Anti-phospholipid syndrome (APS) recapitulates the link between autoimmunity and pregnancy failure: Acquired anti-phospholipid antibodies (aPL) play a pathogenic role in pregnancy complications. The diagnosis of obstetric APS can easily be pursued when women present with laboratory and clinical features fulfilling the international classification criteria. Standard therapeutic approach to obstetric APS consists in the association of anti-platelet agents and anticoagulants. Most patients achieve a live birth thanks to conventional treatment; however, approximately 20% fail to respond and are managed with additional therapeutic tools added on the top of conventional treatment. Surely, a refinement of risk stratification tools would allow early identification of high-risk pregnancies that warrant tailored treatment. In real life, obstetricians and rheumatologists face complex diagnostic scenarios including women with pregnancy morbidities other than those mentioned in classification criteria such as one or two early losses and premature birth after 34 weeks due to preeclampsia or placental insufficiency, women with low-titer aPL not fulfilling criteria laboratory requirements, women with positive non-criteria aPL, asymptomatic aPL carriers, and infertile women found to be aPL-positive. This review focuses on some of the several unanswered questions related to diagnostic, prognostic, and therapeutic aspects in obstetric APS.

中文翻译：

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抗磷脂抗体和生殖失败。

抗磷脂综合征 (APS) 概括了自身免疫与妊娠失败之间的联系：获得性抗磷脂抗体 (aPL) 在妊娠并发症中起致病作用。当女性出现符合国际分类标准的实验室和临床特征时，可以很容易地进行产科 APS 的诊断。产科 APS 的标准治疗方法包括联合使用抗血小板剂和抗凝剂。大多数患者通过常规治疗实现了活产；然而，大约 20% 的患者没有反应，在常规治疗的基础上增加了额外的治疗工具。当然，风险分层工具的改进将允许及早识别需要定制治疗的高风险妊娠。在真实生活中，产科医生和风湿病学家面临复杂的诊断情况，包括患有分类标准中未提及的妊娠疾病的女性，例如一两次早产和 34 周后由于先兆子痫或胎盘功能不全导致的早产，低滴度 aPL 的女性不符合标准实验室要求、具有阳性非标准 aPL 的女性、无症状的 aPL 携带者和被发现为 aPL 阳性的不孕女性。本综述重点关注与产科 APS 诊断、预后和治疗方面相关的几个未解决问题中的一些。