1-12 ANTIPHOSPHOLIPID (HUGHES’) SYNDROME
A treatable cause of recurrent pregnancy loss.
This syndrome was first described by Hughes in 1983. It is an important cause of thrombotic disease, both venous and arterial (especially recurrent cerebral ischemic attacks). Other features include mild thrombocytopenia, chorea, heart valve disease, livedo reticularis, and most commonly, recurrent pregnancy loss.
It is due to an autoantibody directed against phospholipids. It was first described in patients with systemic lupus erythematosis, but most patients with the syndrome do not have lupus. The importance of the syndrome in general medicine, especially in vascular and neurological disease, is now acknowledged.
One of the major features in women is pregnancy loss, typically in the second trimester. Some suffer many miscarriages before the diagnosis is made. Recurrent pregnancy loss (3 or more spontaneous consecutive miscarriages) affects up to 2% of women. Even if only a minority of these are due to the syndrome, the annual loss because of this potentially treatable condition must be huge.
The cause of miscarriage is placental thrombosis leading to insufficiency. Antithrombotic therapy (aspirin or heparin or both) is beneficial. Heparin does not cross the placenta and is not known to cause any adverse fetal effects. "The improved outlook for successful pregnancy in Hughes’ syndrome is a medical achievement worth celebrating." There will be an increased awareness of the syndrome by physicians, obstetricians, and general practitioners.
BMJ January 25, 1997; 314: 244 Editorial from St. Thomas’s Hospital, London
See also: "Randomized Controlled Trial of Aspirin and Aspirin Plus Heparin in Pregnant Women With Recurrent Miscarriage Associated With Phospholipid Antibodies" (Or antiphospholipid antibodies. BMJ January 25, 1997; 253: 253-57 . Treatment with heparin plus aspirin led to a higher rate of live births than aspirin alone. (70% vs 40%)

[index]