الفهرس 
THE IMMUNE SYSTEMOnly 14 pages are availabe for public view
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Abstract
The most common clinical manifestations of Antiphospholipid antibody syndrome (APS) are recurrent fetal loss, venous or arterial thrombosis, and autoimmune thrombocytopenia. Women with these clinical features should be tested for lupus anticoagulant (LAC) and anticardiolipin (aCL) antibodies; most patients with APS have both LAC and aCL immunoglobulin G (IgG) antibodies. The diagnosis of APS requires the presence of both clinical and biological features.
APS increases the risk for maternal and fetal morbidity and fetal mortality in pregnancy. The rate of fetal loss may exceed 90% in untreated patients who have APS. Therapy (including aspirin and heparin) can reduce the rate of fetal loss to 25%.
APS is also associated with infertility and pregnancy complications such as spontaneous abortions, prematurity, stillbirths and Pregnancy-induced hypertension (PIH) with high risk for preterm delivery.
In the present work we assessed the pattern of Antiphospholipid antibody syndrome patients in Maternity Hospital of Ain shams universty during the period of the last five years and the awareness of the physicians as regard their knowledge of this syndrome.
All hospital files during that period were reviewed to select any case of antiphospholipid syndrome (APS) (those were found to be 90 cases of APS).
In our study the incidence of APS with pregnancy in Ain Shams Maternity Hospital during the last 5 years (from Jan 2004 to Jan 2009) was 13 per 10000 cases 0.13%.
Patients had mean age 24 years old with low parity and high abortion rates, with no contraception before. They were admitted due to complications of APS with pregnancy such as Abortions, Preeclampsia, Vascular Thrombosis and Preterm labour.
Pregnancy loss rates were high during first admissions at an earlier gestational age, while readmissions had led to better control of the condition and there were higher rates of live births and less complication.
We found that 61(67.8%) of cases had previous abortions and 33 (36.7%) patient had 3 or more abortions (recurrent abortion).
The medical files contained good obstetric history and examination, but APS clinical manifestations were mentioned only in 67.7% of medical records. Thromboembolic manifestations were recorded in 20 mediccal record (22.2%), while cutaneous manifestations were recorded in 17(18.8%) files, neurological manifestations were recorded in 2(2.2%) files, and 3(3.3%) files mentioned hematological disorder, 10(11.1%)files contain arthrites/arthalagia and 8(8.8%) files mentioned serositis manifistation.
IUGR was found in more than half of the cases and 2 cases had IUFD. CS was the most common mode of delivery the incidence of maternal ICU and neonatal ICU admissions were 20% and 59.6% respectively.
In our study we found that 100% of patients received aspirin and either (UFH) or (LMWH).
Also we assessed the awareness of 50 obstetricians who were willing to participate in the study and answered our questionnaire which assesses the knowledge as regard APS. The awareness of the obstetricians was good as regard APS with variable fluctuations among them.
The study found that there was a significant difference between pregnancy outcomes on admission and readmission with better results on readmission, Also there is highly significant association between APS with SLE and fetal outcome.
We found also a significant relation between obstetrician’s awareness and maternal and fetal outcome.