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Lupus anticoagulant and pregnancyFrom: Douglas L. Madsen (dlmmd@fidalgo.net)Wed Jul 30 01:06:58 1997
Hello from Washington state The following is a case presentation I'd be interested in getting input from list members on. The patient is a 35 y.o. caucasion G2P1 currently 12-13 weeks pregnant with singleton. First pregnancy delivered 8/94 at 41 weeks gestation, induction with PGE2 and pitocin, vaginal delivery of 7#13oz female. Treated intrapartum with Pen G for 37 wk pos Group B Step. Pt. Rh neg and received Rhogam. Post partum developed breast abscess, rxed by drainage successfully. She was noted to have a biologic false positive RPR on first visit and Rheumatoid factor, ANA, Lupus anticoagulant all neg. Anticardiolipin IgG 441 Gpl/ml (nl <10 Gpl/ml, *high* >100 Gpl/ml) Anticardiolipin IgM <10 Gpl/ml, Anticardio IgA 32 SDU (neg <10 SDU) AFP at 15 wks 2.2 MOM. Pt. experienced some mild 1st trimester spotting. Initial BP 110/68, Never above 122/80 remainder of pregnancy or labor. Weight gain 37 lbs. Begun on 81 mg. ASA at 14 weeks. Anticardio IgG peaked at 574 Gpl/ml. Digging into past hx revealed hand arthralgias with *neg* Work up in college. She did develop chloasma on combo OC's. With this pregnacy, she experienced some spotting at 8-9 weeks that has stopped. Anticardio IgG is 71 Gpl/ml (nl < 23.9 Gpl/ml) Lupus Anticoag is now POSITIVE. (PTT8.9 sec Nl 22-36 sec) (DRVVT(LAC) 73.8 sec Nl < 46 sec) (LAC/CNF ratio 2.22 Nl < 1.46) Interestingly enough, her RPR is now neg. Initial BP 124/80. She is on ASA 81 mg daily. The question is, in light of her lab abnormalities should she be considered for Heparin and/or steroid administration. My tendency is to not treat based solely on lab data, and since her first pregnancy proceeded without hypertension, IUGR, etc., I have every reason to expect no different this gestation. Thanks in advance for your response Doug Madsen, MD FACOG Mount Vernon, WA Member of the *THREE DOUG NIGHT* call team 1981-1983 Albuquerque, NM.
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