الفهرس 
Systematic review&evidence based medicineOnly 14 pages are availabe for public view
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Abstract
Antiphospholipid antibody syndrome (APS) is an autoimmune disease that had been given special attention recently as it is claimed to be responsible for many medical disorders and also because its etiology is still questionable so that these autoantibodies may be discovered in the absence of definite cause for their formation.
Although this syndrome affects multiple organs, however its effects on female reproductive functions especially recurrent abortions, preeclampsia and vascular thrombosis are the commonest morbidities encountered by female health care providers.
Therefore researches had been directed towards this kind of systematic reviews which address certain questions concerned with female reproductive health especially obstetric implications (pregnancy &labor) and answering these questions through analysis of data extracted from previous studies.
This type of research helps to analyze results obtained from previous studies through certain search strategy aiming at answering these questions to help setting evidence based protocol regarding best diagnostic and treatment modalities for this syndrome.
Therefore 3 questions were formulated to tackle each of the three points of debate:
1-Is there clear causal relationship between APS and obstetric morbidities as recurrent fetal loss and preeclampsia?
2-What are the best diagnostic modalities (both clinical and laboratory) for this syndrome?
3-What is the best treatment option?
In order to answer these questions navigation through the internet, visiting websites as: Pub med, Science direct, Cochrane collaboration database, Google, Yahoo, using certain keywords searching for studies published during last 15 years concerned with that syndrome.
This was followed by identification of large number of studies which were considered potentially relevant from which those fulfilling the inclusion criteria were considered eligible. Data were extracted from these studies, summarized, tabulated clearly and analyzed to help answering the suggested questions.
Results obtained from that review concluded that:
a) Regarding APS, recurrent fetal loss:
There is clear relationship between RFL and APS especially lupus anticoagulant and anticardiolipin.
b) Regarding APS,preeclampsia:
There is no evidence basis denoting causal relationship between APS and preeclampsia
c) For diagnosis of APS:
International agreement upon use of ”Revised Sapporo criteria ”for diagnosis as follows:
Antiphospholipid antibody syndrome (APS) is present if at least one of the clinical criteria and one of the laboratory criteria that follow are met:-
Clinical criteria
1. Vascular thrombosis:-
One or more clinical episodes of arterial, venous, or small vessel thrombosis, in any tissue or organ.
2. Pregnancy morbidity
(2a) One or more unexplained deaths of a morphologically normal fetus at or beyond the 10th week of gestation, with normal fetal morphology documented by ultrasound or by direct examination of the fetus
(2b) One or more premature births of a morphologically normal neonate before the 34th week of gestation because of:
(v) eclampsia or severe preeclampsia defined according to standard definitions,
(vi) recognized features of placental insufficiency
(2c) three or more unexplained consecutive spontaneous abortions before the 10th week of gestation, with maternal anatomic or hormonal abnormalities and paternal and maternal chromosomal causes excluded
Laboratory criteria:-
1. Lupus anticoagulant (LA) present in plasma, on two or more occasions at least 12 weeks apart, detected according to the guidelines of the International Society on Thrombosis and Haemostasis (Scientific Subcommittee on LAs/phospholipid-dependent antibodies)
2. Anticardiolipin (aCL) antibody of IgG and/or IgM isotype in serum or plasma, present in medium or high titer (i.e. >40 GPL or MPL, or >the 99th percentile), on two or more occasions, at least 12 weeks apart, measured by a standardized ELISA.
3. Anti- β2 glycoprotein-I antibody of IgG and/or IgM isotype in serum or plasma (in titer >the 99th percentile), present on two or more occasions, at least 12 weeks apart, measured by a standardized ELISA, according to recommended procedures.
Diagnosis of APS should be taken cautiously if less than 12 weeks or more than 5 years separate the positive aPL test and the clinical manifestation.
d) As for treatment:
Heparin combined with low dose aspirin (81 mg) was shown to reduce the incidence of pregnancy loss, this effect was obtained when using either low molecular weight heparin (LMWH) or unfractionated heparin (UFH) with continous follow up of that pregnancy by experienced obstetrician as pregnancy in the presence of this syndrome is considered highly risky.
Finally, the review recommends more researches especially those concerned with the causal relation between APS and preeclampsia, and those handling comparison between LMWH and unfractionated heparin.