Thrombophilia and its impact on pregnancy

Summary

In recent years thrombophilia has gained much attention as a risk factor for pregnancy complications. Whereas there is an established correlation between antiphospholipid-antibodies and pregnancy loss, data for other risk factors of thrombosis are less well established. Data suggest associations with antithrombin deficiency, hyperhomocysteinemia and also with factor V Leiden, prothrombin G20210A variation and protein S-deficiency. The association of thrombophilia with pre-eclampsia is still under discussion. A limited number of prospective studies did not reveal an increased risk for pregnancy complications in unselected women with thrombosis risk factors. In a single study low molecular weight heparin seemed to have a positive effect on pregnancy outcome after previous single or recurrent abortions. Experience in prevention of pre-eclampsia by administration of prophylactic heparin is very limited. Data on pregnancy complications in women with known heritable thrombophilia or a history of thrombosis are inconsistent as well. These women usually have a favourable pregnancy outcome. Conclusion: Thrombophilia screening might be justified in women with pregnancy loss. Treatment with low molecular weight heparin might be considered for those with pregnancy loss and thrombophilia. Further prospective studies and controlled interventional trials are urgently needed.

Zusammenfassung

In den vergangenen Jahren hat die Thrombophilie als Risikofaktor für Schwangerschaftskomplikationen große Beachtung gefunden. Während der Zusammenhang mit Antiphospholipid- Antikörpern und Aborten als gesichert gilt, ist dies für andere Thromboserisikofaktoren noch in Diskussion. Daten über Antithrombinmangel, Hyperhomocystein - ämie, Faktor-V-Leiden-Mutation und Prothrombin- G20210A. Variation sowie Protein-S-Mangel in Zusammenhang mit Aborten liegen vor, die Assoziation mit der Präeklampsie wird diskutiert. Eine limitierte Anzahl von prospektiven Studien konnte das erhöhte Risiko zwischen Thrombophilie und Schwangerschaftskomplikationen nicht schlüssig nachweisen. Eine einzige randomisierte Interventionsstudie mit niedermolekularem Heparin bei Spätaborten ergab ein sehr positives Ergebnis hinsichtlich der Verabreichung von Enoxaparin. Daten über Schwangerschaftskomplikationen bei Frauen mit bereits bekannter Thrombophilie oder einer Vorgeschichte von Thrombosen sind ebenfalls nicht übereinstimmend hinsichtlich des Risikos für Aborte und Präeklampsie. Bei diesen Frauen ist jedoch im Allgemeinen mit einem positiven Schwangerschaftsergebnis zu rechnen. Schlussfolgerung: Primäres Thrombophilie- Screening bei Schwangeren ist zurzeit nicht indiziert. Die Prophylaxe mit niedermolekularem Heparin bei rezidivierenden Spätaborten (nach der 10. Schwangerschaftswoche) und vorhandener Thrombophilie soll in Erwägung gezogen werden. Weitere prospektive oder Interventionsstudien sind dringend notwendig.

Keywords

Thrombophilia - pregnancy - fetal loss - abortion - pre-eclampsia - stillbirth

Schlüsselwörter

Thrombophilie - Schwangerschaft - Fehlgeburt - Präeklampsie - Totgeburt

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