Journal Health of Woman. 2026. 2(183): 134-140. doi: 10.15574/HW.2026.2(183).134140
Duka Yu. M.
Dnipro State Medical University, Ukraine

For citation: Duka YuM. (2026). Successful pregnancy management in triple-positive antiphospholipid syndrome with an adverse obstetric history: a case report. Ukrainian Journal Health of Woman. 2(183): 134-140. doi: 10.15574/HW.2026.2(183).134140
Article received: Dec 13, 2025. Accepted for publication: Mar 22, 2026.

Antiphospholipid syndrome is the most common immune-mediated thrombophilia, with obstetric complications including recurrent early miscarriages and placental dysfunction, which can manifest as intrauterine fetal death, preterm delivery, intrauterine growth restriction, and/or the development of preeclampsia (PE).
Aim – to analyze the effectiveness of timely, pathogenetically substantiated, step-by-step secondary prevention in a patient with primary obstetric syndrome complicated by late twin miscarriage, based on the assessment of her pregnancy and the postpartum period.
Clinical case. A woman sought medical consultation after the loss of her first pregnancy at 21 weeks of gestation. During the examination, «non-criterion» polymorphisms of thrombophilia genes were detected, protein S activity was reduced to 27.5% and triple positivity for antiphospholipid antibodies was identified: IgG to cardiolipin – >120 U/ml, IgM and IgG to β₂-glycoprotein І – >200 U/ml and lupus anticoagulant 70.7 s, which indicated an extremely high risk of thromboembolic complications. Pregnancy occurred against the background of acetylsalicylic acid (ASA) therapy in combination with low molecular weight heparin (LMWH) and pregravid cofactor vitamin therapy. During pregnancy, the patient received LMWH at a therapeutic dosage, ASA at a dose of 100 mg/day, hydroxychloroquine 200 mg/day. According to the results of the first-trimester combined screening with PE risks calculation, the woman was classified into the low-risk group for its development. At 19-22 and 32-33 weeks of gestation, the soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio was evaluated. The pregnant woman was classified into the low-risk group for early PE and the extremely high-risk group for late PE. Consequently, sFlt-1/PlGF assessment after 32 weeks were performed every 2 weeks. Delivery took place at 39 weeks, spontaneously, in vertex presentation, without complications. A girl was born weighing 2350 g, with a lenght 49 cm, and an Apgar score of 7/7.
Conclusion. This clinical case is a vivid example of how individualized, timely, and adequate prophylactic therapy, started at the pregravid stage and targetedly adjusted during the gestational process, can effectively prevent placenta-associated complications, even in a patient with a burdened obstetric history and an extremely high risk of thromboembolic complications. Moreover, this case confirms the necessity and feasibility of using the entire modern diagnostic arsenal available in Ukraine to predict "major" obstetric syndromes, which currently show no downward trend.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The woman's informed consent was obtained for the study.
The author declares no conflict of interest.
Keywords: pregnancy, late miscarriage, twins, antiphospholipid syndrome, triple positivity, thrombophilia, placental dysfunction, prevention, treatment.

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