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Re: Lupus anticoagulant and pregnancy From: Malcolm Griffiths (malcolm@mgriff22.demon.co.uk) Wed Jul 30 17:17:58 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Deborah Wage: "Re: Lactation Consultant and Breastfeeding Promotion" Previous message: John G. M. Robertson MD: "Re: Lupus anticoagulant and pregnancy" In reply to: Douglas L. Madsen: "Lupus anticoagulant and pregnancy" Next in thread: Jose C. Ferreira: "Re: Lupus anticoagulant and pregnancy" In message <v01540b01b0047c647d28@[206.129.157.33]>, "Douglas L. Madsen" <dlmmd@fidalgo.net> writes Despite the presence of autoantibodies she had a good result last time. Lupus syndrome is lupus or other cardiolipin antibodies in a woman with a history of thromboembolic disorders and/or history of recurrent pregnancy loss. This woman has neither of these latter features. It is only in such cases that any benefit has been shown from interventions with steroids, aspirin or heparin. Therefore be brave and don't treat. You could though compromise and increase the level of fetal surveillance. >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. > -- Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp., LU6 2DT, UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "It is dangerous to be right on a subject on which the established authorities are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths) Next message: Deborah Wage: "Re: Lactation Consultant and Breastfeeding Promotion" Previous message: John G. M. Robertson MD: "Re: Lupus anticoagulant and pregnancy" In reply to: Douglas L. Madsen: "Lupus anticoagulant and pregnancy" Next in thread: Jose C. Ferreira: "Re: Lupus anticoagulant and pregnancy"

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