Mehl SLE and antiphospholipid 12-13 (1)

Question 1

mehl. pathophysiology?

Answer 1

SLE causes uteroplacental insufficiency and recurrent miscarriage when patient has anti-phospholipid
antibodies.

Question 2

mehl. what do anti-phospholipid antibodies?

Answer 2

result in microthrombi within uteroplacental microvasculature leading to decreased blood flow and fetal compromise.

Question 3

mehl. what complications happens if not miscarriage?

Answer 3

If miscarriage does not occur, intrauterine growth restriction (IUGR) and oligohydramnios may result secondary to the reduced uteroplacental oxygen delivery.

Question 4

mehl. Tx if women has miscarriage due to phospholipid syndrome?

Answer 4

Women with Hx of miscarriage due to phospholipid syndrome in SLE are treated with combination therapy
of low-dose aspirin + LMWH in subsequent pregnancies. Warfarin is avoided because it is teratogenic.

Question 5

mehl. SLE cause what complication HTN?

Answer 5

SLE resulting in uteroplacental insufficiency is a risk factor for preeclampsia, since the latter is caused by reduced uteroplacental perfusion.

Question 6

mehl. how to detect IUGR?

Answer 6

IUGR in pregnancy is best ascertained by looking at fetal abdominal circumference.

Sounds weird (i.e., student says, “Why not head circumference or something.”), but it’s because abdominal circumference reflects liver size and overall fetal fat accumulation, which are notably affected in IUGR. When the placenta is not delivering adequate oxygenation and nutrients, the fetus often prioritizes brain over abdominal growth, leading to a reduced abdominal circumference.

Question 7

UW antiphospholipid table. Dx?

Answer 7

Vascular thrombosis (TIA/stroke/DVT) and/or pregnancy complications (eg reccurent miscarriage) PLUS >=1 of the following antibodies: anti-cardiolipin; lupus anticoagulant; anti-beta2-glycoprotein antibody

Question 8

UW antiphospholipid table. Tx?

Answer 8

anticoagulation (eg heparin, warfarin)