Antiphospholipid syndrome ( APS) - Causes, Symptoms and Treatment .MF .
Antiphospholipid syndrome (APS) - is an autoimmune disease characterized by the generation of large amounts of antibodies to phospholipids - a chemical structure of which is constructed of the cells.
Antiphospholipid syndrome occurs in approximately 5% of pregnant women.In 30% of cases of ASF is a major cause of miscarriage - the most urgent problems of modern obstetrics.Failure to comply with certain measures, APS can lead to very adverse and life-threatening complications during pregnancy and after childbirth.
The main precipitating factors leading to the development of APS include:
- a genetic predisposition;
- bacterial or viral infection;
- -System autoimmune diseases lupus erythematosus (SLE), periarteritis nodosa;
- long-term use of drugs (hormonal contraceptives, psychotropic drugs);
Symptoms of antiphospholipid syndrome
How does antiphospholipid syndrome?The clinical manifestations of the disease are varied, but may be absent altogether.The latter are often, when
The most "harmless" APS symptoms include the appearance of the underlined vascular pattern in different parts of the body.The most common vascular pattern is expressed in the legs, feet, thighs.
In more severe cases, APS can manifest itself in the form of the appearance of non-healing ulcers on the lower leg, gangrene of the toes (due to the chronic deterioration of blood supply).Increased blood clots in the vessels when the ASF may lead to pulmonary embolism (acute blood clots), which is extremely dangerous!
Less common symptoms of APS include a sudden decrease in vision, until the appearance of blindness (due to thrombosis of arteries and veins of the retina);the development of chronic renal failure that can occur in the form of blood pressure increase and the appearance of urinary protein.
itself pregnancy exacerbates manifestations of APS, so if you have already been diagnosed AFS- obstetrician gynecologist to consult before a planned pregnancy.In the presence of the above symptoms you should do so immediately!
survey in APS
To confirm the diagnosis, "Antiphospholipid syndrome" need to take a blood test from a vein on the markers on the AFS- lupus anticoagulant (LA) and antibodies to cardiolipin (aCL).If the analysis was positive (ie if the discovered markers APS), should be re-take again in 8-12 weeks.And if re-analysis was also positive, then treatment is prescribed.
To determine the degree of severity of the disease is required to prescribe a common blood test (in APS marked decrease platelet count) and coagulation (gemostaziorammu) - a blood test for hemostasis (blood clotting).In the presence of APS in pregnancy coagulation shall at least once every 2 weeks.In the postpartum period, this analysis shall be the third and fifth day after birth.
ultrasound and Doppler study (study of blood flow in the system "mother-placenta-fetus") carried out in pregnant women with APS more likely than pregnant women without pathologies.Starting with 20 weeks, these studies are carried out every month, in time to anticipate and reduce the risk of placental insufficiency (impaired blood circulation in the placenta).
CTG (kardiotografiyu) is also used to assess the condition of the fetus.This study was performed on a mandatory basis, starting from 32 weeks of pregnancy.In the presence of chronic fetal hypoxia, placental insufficiency (which often happens when APS) - CTG carried out daily.
Treatment of antiphospholipid syndrome
What treatment APS appointed during pregnancy?As has been said, if you know about the diagnosis and examined, before planning pregnancy should refer to the obstetrician-gynecologist.
To prevent the development of disorders from the blood coagulation system, even before pregnancy prescribe corticosteroids in small doses (prednisolone, dexamethasone, metipred).Further, when a woman becomes pregnant, she continues to take these drugs until the postpartum period.After only two weeks after the delivery of these drugs gradually overturned.
In cases where the diagnosis of APS is set during pregnancy - tactics of the same.Treatment with glucocorticoids is appointed in any case, if there is APS, even if the pregnancy is totally normal!
Because long-term use of glucocorticoids leads to a weakening of the immune system, the parallel is prescribed in small doses of immunoglobulin.
just pregnancy immunoglobulin is administered 3 times - up to 12 weeks, 24 weeks and just before birth.
required for the correction of the blood coagulation system prescribed antiplatelet agents (Trental chimes).
Treatment is carried out under the supervision of hemostasiogram indicators.In some cases, additional prescribed Heparin and Aspirin in small doses.
addition to the main treatment used plasmapheresis (blood cleansing by removing the plasma).This is done to improve the rheological properties of the blood, to enhance immunity and to increase the sensitivity to administered drug.When using plasmapheresis dose corticosteroids and antiplatelet agents can be reduced.This is especially true for pregnant women who can not tolerate steroids.
During birth to closely monitor the state of the blood coagulation system.Deliveries must always be carried out under the control of CTG.
With early diagnosis, careful observation and treatment, pregnancy and childbirth are favorable and end the birth of healthy children.The risk of obstetric complications in this case will be minimal.
If you are diagnosed with APS, it is not necessary to be upset and depriving myself of pleasure to be a mother.Even if there was a miscarriage should not be adjusted to the fact that the next time will be the same.With the power of modern medicine, the ASF is not a verdict today.The main thing to follow the doctor's instructions and be prepared for long-term treatment, and numerous surveys that are made for the sole purpose - to protect you and the unborn child from the very unpleasant complications.
Complications listed below, there are 95 of the 100 patients with APS in the absence of dynamic observation and treatment.These include:
- miscarriages (recurrent miscarriages in early pregnancy);
- fetal growth retardation, fetal hypoxia (lack of oxygen);
- placental abruption;
- development of severe preeclampsia (complication of pregnancy, accompanied by an increase in blood pressure, the appearance of pronounced edema, protein in the urine).If untreated, preeclampsia can lead not only to the death of the fetus, and the mother;
- pulmonary embolism.
Prevention antiphospholipid syndrome
Prevention APS includes a survey before the planned pregnancy markers AFS- lupus anticoagulant (LA), antibodies to cardiolipin (aCL).
Consultation obstetrician-gynecologist at APS
Question: Is it possible to be protected in the presence of APS oral contraceptives?
Answer: No way!Receiving oral contraceptives exacerbate during the ASF.
Question: Does APS leads to infertility?
Question: If the pregnancy is normal, whether to take the "reassurance" on markers of APS?
Answer: No, if the normal coagulation.
Question: How long to take antiplatelet drugs during pregnancy in the presence of APS ?
Answer: The whole pregnancy without interruption.
Question: Can the appearance of the ASF trigger smoking?
A: It is unlikely, but if you already have an APS, the smoke was even more aggravated.
Question: How long you can not get pregnant after a miscarriage because of the APS?
Answer: At least 6 months.During this time, should be fully examined and start taking antithrombotic drugs.
Question: Is it true that pregnant women with APS is impossible to do a caesarean?
Answer: Yes and no.By itself, the surgery increases the risk of thrombotic complications.But if there is evidence (placental insufficiency, fetal hypoxia, etc.), the required operation.
Obstetrician-gynecologist, Ph.D.Christina Frambos.