Antiphospholipid syndrome pregnancy — SCE Rheumatology MCQ

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ModeratePregnancy in Rheumatic Disease, Rare ConditionsAntiphospholipid syndrome pregnancySCE Rheumatology

A 29-year-old woman with obstetric antiphospholipid syndrome has had three early miscarriages and persistently positive lupus anticoagulant. She is now 7 weeks pregnant with no previous thrombosis. Platelets and renal function are normal. What is the most appropriate management?

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Correct answer: D — Low-dose aspirin plus prophylactic low molecular weight heparin

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

Low-dose aspirin plus prophylactic low molecular weight heparin is best because obstetric APS without prior thrombosis is commonly managed with low-dose aspirin and prophylactic LMWH during pregnancy. A is less suitable because aspirin only after delivery misses antenatal risk; B is less suitable because warfarin is teratogenic and generally avoided in pregnancy; C is less suitable because rivaroxaban is not used for APS pregnancy management; D is less suitable because waiting for thrombosis ignores established obstetric APS. Clinical pearl: pregnancy APS management differs from long-term thrombotic APS management.

Reference: BSH APS guideline 2024; BSR pregnancy and breastfeeding guideline 2022