A Longitudinal Single-Patient Case Report on Antiphospholipid Syndrome and Alloimmunity Affecting Pregnancy Outcomes in Women

Abstract

Background: This report describes a single-patient longitudinal case followed over ten years. Pregnancy outcomes are often poor in women with antiphospholipid syndrome (APS) and alloimmune abnormalities. Optimal treatment remains controversial despite multiple diagnostic and therapeutic options. It describes the long-term clinical course and management of a woman enrolled in the program for over ten years with recurrent pregnancy loss associated with APS and alloimmunity.

Case Presentation: A 40-year-old multigravida woman (G4P0A3) presented at 9 weeks’ gestation with a history of three consecutive first-trimester miscarriages occurring between 8–10 weeks. The author had no significant medical or family history. Investigations revealed persistent lupus anticoagulant and elevated anticardiolipin IgG antibodies, fulfilling diagnostic criteria for APS. Additional testing demonstrated maternal anti-paternal HLA antibodies, suggesting an alloimmune contribution. Uterine artery Doppler showed increased resistance indices. A multidisciplinary team initiated low-dose aspirin and prophylactic low-molecular-weight heparin, with consideration of immunomodulatory therapy.

Nursing Intervention: Nursing care emphasized medication administration, monitoring for bleeding or thrombosis, maternal–fetal surveillance, and emotional support. Education focused on adherence, follow-up visits, and lifestyle modifications.

Outcome: The pregnancy progressed without major complications. Serial ultrasounds demonstrated appropriate fetal growth and improved placental perfusion. The patient delivered a healthy neonate at 37 weeks via elective cesarean section. Postpartum anticoagulation was continued for six weeks without adverse events. Despite multiple early pregnancy losses, two pregnancies resulted in live births following combined anticoagulant and immunomodulatory therapy. Subsequent delayed initiation of treatment was associated with fetal loss, highlighting the importance of early intervention.

Conclusion: APS combined with alloimmune factors is an under-recognized cause of recurrent pregnancy loss. Early diagnosis, individualized therapy, and coordinated multidisciplinary and nursing care are essential for improving maternal and fetal outcomes.