I. Diagnosis.
1.Vascular embolism.
(1) Embolism confirmed by clinical event angiography, ultrasound, etc.
(2) Histopathologically confirmed vascular embolism without significant vessel wall inflammation.
2.Pathological pregnancy.
(1) 1 or more unexplained, morphologically normal fetuses confirmed by ultrasound or direct fetal examination at or beyond 10 weeks of gestation with intrauterine fetal death.
(2) 1 or more preterm deliveries due to preeclampsia or placental insufficiency at 34 weeks of gestation or less due to normal fetal morphology.
(3) 3 or more unexplained spontaneous abortions within 10 weeks of gestation, except for maternal anatomical and endocrine abnormalities and parental chromosomal abnormalities.
3. Laboratory.
ACA (2 or more times at 6 weeks interval), LAC, improved detection rate of ACA in patients with recurrent miscarriage, and routine addition of anti-β2-GP-1 antibody more specific.
At least 1 clinical criteria and 1 laboratory criteria above.
II. Treatment
1.Immunosuppressive therapy: persistent positive APA or persistent moderate to high level, prednisone 5mg/d (pregnancy class B drug), start dosing when pregnancy is determined, antibody turns negative 1-2 months can be considered to stop, if frequent positive dosing until the end of pregnancy.
2.Anticoagulation therapy – recognized effective treatment
(1) Aspirin: 25-75mg/d for platelet activation status (elevated platelet aggregation test or GMP-140).
(2) Low molecular heparin: hypercoagulable state with D-2 aggregates ≥ 1.0ug/ml, detect changes from the time of determination of pregnancy dosing until 3 days before delivery. The starting dose is 5000u/d and subsequent doses are adjusted according to the maintenance of D-2 aggregation levels at 0.2-0.4ug/ml. The general dosage is 5000U/d to every 8-12h by subcutaneous injection.
3.Specific regimen
(1) Aspirin for occasional positive ACA or with elevated platelet aggregation.
(2) Occasional positive ACA with hypercoagulable blood, apply low molecular heparin.
(3) Occasional positive ACA with elevated platelet aggregation and hypercoagulability, aspirin + low molecular heparin.
(4) Frequent positive or persistent positive ACA without elevated platelet aggregation and hypercoagulability, prednisone.
(5) Frequent positive or persistent positive ACA with elevated platelet aggregation, prednisone + aspirin.
(6) Frequent positive or persistent positive ACA with hypercoagulability, prednisone + low molecular heparin.
(7) Frequent positive or persistent positive ACA with elevated platelet aggregation and hypercoagulability, prednisone + aspirin + low molecular heparin.
III. About drugs
Aspirin: pregnancy class C drug, but small dose application is safe for pregnancy (less than 150mg/d), still be careful.
Heparin: does not pass through the placenta, no teratogenic effect on fetus, during application, check D-2 specific and APTT every 2-4 weeks, if it is less than 0.3mg/L, or APTT prolonged 1.5 times stop the drug; clinically, it is mostly used after pregnancy is confirmed, not before pregnancy, it lasts until delivery; in addition, heparin is easy to cause osteoporosis, for prevention, women under treatment should take daily calcium 1000mg/d and 600IU of vitamin D.