Hughes/antiphospholipid syndrome is usually associated with recurrent miscarriage, but it can also cause other pregnancy complications.
Recurrent miscarriage means having three or more miscarriages in a row, and it affects about one in every hundred couples trying for a baby. At least 15% of recurrent miscarriages occur as a result of Hughes/antiphospholipid syndrome, and it is now recognised as the most common, treatable cause. With correct diagnosis and treatment, the pregnancy success rate has risen from 20% before 1990 to over 80% today.
As Hughes/antiphospholipid syndrome pregnancies are classed as high risk, it is best to try and find a specialised or early pregnancy unit where doctors have prior clinical experience.
Treatment will depend on individual medical history, test results and current circumstances. Generally, if a woman is diagnosed with Hughes/antiphospholipid syndrome following recurrent miscarriages, she will be treated daily with low dose aspirin (75mg-150mg). It is also common to combine this treatment with daily heparin injections, particularly if a miscarriage has happened in the mid or late trimesters, or if there have been previous pregnancy complications such as pre-eclampsia. The final decision on how best to treat this aspect of Hughes/antiphospholipid syndrome should be taken after discussion with a specialist in this area.
If a woman has been diagnosed with Hughes/antiphospholipid syndrome prior to becoming pregnant and is already being treated with warfarin, she will have to change over to daily heparin injections, ideally before the embryo is six weeks old, as warfarin is potentially harmful to the baby.
Some women with Hughes/antiphospholipid syndrome can have successful pregnancies without any treatment – the reasons for this are still not clear – but pregnancy loss and/or complications are often the first and, in some cases, the only sign of the condition in women.
Pregnancies can be affected in a number of ways:
The majority of miscarriages in women with Hughes/antiphospholipid syndrome occur at the early stages of pregnancy in the first 13 weeks.
Losing a baby in the second and third trimesters (from 14 weeks until birth) is rare in most pregnancies, but is very strongly associated with Hughes/antiphospholipid syndrome, with many losses occurring between three and six months.
Pre-eclampsia affects up to 10% of all pregnancies, but it is twice as likely to occur in women with Hughes/antiphospholipid syndrome, begins at an earlier stage and is more severe.
Intrauterine growth restriction (IUGR) refers to the reduced growth of a baby while in the womb. It is estimated to affect between 10-30% of babies born to mothers with Hughes/antiphospholipid syndrome.
In the management of pregnancy in Hughes/antiphospholipid syndrome, Doppler ultrasound scans will be carried out to discover if there is a fall in foetal blood supply. If there is a problem, the scan can help the specialists decide whether to move towards an earlier (possibly Caeserean) delivery.
As it is not currently possible to identify which women have solely pregnancy-related Hughes/antiphospholipid syndrome, any woman who has been diagnosed is potentially at increased risk from blood clots and should be advised to continue taking 75mg aspirin daily as a precaution.
It can be devastating to miscarry one baby after another, and the experience can place enormous strain on you and your partner. The Miscarriage Association's website: www.miscarriageassociation.org.uk/ provides a wealth of information on coping strategies, leaflets and helplines all designed to support your grieving process.
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