ABSTRACT
This chapter briefly describes anti-phospholipid antibodies, discusses their proposed mechanism(s) of action, and outlines an approach to management of women with these antibodies. It focuses on the use of corticosteroid therapy in prevention of anti-phospholipid antibody-mediated fetal loss. Recurrent pregnancy loss, distressing to the mother and frustrating for the obstetrician, has undergone a revival of interest in recent years. The first stimulus to this revival was the recognition by Nilsson and co-workers in 1975 of an association between recurrent pregnancy loss and a circulating anticoagulant. This “anticoagulant”, an anti-phospholipid antibody now known as lupus anticoagulant, paradoxically is associated with thrombotic rather than hemorrhagic episodes and is considered to contribute to placental infarction and fetal death. The various autoantibodies that have been implicated in fetal loss include anti-phos-pholipid, antinuclear and anti-Ro antibodies. Recent evidence clears antinuclear antibodies from an association with fetal loss.
