Antiphospholipid syndrome and pregnancy

Antiphospholipid syndrome (APS) is an autoimmune disease which means that the immune system creates abnormal antibodies that attack components of the body itself thus causing the disease. In APS, these antibodies target proteins that are linked to phospholipids in cell membranes. The most important of these proteins is called beta-2-glycoprotein I.

Although patients with APS may experience a range of different symptoms, the most characteristic features that are used to define the disease are vascular thrombosis and pregnancy morbidity. Therefore, midwives may encounter patients with APS in their everyday practice.

By definition, APS is diagnosed in patients who test positive for antiphospholipid antibodies and who have suffered either vascular thrombosis or pregnancy morbidity, or both. The definition of pregnancy problems that qualify for diagnosis of APS is complex but can be summarised as either one late fetal loss (after 10th week of gestation) or three early fetal losses (before week 10), or one or more premature births before week 34 due to eclampsia, severe pre-eclampsia or placental insufficiency.