O22 Pregnancy planning in non-criteria antiphospholipid syndrome

Abstract Case report - Introduction Antiphospholipid Syndrome (APS) is an autoimmune condition manifested by vascular thrombosis with or without pregnancy related morbidities. APS classification criteria require detection of persistent antibodies: Anti-Cardiolipin Antibody (aCL), Anti-Beta Glycoprotein I (ab2GPI) and circulating Lupus Anticoagulant (LAC). Criteria for the diagnosis obstetric antiphospholipid syndrome allow optimal treatment planning in reduction foetal maternal morbidity. There are, however, several “non-criteria” features APS, including late pre-eclampsia, which may also infer adverse outcomes. We highlight a dilemma young female lupus history previous that was complicated pre-eclampsia. description describe case 26-year-old systemic erythematosus (SLE), “triple positive” markers (aPL) non-criteria During her first she presented at 22 weeks severe frequent migraine episodes. She had no other active clinical manifestations SLE. prior therefore morbidity nor any thrombotic been commenced on low-dose aspirin (LDA) start already taking hydroxychloroquine (HCQ). The dose HCQ increased to 400mg daily leading improvement headaches. strong ACL antibodies, positive LAC ab2GPI antibodies. ANA hypocomplementemia neutropenia but normal range double-stranded DNA After discussion tertiary centre, it recommended continue LDA. Low molecular weight heparin (LMWH) not proposed as did fulfil APS. Her subsequently pre-eclampsia post-partum sepsis. Two years later sought advice plan second pregnancy, raising important questions whether same strategy should be followed if alternative approaches considered, given its association Again, meet international consensus (revised Sapporo) further high-dose 150mg/day alone. Uterine artery dopplers were LMWH bilateral notching noted. Dopplers normal. blood pressure (BP) fluctuates between 130-145mmHg systolic. has occasional crops mouth ulcers SLE features. Migraines every 2—3 although attacks are infrequent. C4 persistently low Ds urine protein/creatinine ratio. Discussion Our raises how safely managed patients APS-related complications who nevertheless have risk factors, form antibody positivity treated LDA proved insufficient avoiding outcome objective prophylactic treatments prevent outcomes such miscarriage, carry significant psychological depression anxiety. In pregnancies, mothers existing history, current guidance provides few recommendations preventative interventions, even where factors apparent. Furthermore, now well recognised, potential fail trigger interventions they included within criteria. These include placental abruption loss, unexplained vitro fertilisation failures, two miscarriages three non-consecutive miscarriages. titres intermittent aPL included. Studies suggest women benefit from standard includes addition aspirin, good dose-dependent effect preventing through inhibition platelet aggregation Ab-related thrombosis. However, itself prothrombotic presence triple factor Further studies needed define strategies. Key learning points