

D. Erkan , S. Patel , M. Nuzzo , M. Gerosa , P. L. Meroni , A. Tincani , and M. D. Lockshin Management of the controversial aspects of the antiphospholipid syndrome pregnancies: a guide for clinicians and researchers
Rheumatology Rheumatology 47: iii23-iii27.

American College of Obstetricians and Gynecologists (ACOG). Antiphospholipid Syndrome. ACOG Practice Bulletin, number 68, November 2005.

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