Profilaxia e evolução clínica de gestantes com síndrome dos anticorpos antifosfolipídeos

Abstract

Antiphospholipid antibody syndrome is considered to be one of the principal causes of miscarriages. The objective of this study was to evaluate and compare with literature prophylaxis against miscarriages utilizing low doses of heparin and aspirin with emphasis on the clinical complications of the syndrome. In a prospective study, 34 gestations of women with histories of multiple miscarriages and positive levels of antiphospholipid antibodies were studied in the period from April 1998 to July 2004. These patients were compared with a control group of 40 gestations of women without history of miscarriages. Complications such as hypertensive disease in pregnancy, fetal growth restriction, oligohydramnios, premature separation of the placenta, prematurity and miscarriages were investigated. Serologic tests for anticardiolipin antibodies and lupus anticoagulant were also performed for all the women who had suffered from miscarriages. Diagnosis of anticardiolipin antibodies was achieved using the ELISA test. Investigation of the lupus anticoagulants was made by the partial activated thromboplastin time. Women with positive antiphospholipid antibodies were submitted to prophylactic treatment during the gestation using low doses of acetylsalicylic acid (100 mg/day) associated with low doses of subcutaneous heparin (5,000 IU twice daily). Statistical analysis was made using percentages, the Fisher exact test and the non-paired t-test. An alpha error of 0.05 was considered acceptable. The age range of the study group was from 17 to 41 years old and of the control group the ages varied from 18 to 36 years old. Three miscarriages (8.8%) occurred in the study group and none in the control group. Hypertensive disease specifically related to pregnancy, oligohydramnios and separation of the placenta were not associated to these antibodies. However, there was a correlation between the antibodies and intrauterine growth restriction, low birth weights and prematurity. In conclusion, prophylaxis is efficient in the prevention of miscarriages, however it does not prevent against low birth weights, prematurity and intrauterine growth restriction.