APLA positive pregancy with prior pregnancy losses.

Learn about APLA: What is line of management of patient with recurrent abortion with ANA and APL positivity??

APLA positive preg women should be energetically treated with with Unfractionated Heparin or  LMWH( Enoxaparin or Dalteparin-).

Following is the history of a woman under my care who  came at 20 weeks  after tree preg losses. This woman had one unexplained IUFD earlier without any anatomic abnormality of foetus, or PIH. ”Prior to that she had had two unexplained early preg losses and one IUFD at term   for which detailed investigations were  down at  a reputed Hospital at South India .They  advised to take LMWH & ecosprin as soon as cardiac activity was demonstrable in USG at about 5 weeks of preg by TVS. But due poor education, counseling ,poor economic status  and availably of heparin in nearby village  the coupe didn’t  comply with these valuable and just advices issued by South Indian doctors She reported to Ante OPD at  West  Bengal and  communicated us that they have  lost the prescriptions but reports were with them..

Now the solution:- Firstly LMWH/Heparin unfractionated should have been started earlier with Ecosprin 150 mg OD, These suppl were omitted in this case at a Block level community Health center, Now  it is our turn to treat her in 4^th Preg. Firstly we have to  verify at tertiary care center  whether these tests(ANA & aPL) done earlier  were done by  immunoflorescence.technology & what is the titre of   aPl, aCL, b2glycoprotein and la antibodies

The common brand names of Enoxaparin are Inj Lonopin, (Bharat serum): Inj LMWH (Nicholas):; Inj Exhep ( Emcure) & Inj Cute ox (Gland) In PFS=40 mg in 0,4 ml PFS .The Enoxaparin is expressed as 40 /60 mg and mostly dispensed by the companies as PFS.   : Similarly another LMWH titled daltepaparin may be used instead. This daltepaparin   are available in the market as  Inj Bearing 5000 IU as vial of 25,000 units or carping (amaranth) Inj Harbor( Elder).Even if possible to monitor adequately if she remind close to hospital then low cost Crude heparin derived from Porcine intestinal mucosa may be used : Brand names are Inj Hep, Multidose vial or Heparin) can be used in this case at the dose of 60 units daily  as LMWH along  with ecosprin  150 mg OD schedule. .. The same applies with steroids.->not to be used in APLA negative women.. In APLA negative only use spirit ( ASA) has shown some response.

There's no evidence for using LMWH in APLA

What  is Sjorgen’s Anti SSA and Anti SSB antibodies found in autoimmune disorders particularly Jorgen’s syndrome is an autoimmune disease characterized by dryness of the mouth and eyes. Autoimmune diseases feature the abnormal production of extra antibodies in the blood that are directed against various tissues of the body. The misdirected immune system in autoimmunity tends to lead to inflammation of tissues. . But presence of ANA +ve in isolation can cause oligohydramnios from 24 week .. She may have RPL due to ANA +ve alone. And one  IUFD which again may be due to ANA + passivity.

Management of isolated ANA +ve withhold APL positivity:--  to Manage it with ecosprin 75,lots of fluids orally, lycostar,alamine forte, proteins, rest in left lateral, argipreg  sachets. Follow such preg women with BOH with multibvessel Dopplet r twice weekly.Additinally routine tets if  to done earlier then can ve done Thyroid  status, PLBS(post lunch)  APLA, Level 2 scan from a good radiologist, B P status, Biweekly Doppler Muti vessel dopplerm,DFMC, CTG , AFI ,Antenatl coticostreoids, anticilate delivery at 30-34 weeks ant a highr center with good neonatal care facilities,.