Dr. Guinto answers questions about APAS

This transcript is found in my book, Lost but Found as an appendix. My doctors, Dr. Valerie Guinto and Dr. Carol Gloria, have been most gracious in sharing their expertise about APAS and RID/RIF.

Hope you can support my book and share with women who may be suffering from recurrent pregnancy losses. You can get my book here. 

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In this interview, my obstetrician and perinatologist, Dr. Valerie Tiempo Guinto sheds light on APAS/APS. 

Dr. Valerie Tiempo Guinto is the Chief of Maternal-Fetal Medicine Section at the University of the Philippines-Philippine General Hospital. She was also the President of Philippine Society of Maternal Fetal Medicine in 2017 and is the Head on the Task Force on Recurrent Pregnancy Loss of the Philippine Obstetrical and Gynecological Society.

  1. What is APAS? 

Antiphospholipid antibody syndrome or APAS or APS is an acquired condition wherein the individual’s immune system harmfully reacts to the individual’s own body or self, manifesting clinically as increased clotting in the veins and in the arteries and/or pregnancy loss. The clots may break and get thrown to the circulation and affect major organ systems such as the brain, the kidneys, and the lungs. In pregnancy, it can cause repeated miscarriages or stillbirth.

  1. How prevalent is APAS in the Philippines? 

We do not know the exact number for this in the Philippines, although in my practice as a maternal-fetal medicine specialist/perinatologist, I see many mothers afflicted by this condition. According to international studies, it can affect up to twenty percent to forty percent of women who had at least two miscarriages.

  1. How is a person diagnosed with APAS? 

The diagnosis of APAS rests on documentation of the presence of two criteria: clinical and laboratory. For the clinical criteria, there should be at least one episode of a thromboembolic disorder (increased clotting and clots thrown in the circulation causing damage to organ systems) and/or problems in previous pregnancies, such as severe preeclampsia causing premature delivery of a baby, growth restricted babies, stillbirth, or repeated miscarriage. For the laboratory criteria, at least one of the prescribed laboratory tests should be positive.

  1. What are the symptoms of APAS?

People who have APAS have problems with increased clotting, which may manifest as stroke (usually before forty years old) if it’s the brain that was involved.  There may also be problems with the lungs and other organs like the kidneys, after they are subjected to conditions that would further increase clotting such as immobility, long hours of air travel, and the presence of a chronic disease or pregnancy. In pregnancy, the pregnant woman may develop preeclampsia or hypertension in pregnancy early or before the eighth month of pregnancy, repeated miscarriage, stillbirth, or growth restriction. The association of APAS with infertility, however, is still controversial.

  1. How is APAS treated? 

Thorough evaluation of the medical condition is done prior to pregnancy and involved organ systems are treated first before trying for pregnancy. While trying for pregnancy, low dose aspirin is started. Once pregnant, further anticoagulant treatment is given. In some cases, some other immunologic treatment administered by reproductive immunologists is given to further control the condition. In the baby, the pregnancy is closely monitored by fetal surveillance techniques done by maternal-fetal medicine specialists/perinatologists to see complications as they develop. These are addressed accordingly. The pregnancy is pushed to term or as close to term as possible to improve the outcome of the pregnancy. Delivery may be through vaginal or caesarean section depending on the mother’s and the baby’s conditions.

  1. Who manages an APAS pregnancy? 

APAS is a condition needing multi-specialty care. The maternal-fetal medicine specialists/perinatologists are trained to work-up before and after conception and manage women and their babies with this condition from before conception to after delivery. Maternal-fetal medicine specialists/perinatologists went through five years of medical training, four years of residency in obstetrics and gynecology, two years of subspecialty training in maternal-fetal medicine and have passed rigid examinations (written, oral, and practical examinations) to qualify as subspecialists in the practice of high-risk pregnancies. They work closely with the reproductive immunologists who administer the immunologic treatment and help control the condition in the mother.  Other specialties involved are rheumatologists (when there are connective tissue diseases such as systemic lupus erythematous), geneticists, reproductive medicine/infertility specialists (when there is infertility), other specialties in internal medicine, nutritionists, and other allied medical professionals.

Hope this helps, loves! Dr. Guinto holds clinic at Asian Hospital, St. Lukes BGC, and in Joshua Clinic near PGH. Join the APAS and RID Facebook Support Group to check her latest clinic schedule.

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