|
ABSTRACT
The issue of obstetric consequences of APA syndrome is now well
settled in the obstetric academics. It is pertinent now to take
it from the realms of academic world to day to day practice.
APA syndrome is basically an autoimmune disorder. Its origin was
in some medical conditions like deep vein thrombosis. However,
it is now implicated conclusively in obstetric conditions like
recurrent missed abortions, pre-eclampsia remote from term,
I.U.G.R., accidental hemorrhage and the like. Decidual
vasculopathy generated by accumulation of these antibodies is
the current explanation provided for its effects.
We got working in this field about 15 years ago. Initially we
investigated only recurrent missed abortions of late I-trimester
and II trimester. Nearly 80% of such carefully selected cases
tested positive. We then enlarged the scope of these
investigations to other areas as well. We found
association of APA syndrome with other obstetric conditions
notable amongst these was pre-eclampsia remote from term.
Treatment protocol established in these cases was according to
the degree of positivity. We classified <10 GPL as negative,
10-20 as
weakly positive, 20 to 100 as moderately
positive and more than 100 as strongly positive. For
weak and moderate positive cases, we gave low dose aspirin 1.2
mg/kg./day in the interval period. Than allowed a conception. We
restarted aspirin at 12 weeks and went on to give for 36 weeks.
In strong positive cases we gave prednisolone in a dose of 10-20
mg/day for three months in the interval period allowed a
conception and then started aspirin in the some dose from 12
weeks to 36 wks. Our published data showed very satisfactory
results in the otherwise furious looking conditions.
|
