ABSTRACT
Recurrent pregnancy loss in any trimester in nonlupus patients probably is the most frequently encountered clinical presentation of the primary antiphospholipid syndrome. There is, sufficient scientific evidence to support the rationale for routinely screening antiphospholipid antibodies (aPL), namely, the lupus anticoagulant (LA) and anticardiolipin antibodies, in women with repeated abortion and/or fetal demise. The possibility that heparin may decrease the risk for placental thrombosis and subsequent fetal distress or loss in women with aPL enhances its attractiveness as a first line agent. The rationale for the use of immunosuppressive doses of prednisone is based on the original observation by C. L. Conley and R. D. Hartmann that adrenocorticotropic hormone suppresses LA activity. Immunoglobulins play a central role in immune regulation, and a wide spectrum of human diseases are associated with decreased or abnormal regulation of immunoglobulin levels. As intravenous immunoglobulin is expensive and plasmapheresis technically difficult, patients cannot be recommended as first-line therapy until definite data are available.
