A Challenging Case of Recurrent Pregnancy Loss with Suspected Antiphospholipid Syndrome Managed Successfully

Dr. Syeda Sana Ali*, Dr. Manal Ibrahim Sabbar¹, Dr. Ikran Adan²

1. MBChB, MRCOG, CABOG, Consultant Obstetrician and Gynecologist, Al Tadawi Specialty Hospital, Dubai, UAE.

2. MBChB, MRCOG, MSc (Obs/Gynae), Specialist Obstetrician and Gynecologist, Al Tadawi Specialty Hospital, Dubai, UAE.

*Correspondence to: Dr. Syeda Sana Ali, MBBS, FCPS, MRCOG, Fellowship in IVF and reproductive medicine, Specialist Obstetrician and Gynecologist, Al Tadawi Specialty Hospital, Dubai, UAE.

Copyright                          

© 2026 Dr. Syeda Sana Ali, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 06 January 2026

Published: 01 February 2026

DOI: https://doi.org/10.5281/zenodo.19366436

Abstract

A 41-year-old gravida 5 para 1 with three miscarriages and one stillbirth was managed for suspected antiphospholipid syndrome (APS).

Early diagnosis, antithrombotic therapy, and vigilant follow-up resulted in a healthy live birth.      This case illustrates how individualized, evidence-based care can transform outcomes in high-risk pregnancies.

Introduction
Antiphospholipid syndrome (APS) is an autoimmune condition characterised by recurrent pregnancy loss, thrombosis, and persistently elevated antiphospholipid antibodies. Early diagnosis is crucial because timely initiation of low-dose aspirin and low-molecular-weight heparin significantly improves maternal and fetal outcomes. However, APS can present with subtle clinical features in early pregnancy, making recognition challenging. In particular, abnormal β-hCG rises, early bleeding, and ultrasound changes can mimic non-viable pregnancy, ectopic pregnancy, or early growth restriction, delaying intervention.

This case highlights the importance of early recognition, structured evaluation, and timely treatment.                                                                               

Case Presentation

The patient (41 years, G5P1A3) presented at five weeks and six days of gestation with a history of three first-trimester miscarriages (after fetal heartbeat) and one stillbirth at 24 weeks. She denied vaginal bleeding or systemic symptoms. During her most recent pregnancy she developed severe oligohydramnios and reversed umbilical-artery flow, leading to intrauterine fetal demise at 27 weeks.

Anticardiolipin IgG = 1.163 ; IgM = 1.499. β2-glycoprotein and lupus anticoagulant were not tested owing to insurance limits, but a clinical diagnosis of APS was made.

Management and Follow-up

At 5 weeks and a few days (positive UPT), the patient began folic acid and aspirin 150 mg OD. After confirmation of fetal cardiac activity, enoxaparin 4000 IU SC OD was initiated.

Serial growth scans, AFI, and Doppler studies were performed throughout pregnancy.

At 34 weeks the fetus was breech with a borderline AFI of 8.8 cm, and the patient developed diet-controlled gestational diabetes mellitus. So, in view of her history, borderline AFI 8.8 cm, age, and footling breech presentation, an elective lower-segment cesarean section after steroid cover was performed at 37 weeks, resulting in the delivery of a female infant weighing 2390 grams.

Both mother and baby recovered well, and enoxaparin was continued for 6 weeks  postpartum.

Results

Treatment achieved a 100 % live-birth rate compared with 20 % before therapy. Fetal growth and maternal stability were maintained throughout the third trimester.

Discussion

APS accounts for up to 15 % of recurrent miscarriages. Combined aspirin + LMWH therapy significantly reduces pregnancy loss [1–3]. Even when full laboratory confirmation is unavailable, empirical therapy in high-risk cases is justified [4, 5].

This case highlights the benefits of early screening, multidisciplinary care, and individualized follow-up in optimizing pregnancy outcomes.

Conclusion

Timely diagnosis, prophylactic antithrombotic therapy, and structured monitoring can yield successful outcomes in suspected APS, even among women with recurrent loss and poor obstetric history.

Acknowledgment

The authors thank the Department of Obstetrics and Gynecology, Al Tadawi Specialty Hospital, Dubai, for clinical and institutional support throughout case management and manuscript preparation.