A woman with a history of fetal demise, an elevated anticardiolipin antibody titer, lupus anticoagulant but no evidence of systemic lupus erythematosus received anticoagulation with heparin in adjusted subcutaneous doses. Daily fetal monitoring demonstrated reactive nonstress tests and normal biophysical profiles initially. At 30 weeks' gestation, however, repeated spontaneous decelerations developed, and fetal bradycardia necessitated delivery. The combination of a poor obstetric history and the presence of high cardiolipin antibody titers requires close fetal surveillance. The benefits of anticoagulation in this setting deserve further study.
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