A systematic analysis of the data available in the modern literature on the microangiopathic antiphospholipid syndrome (APS) and other variants of the development of thrombotic microangiopathy (TMAP), incl. HELLP-syndrome and preeclampsia, up to 20 weeks of gestation, options for management of such pregnancies and the risks of obstetric complications in patients with APS was performed. A description of 2 clinical cases of various microangiopathic APS in obstetric practice, complicated by the development of HELLP-syndrome up to 20 weeks of gestation, is presented. These cases not only demonstrate the possibility of HELLP-syndrome debut before the 20th week of pregnancy, but also the development of HELLP-syndrome with a normal Sflt1/PLGF level, which seems to confirm the apartness of HELLP-syndrome from pre-eclampsia. In both cases, positivity for all three groups of main antiphospholipid antibodies was registered, which initially increased the risk of obstetric complications, despite the adequacy of treatment. The need to isolate a microangiopathic APS is confirmed by the danger of development of all cases of TMAP signs in APS patients: the risk of TMAP generalization up to the catastrophic APS is unreasonably high. Only the use of heparins (including low molecular weight heparins) in combination with acetylsalicylic acid can be considered as the “gold” standard for the management of such patients. Addition of hydroxychloroquine may improve the outcome of such pregnancies, which requires confirmation in large multicenter studies.

Keywords: antiphospholipid syndrome, microangiopathic antiphospholipid syndrome, thrombotic microangiopathy, HELLP-syndrome, pre-eclampsia, catastrophic antiphospholipid syndrome