When should fetal surveillance with serial ultrasounds begin for patients with antiphospholipid syndrome in pregnancy?

For patients with antiphospholipid syndrome (APS) in pregnancy, fetal surveillance with serial ultrasounds is typically recommended to begin around 32 weeks. This timing is important because women with APS are at an increased risk for complications such as placental insufficiency, preterm birth, and fetal growth restriction, which can affect fetal wellbeing.

Starting fetal surveillance at 32 weeks allows for timely intervention if growth or well-being concerns arise. By this point in the pregnancy, the placenta plays a crucial role in fetal health, and it's critical to monitor its function and the growth of the fetus. If placental problems are detected early enough, healthcare providers can take necessary measures to optimize outcomes for both the mother and the baby.

Delaying surveillance until later in the pregnancy, such as at 34 or 36 weeks, would potentially miss crucial opportunities to address these issues, leading to increased risks for adverse outcomes. Conversely, starting fetal surveillance too early, such as at 30 weeks, may not provide a significant advantage since most fetal assessments focus on the later stages of gestation when fetal growth patterns can be more accurately evaluated.