What Is the Treatment for Antiphospholipid Syndrome-Caused Miscarriage?

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Ask the experts

I have been diagnosed with the APS Syndrome. I have lost two babies due to this, one at 31 weeks, and the other at 22 weeks. I had a successful pregnancy outcome between the two losses, but it was only a miracle. That baby was taken at 34 weeks. My question is this, only after my second loss was I diagnosed, so I am now on heparin and baby aspirin, what are the numbers of success rates with this treatment against the antibodies?

Doctor's Response

This is an evolving area of medicine. Your current treatment is up to date. Here is a study of this very subject with the full abstract and statistics:

BMJ 1997 Jan 25;314(7076):253-257

Randomized controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies.

Rai R, Cohen H, Dave M, Regan L

Objective: To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with a history of recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies), lupus anticoagulant, and cardiolipin antibodies (or anticardiolipin antibodies). 

Design: Randomized controlled trial. Setting: Specialist clinic for recurrent miscarriages. Subjects: 90 women (median age 33 (range 22-43)) with a history of recurrent miscarriage (median number 4 (range 3-15)) and persistently positive results for phospholipid antibodies. 

Intervention: Either low dose aspirin (75 mg daily) or low dose aspirin and 5000 U of unfractionated heparin subcutaneously 12 hourly. All women started treatment with low dose aspirin when they had a positive urine pregnancy test. Women were randomly allocated an intervention when fetal heart activity was seen on ultrasonography. Treatment was stopped at the time of miscarriage or at 34 weeks' gestation. 

Main Outcome Measures: Rate of live births with the two treatments. 

Results: There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live births with low dose aspirin and heparin was 71% (32/45 pregnancies) and 42% (19/45 pregnancies) with low dose aspirin alone (odds ratio 3.37 (95% confidence interval 1.40 to 8.10)). More than 90% of miscarriages occurred in the first trimester. There was no difference in outcome between the two treatments in pregnancies that advanced beyond 13 weeks' gestation. Twelve of the 51 successful pregnancies (24%) were delivered before 37 weeks' gestation. Women randomly allocated aspirin and heparin had a median decrease in lumbar spine bone density of 5.4% (range -8.6% to 1.7%). Conclusion: Treatment with aspirin and heparin leads to a significantly higher rate of live births in women with a history of recurrent miscarriage associated with phospholipid antibodies than that achieved with aspirin alone.

Health Solutions From Our Sponsors

Reviewed on 1/11/2018
CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW