Персистенція антифосфоліпідних антитіл, особливості менеджменту вагітності: Клінічний випадок

Since antiphospholipid syndrome (APS) is a rare condition, it is often overlooked by clinicians. At the same time, APS is one of the causes of serious obstetric complications, including early pregnancy loss and preterm birth.This clinical case describes the course of pregnancy by trimesters, labor, and postpartum period in a woman with systemic lupus erythematosus associated with APS, highlighting the management of pregnancy, labor, and postpartum care.A 31-year-old woman was hospitalized at 4 weeks of pregnancy with a threatened miscarriage. This was her third pregnancy. The first and second pregnancies ended in early miscarriage. She has a family history of thrombosis: her father died from pulmonary artery thrombembolism at 49 years old, paternal relatives had thrombosis, and her maternal grandfather died from a stroke. The patient’s personal medical history is not complicated by thrombosis.After excluding inherited thrombophilia, clinical and laboratory tests revealed the antiphospholipid antibodies (anti-β2-glycoprotein 1, anticardiolipin, lupus anticoagulant) and an elevated titer of antinuclear antibodies (ENA screening, anti-double-stranded DNA antibodies). The patient was given combined antithrombotic therapy with aspirin and enoxaparin, combined with hydroxychloroquine. At 37 weeks, woman delivered a baby per vias naturalis without any complications during labor or the postpartum period.Conclusions. Considering that APS is a common cause of pregnancy loss, this pathology requires proper attention from clinicians. The diagnosis and management of this thrombophilia are further complicated by the lack of an accepted standard for the care of such patients in Ukraine. Additionally, the existing APS criteria do not cover all patients who face difficulties in carrying a pregnancy due to the presence of antiphospholipid antibodies. This creates difficulties in recognizing these women, leaving them without appropriate treatment.