How do I interpret the results of antiphospholipid antibody testing in a patient with recurrent miscarriages?

For a patient presenting with recurrent miscarriages (defined as three or more first-trimester miscarriages), referral for investigation and management is recommended ¹. As part of this investigation, pre-conception screening for antiphospholipid antibodies, specifically lupus anticoagulant and anticardiolipin antibodies, should be offered ¹,².

Interpretation of results:

• If antiphospholipid antibodies are found, this indicates that treatment with aspirin plus heparin will be considered in future pregnancies, continuing until at least 34 weeks of gestation ¹.
• The interpretation of thrombophilia screen results, including antiphospholipid antibodies, should be undertaken by clinicians with expertise in this area ².
• Women who have experienced recurrent miscarriage should be managed by a person with the necessary skills and expertise, and offered referral to a specialist clinic ².

Further considerations:

• Antiphospholipid syndrome is also identified as an autoimmune disease that places pregnant women at high risk of pre-eclampsia, for which daily aspirin (75 mg to 150 mg) from 12 weeks until birth is advised ⁴.