Antiphospholipid syndrome

Question 1

List tests to complete to exclude a heritable thrombophilia

Answer 1

• Factor V Leiden mutation
• Prothrobin G20210A mutation
• Protein S and C
• Antithrombin

Question 2

Outline a management plan for a woman with antiphospholipid syndrome

Answer 2

Preconception:

• Low-dose aspirin
• Complete screening/investigations if required.

Antepartum:

• Stop warfarin as soon as conception occurs and/or start clexane.
  
  • Prophylactic dose if no previous VTE.
  • Therapeutic dose if previous VTE.
• Baseline urine PCR and PET bloods.
• Monitor regularly for PET
• Uterine artery dopplers at 20/24 weeks.
• Serial growth scans

Intrapartum:

• IOL at 39 weeks
• Bridge clexane with UFH. Neuraxial anaesthesia okay after stopping UFH for 6 hours.
• Active third stage management

Postpartum:

• Recommence anticoagulation (warfarin or clexane) and continue for 6 weeks postpartum or lifelong.
  
  • Can breastfeed with both.
• Avoid oestrogen containing contraception.