A 28-year-old woman with three consecutive first trimester miscarriages is found to have persistent lupus anticoagulant positivity on testing done 12 weeks apart. She conceives again. What is the recommended therapy during this pregnancy?

• A Low dose aspirin alone
• B Prophylactic low molecular weight heparin alone
• C Oral prednisolone combined with low dose aspirin
• D Low molecular weight heparin combined with low dose aspirin ✓

Explanation

Obstetric antiphospholipid syndrome is treated throughout pregnancy with prophylactic or intermediate dose low molecular weight heparin plus low dose aspirin, which improves live birth rates substantially. Aspirin alone or heparin alone is inferior for recurrent pregnancy loss due to antiphospholipid antibodies. Prednisolone is not recommended because maternal and fetal morbidity outweigh benefit. Diagnosis itself requires persistent antiphospholipid antibodies on two occasions at least 12 weeks apart, as stated in this vignette.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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