A 27-year-old woman has had three consecutive first-trimester miscarriages. Testing shows lupus anticoagulant positivity on two occasions 12 weeks apart. She is now planning her next pregnancy. What is the recommended treatment to improve live birth rates?

• A Low-dose aspirin alone from conception
• B Therapeutic dose unfractionated heparin infusion from the first trimester
• C Oral prednisolone throughout pregnancy
• D Prophylactic low molecular weight heparin plus low-dose aspirin ✓

Explanation

Antiphospholipid syndrome is the best-defined treatable cause of recurrent pregnancy loss. The combination of prophylactic or intermediate dose low molecular weight heparin with low-dose aspirin, started in early pregnancy, roughly doubles the chance of a live birth compared with no treatment. Aspirin alone is inferior, corticosteroids add maternal morbidity without benefit, and full therapeutic anticoagulation increases bleeding risk without improving outcomes.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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