Nasmapheresis and pregnancy outcome in patients with antiphospholipid syndrome

Objective: To assess plasmapheresis with tow dose prednisone on obstetric and neonatal outcomes among unsuccessfully treated pregnant women with documented anti phospholipid syndrome (APS). Methods: Eighteen pregnant women received prednisone (10 mg/day) and plasmapheresis at 7.08 +/- 0.6 weeks of gestation, for 3 sessions per week, until lupus anticoagulant activity suppressed and IgG anticardiolipin towered. Serial pulsatility indexes (PI) of umbilical and uterine arteries were performed. Results: The live birth rate was 100\%; mild pre-eclampsia 5.5\%; preterm deliveries 22.22\%; intrauterine growth restriction 11.11\%; thrombocytopenia 5.5\%; oligohydramnios and fetal distress 16.6\%. There were no perinatal deaths, thrombotic events or lupus flare. Uterine artery PI was reduced and umbilical artery PI was > 95th percentile. Conclusion: Plasmapheresis and tow dose prednisone were associated with a low rate of obstetric and neonatal complications. Plasmapheresis may be used to treat pregnant women with documented APS when first lines (aspirin and/or heparin) fait to prevent pregnancy loss. (c) 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. AIL rights reserved.