Abstract

*Er-haymini Khalil, S. Ouakasse, N. Jeraf, A. Driouech, A. Ouzaa, F. Alilou M. H. Alami, Z. Tazi, A. Filali and R. Bezad

ABSTRACT

Antiphospholipid syndrome (APS) is responsible in its obstetric form for both maternal and fetal complications. It is then defined by the occurrence of at least three false sofas consecutive spontaneous before ten weeks of amenorrhea (WA), fetal death or birth premature before 34 WA related to preeclampsia, eclampsia, or severe placental insufficiency (intrauterine growth retardation, oligohydramnios). During pregnancy, APS can also appear complicate retroplacental hematoma, hemolysis syndrome, elevated liver enzymes, low platelet count (HELLP) and thrombosis which can sometimes form part of catastrophic antiphospholipid syndrome. A history of thrombosis or the presence of a circulating anticoagulant are predictors of complications during pregnancy. The management of these high-risk pregnancies is multidisciplinary (internist, anesthesiologist, obstetrician) and requires a consultation preconception in order to find the rare contraindications and to optimize the treatment. This one rest on aspirin combined with heparin, the dosage of which varies according to the patient's history. The duration of the therapeutic window around childbirth depends on the type of history but must be short in order to limit maternal risks in the postpartum period (thrombosis, HELLP, catastrophic syndrome). Clinical and biological monitoring is monthly, closer if necessary, at the end of pregnancy. Obstetric ultrasound with Doppler, performed regularly, looks in particular for the presence of notches on the uterine arteries which are predictive of an increased risk of complications placental vascular.