17 Obstetric Antiphospholipid Syndrome

Clinicians first recognized that pregnancy loss was associated with antiphospholipid antibodies (aPL) in the latter third of the last century. The term antiphospholipid syndrome (APS) was introduced in 1986 [1] to formalize the association of aPL with pregnancy loss, as well as with thrombotic events. Over a decade of subsequent international laboratory and clinical experience led to the development of an International Consensus Statement on preliminary criteria for definite APS published in 1999 [2]. There is widespread recognition, however, that refining the diagnostic criteria of APS is an ongoing process [3]. In this regard, no area has generated more controversies than obstetric APS, in part because of the substantial differences in patient selection for various studies. The purpose of this chapter is to critically analyze the relationship between aPL and obstetric problems, as well as to outline appropriate management strategies when aPL are found in association with pregnancy loss.