Treatment of pregnancy complications

Pregnancy morbidity and vascular thrombosis provide the clinical manifestations of the antiphospholipid syndrome (APS), a chronic autoimmune condition serologically characterized by the positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of the treatment of obstetric APS. However, the debate is still open: controversies involve the management of rare aPL-mediated obstetric complications, the treatment of vascular manifestations, and the treatment of refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. In addition, no treatment trial has ever investigated the optimal treatment of aPL women stratifying upon the different risk profile (aPL profile, associated autoimmune disease, previous obstetrical history). The recommended therapeutic managements of different aPL-related obstetrical clinical manifestations are hereby presented, with a critical appraisal of the evidence supporting each approach.