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Obstetric APS — RACP Adult Medicine MCQ

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ModerateRheumatologyObstetric APSRACP Adult Medicine

A 28-year-old woman has obstetric APS (three consecutive early miscarriages). She has lupus anticoagulant and anti-cardiolipin antibodies confirmed on two occasions 14 weeks apart. She is not currently pregnant but wishes to conceive. What is the most appropriate management during the next pregnancy?

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Correct answer: E — Aspirin alone

For obstetric APS without prior thrombosis, low-dose aspirin (commenced pre-conception) is the standard management. If this fails, prophylactic-dose LNMWH is added. Warfarin is teratogenic and contraindicated in the first trimester. Hydroxychloroquine may be considered as adjunctive therapy given its antithrombotic properties.

Reference: EULAR – 2019 – APS Guidelines; RCOG 2024 – Recurrent Miscarriage