A 28-year-old woman has had three consecutive first-trimester miscarriages. Evaluation shows lupus anticoagulant positivity on two occasions 12 weeks apart and persistently elevated anticardiolipin IgG antibodies. What is the recommended treatment in her next pregnancy?

• A Low-dose aspirin alone
• B Prophylactic low molecular weight heparin plus low-dose aspirin ✓
• C Warfarin throughout pregnancy
• D Oral prednisolone plus low-dose aspirin

Explanation

Antiphospholipid syndrome is the only clearly treatable cause of recurrent pregnancy loss. The evidence-based regimen is prophylactic or intermediate-dose low molecular weight heparin combined with low-dose aspirin started in early pregnancy, which raises live birth rates substantially. Aspirin alone is inferior. Warfarin is teratogenic and avoided in pregnancy. Glucocorticoids add maternal morbidity without improving outcomes and are no longer recommended for this indication.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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