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Obstetric antiphospholipid syndrome — DRCOG MCQ

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HardAntenatal CareObstetric antiphospholipid syndromeDRCOG

A woman planning pregnancy has had three miscarriages before 10 weeks and lupus anticoagulant remains positive on tests 12 weeks apart. Uterine imaging and parental karyotypes are normal. Which intervention offers the best evidence-based pregnancy plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Arrange specialist care using low-dose aspirin plus prophylactic heparin during pregnancy

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

D is correct. Recurrent early losses plus persistent lupus anticoagulant meet the clinical and laboratory pattern of obstetric antiphospholipid syndrome, for which low-dose aspirin combined with heparin in pregnancy improves the chance of success. E and A omit one component of the supported combination. B exposes the fetus to warfarin and is not the recurrent-miscarriage regimen. C ignores the causal thrombophilic diagnosis; progesterone has a separate role in selected bleeding pregnancies with previous miscarriage. Preconception review should also address thrombosis history, other antibodies and an individual antenatal monitoring plan.

Reference: RCOG Green-top Guideline No. 17: Recurrent miscarriage: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17/