Treatment for woman c/o APLA with previous history of still births and abortions?
|A|| Aspirin only|
|B|| Aspirin + low mol. Weight Heparin|
|C|| Aspirin + low mol. Weight Heparin + prednisolone|
(Ref: H 17th - Pg 2082)
Special Conditions in SLE that May Require Additional or Different Therapies
Pregnancy and Lupus
1. Fertility rates for men and women with SLE are normal.
2. Rate of fetal loss is increased (approximately two- to threefold) in women with SLE.
3. Fetal demise is higher in mothers with high disease activity, antiphospholipid antibodies, and/or nephritis. Suppression of disease activity can be achieved by administration of systemic glucocorticoids.
4. A placental enzyme, 11--dehydrogenase 2, deactivates glucocorticoids; it is more effective in deactivating prednisone and prednisolone than the fluorinated glucocorticoids dexamethasone and betamethasone.
5. Therefore, maternal SLE should be controlled with prednisone/prednisolone at the lowest effective doses for the shortest time required.
6. In SLE patients with aPL (on at least two occasions) and prior fetal losses, treatment with heparin (standard or low-molecular-weight) plus low-dose aspirin has been shown in prospective controlled trials to increase significantly the proportion of live births.
7. An additional potential problem for the fetus is the presence of antibodies to Ro, sometimes associated with neonatal lupus consisting of rash and congenital heart block.
8. The latter can be life-threatening; therefore the presence of anti-Ro requires vigilant monitoring of fetal heart rates with prompt intervention (delivery if possible) if distress occurs.