Neonatal lupus risk — SCE Rheumatology MCQ

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HardPregnancy and rare rheumatic diseaseNeonatal lupus riskSCE Rheumatology

A woman with persistent lupus anticoagulant has had three miscarriages before 10 weeks, no previous thrombosis and no other cause of pregnancy loss. She is now six weeks pregnant. What antithrombotic regimen is recommended?

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Correct answer: B — Prophylactic LMWH plus low-dose aspirin

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

B is correct. This is criteria obstetric APS without prior thrombosis; standard management combines low-dose aspirin with prophylactic LMWH, then reassesses postpartum thrombosis risk. A exposes the fetus to warfarin embryopathy. C undertreats established obstetric APS. D uses a DOAC without evidence and with pregnancy concerns. E unnecessarily escalates heparin and incorrectly labels aspirin contraindicated. The exact LMWH product and duration are agreed with maternal medicine, but the aspirin-plus-prophylactic-heparin principle is the discriminating point.

Reference: EULAR recommendations for management of antiphospholipid syndrome: https://ard.bmj.com/content/78/10/1296