How is this condition (Antiphospholipid syndrome) diagnosed?

There is a test for the specific antibodies causing the syndrome. This test has yet to be perfected. It is therefore possible to have a negative result in a person who has strong clinical indicators of the antiphosholipid syndrome. The test can also be falsely positive.

The test will usually be done if a woman has a history of recurrent early pregnancy loss.

Can anti-phospholipid syndrome be successfully treated in pregnancy?

The management of this condition continues to evolve. The current popular method is a combination of low-dose aspirin and a form of heparin. The heparin may otherwise be used alone without the Aspirin. The treatment is continued to very late pregnancy or throughout the course of pregnancy. This treatment has been shown to dramatically help the affected women, raising likelihood of delivering a live baby from less than 25% to over 75%.

How common is the antiphospholipid syndrome?

Not common. People with conditions known as connective tissue diseases (the most common being systemic lupus erythematosus, or SLE) are the ones at greatest risk. These conditions are, however, uncommon. Moreover, the antibodies may be found in women with none of the known connective tissue diseases. These women will be at risk of recurrent miscarriage and will need appropriate treatment during their pregnancies.

To add to the complexity of the picture, not all individuals with SLE will have the offending antibodies causing antiphospholipid syndrome.

Is anti-phospholipid syndrome responsible for early pregnancy loss only?

No. Fetal loss may be in mid-trimester and sometimes late, causing stillbirth. This is why some experts advocate that treatment is maintained throughout the course of the pregnancy. There is, however, no consensus among experts whether that is necessary.

Does SLE affect the baby otherwise?

Apart from the risk of pregnancy loss, the fetus may be affected by other antibodies that are found in people with SLE (but not other forms of anti-phospholipid syndrome). Some babies are born with serious heart problems that could occasionally be fatal. There is no known way of `preventing this from happening. Mercifully, this is uncommon.

In managing SLE, steroids are used as well and, these will be continued for several weeks after delivery.

It is important- that any pregnant woman affected by this condition is given as much detail about it as is practicable, so she can understand the potential problems and the possible implications and solutions.

Does the use of steroids after delivery preclude breast-feeding?

No.

Is the anti-phospholipid syndrome passed over to the baby?

No.

Going back to unexplained isolated miscarriage. Are there any factors that make this likely to happen?

Apart from those that have been mentioned already, hormonal imbalances are to blame in some cases. Women with polycystic ovarian disease are a case in point.

The older woman (over 35 years) is at a significantly higher risk of miscarriage, presumably because the risk of a chromosomally abnormal fetus increases with the age of the mother.

Fibroids

What about the presence of fibroids in the womb?

There is some evidence that fibroids, especially if they have grown inside the uterine cavity, may make conception difficult and if this has successfully occurred there may be a risk of miscarriage. It is important to stress that most women with fibroids will encounter no such problems.

Fibroids which grow outside the uterine cavity (and which are commoner) do not seem to pose this risk.