A 28-year-old woman has had three consecutive first-trimester miscarriages. Lupus anticoagulant is positive on testing done 12 weeks apart. She conceives again. What is the standard treatment during this pregnancy?

• A Low molecular weight heparin alone
• B Weekly intravenous immunoglobulin infusions
• C Oral prednisolone throughout pregnancy
• D Low molecular weight heparin combined with low-dose aspirin ✓

Explanation

Antiphospholipid syndrome is the best-defined treatable cause of recurrent pregnancy loss, confirmed when lupus anticoagulant or anticardiolipin antibodies persist on testing at least 12 weeks apart. Standard therapy in the next pregnancy is prophylactic or intermediate-dose low molecular weight heparin combined with low-dose aspirin started early, which substantially raises live birth rates over aspirin alone. Glucocorticoids add maternal morbidity without clear additional benefit and are reserved for selected refractory cases, and IVIG has shown no advantage over the heparin-aspirin combination in trials.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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