Re: Lupus anticoagulant and pregnancy
From: John G. M. Robertson MD (jgmr@unixg.ubc.ca)
Wed Jul 30 09:50:58 1997
Recent article in NEJM talks about a simmilar concern - I believe
it was IUGR but I'm not sure - The intervention arm had a worse outcome.
Was in the last few weeks, I will try to look again and quote the article.
John
J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
(604) 793-9988 e-mail jgmr@unixg.ubc.ca
The best we can do for one another is to exchange our thoughts freely;
and that, after all, is about all. James A. Froude (1818-1894)
On Wed, 30 Jul 1997, Douglas L. Madsen wrote:
> 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.
>
