Download PDF
Hamostaseologie 2000; 20(01): 77-82
DOI: 10.1055/s-0037-1619472
Original article
Schattauer GmbH

Schwangerschaft und Thrombophilie

Pregnancy and Thrombophilia
L. Heilmann
1   Abt. Gynäkologie und Geburtshilfe, Stadtkrankenhaus Rüsselsheim (Leitung: Prof. Dr. L. Heilmann)
› Author Affiliations
Further Information

Publication History

Publication Date:
22 December 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

In der Schwangerschaft führen eine Reihe von erworbenen und angeborenen thrombophilen Faktoren zu einem komplikativen Schwangerschaftsausgang. Darüber hinaus ist erwiesen, daß thrombophile Faktoren ein zusätzliches Risiko darstellen, aufgrund dessen sich eine höhere Inzidenz von Präeklampsien, intrauterinem Fruchttod und wiederholtem Spontanabort ergeben kann.

Summary

In a number of adverse pregnancy outcome including preeclampsia, recurrent spontaneous abortion, restricted fetal growth and fetal death a role for thrombophilia (acquired and hereditable) has been postulated. Monitoring of acquired factors such as antiphospholipidantibodies and hereditable factors (factor V Leiden, prothrombin mutation) may help predict the occurrence of pregnancy complications.

Schlüsselwörter

Schwangerschaft - Thrombophilie - Thrombose - Präeklampsie - wiederholter Abort

Keywords

Pregnancy - thrombophilia - deep vein thrombosis - preeclampsia - recurrent abortion
 

  • Literatur

  • 1 Backos M, Chilcott I, Ray R, Regan L. Pregnancy complications in women with recurrent miscarriage and antiphospholipid-antibodie treated with aspirin and heparin. Hum Reprod 1997; 12: 61.
    PubMedGoogle Scholar
  • 2 Bertina RM, Koeleman BCC, Koster T, Rosendaal FR, Dirven RJ, deRonde H, van der Velden PA, Reitsma PH. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 1994; 369: 64-7.
    CrossrefPubMedGoogle Scholar
  • 3 Bockarewa MI, Bremme K, Blombäck M. Arg 506-GLn mutation in factor V and risk of thrombosis during pregnancy. Br J Haematol 1996; 92: 473-78.
    CrossrefPubMedGoogle Scholar
  • 4 Brenner B, Blumenfeld Z. Thrombophilia and fetal loss. Blood Rev 1997; 11: 72.
    CrossrefPubMedGoogle Scholar
  • 5 Brenner B, Lanier N, Tahler I. HELLP syndrome associated with factor V R 506 Q Mutation. Br J Haematol 1996; 92: 999.
    CrossrefPubMedGoogle Scholar
  • 6 Brenner B, Sarig G, Weiner Z, Youmis J, Blumenfeld Z, Lanir N. Thrombophilic polymorphismus are common in women with fetal loss without apparent cause. Thromb Haemost 1999; 82: 6-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Clark AL, Branch DW, Silver RM. et al. Pregnancy complicated by the antiphospholipid syndrome: Outcomes with intravenous immunoglobulin therapy. Obstet Gynecol 1999; 93: 437.
    PubMedGoogle Scholar
  • 8 Conard J, Horellou MH, van Dreden P, Lecomte T, Samama M. Thrombosis and pregnancy in congenital deficiencies in ATIII, protein C or protein S. Thromb Haemost 1990; 63: 319-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Conard J, Horellou MH, van Dreden P, Samama M. Pregnancy and congenital deficiency in antithrombin III or protein C. Thromb Haemost 1987; 58: 39.
    PubMedGoogle Scholar
  • 10 Cook G, Walker D, Mc Call F. Familiar thrombophilia and activated protein C resistance – thrombotic risk in pregnancy ?. Br J Haematol 1994; 87: 873-5.
    CrossrefPubMedGoogle Scholar
  • 11 Cumming AM, Tait RC, Fildes S, Young A, Keeney S, Hay CRM. Development of resistance to activated protein C during pregnancy. Br J Haematol 1995; 90: 725.
    CrossrefPubMedGoogle Scholar
  • 12 De Stefano V, Mastrangelo S, Paciaroni K, Ireland M, Lane DA, Scirpa P, Bizzi B, Leone G. Thrombotic risk during pregnancy and puerperium in women with APC resistence – effective subcutaneous heparin prophylaxis in a pregnant patients. Thromb Haemost 1995; 74: 793-4.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 De Vries JIP, Dekker GA, Huijgens PC. Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies. Br J Obstet Gynaecol 1997; 104: 1248.
    CrossrefPubMedGoogle Scholar
  • 14 Dekker GA, de Vries JP, Doelitsch PM, Huijens PC, von Blomberg B ME, van Geijn HP. Underlying disorders associated with severe early onset preeclampsia. Am J Obstet Gynecol 1996; 173: 1042.
    PubMedGoogle Scholar
  • 15 DeSwiet M. Thromboembolic disease. In: James DK. et al. High risk pregnancy. Saunders WP; 1999
    Google Scholar
  • 16 Dilley A, Hopper W, Janil ME, Austin H, Evatt R, Philipp CS. The role of four coagulation genes in thrombosis during pregnancy: Factor V Leiden, Prothrombin 20210, MTHFR, ACE. Thromb Haemost 1999; 82 (Suppl. 01) 227.
    PubMedGoogle Scholar
  • 17 Dizon-Townson DS, Nelson LM, Easton K, Ward K. The factor V Leiden mutation may predispose women to severe preeclampsia. Am J Obstet Gynecol 1996; 175: 902.
    CrossrefPubMedGoogle Scholar
  • 18 Doggen CJM, Kunz G, Rosendaal FR. A mutation in the thrombomodulin-gen, 127 G to A loading for Ala25Thr and the risk myocardial infarction in men. Thromb Haemost 1998; 80: 743.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Eldor A, Kupferminc MJ, Steinmann N, Many A, Bar-Am A, Jaffa A, Fait G, Lesing JB. LMW Heparin during pregnancy for women with previous obstetric complications and thrombophilia. Thromb Haemost 1999; 82 (Suppl. I): 58.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Friederich PW, Samson BJ, Simioni P, Zanardi S, Huisman MV, Kindt I, Prandoni P, Büller HR, Girolami A, Prins MH. Frequency of pregnancy related thromboembolism in anticoagulant factor deficient women: Implications for prophylaxis. Ann Int Med 1996; 125: 955-60.
    CrossrefPubMedGoogle Scholar
  • 21 Gerhardt A, Zotz RB, Struwe S, Maruhn-Delowski B, Beckmann MW, Bender HG, Scharf RE. Predictors of thrombosis in pregnancy and puerperium. Thromb Haemost 1999; 82 (Suppl. I): 226.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Girling J, deSwiet M. Inherited thrombophilia and pregnancy. Current Opinion Obstet Gynecol 1998; 10: 135-44.
    PubMedGoogle Scholar
  • 23 Grandone E, Margaglione M, Colaizzo D. Factor V Leiden, C >T MTHFR Polymorphismus and genetic susceptibility to preeclampsia. Thromb Haemost 1997; 77: 1052.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Grandone E, Margaglione M, Colaizzo D. Prothrombotic genetic risk factors and the occurrence of gestational hypertension with or without proteinuria. Thromb Haemost 1999; 81: 349.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Greer IA. Epidemiology, risk factors and prophylaxis of venous thromboembolism in obstetrics and gynecology. Bailliers Clin Obstet Gynecol 1997; 11: 403-30.
    PubMedGoogle Scholar
  • 26 Hallak M, Senderowicz J, Cassel A, Shapira Ch, Agkai E, Auslender R, Abramovici H. Activated protein C resistance (factor V Leiden) associated with thrombosis in pregnancy. Am J Obstet Gynecol 1997; 176: 889-93.
    CrossrefPubMedGoogle Scholar
  • 27 Hellgren M, Svensson PJ, Dahlbäck B. Resistance to activated protein C as a basis for venous thromboembolism associated with pregnancy and oral contraceptives. Am J Obstet Gynecol 1995; 173: 210-3.
    CrossrefPubMedGoogle Scholar
  • 28 Hellgren M, Tengborn L, Abildgaard U. Pregnancy in women with congenital antithrombin III deficiency: Experience of treatment with heparin and antithrombin. Gynecol Obstet Invest 1982; 13: 76-89.
    CrossrefPubMedGoogle Scholar
  • 29 Hirsch DR, Mikkola KM, Marks PW, Fox EA, Dorfman DM, Evenstein BM, Goldhaber SZ. Pulmonary embolism and deep venous thrombosis during pregnancy or oral contraceptive use. Prevalence of factor V Leiden. Am Heart J 1996; 131: 1145-8.
    CrossrefPubMedGoogle Scholar
  • 30 Katano K, Aoki K, Sasa H. β2-glycoprotein1-dependent anticardiolipin-antibodies as a predictor of adverse pregnancy outcomes in healthy pregnant women. Hum Reprod 1996; 11: 509.
    CrossrefPubMedGoogle Scholar
  • 31 Krauss Th, Augustin HG, Osmers R, Meden H, Unterhalt M, Kuhn W. Activated protein C resistance and factor V Leiden in patients with hemolysis, elevated liver enzymes, low platelet syndrome. Obstet Gynecol 1998; 92: 457.
    PubMedGoogle Scholar
  • 32 Kupferminc MJ, Eldor A, Steinman N. Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med 1999; 340: 9.
    CrossrefPubMedGoogle Scholar
  • 33 Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss:Treatment with heparin and low-dose aspirin is superior to lowdose aspirin alone. Am J Obstet Gynecol 1996; 174: 1584.
    CrossrefPubMedGoogle Scholar
  • 34 Landy HJ, Kessler C, Kelly WK, Weingold AB. Obstetric performance in patients with the lupus anticoagulant and/or anticardiolipin antibodies. Am J Perinat 1992; 9: 146.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Laskin CA, Bombardier C, Hannah ME. Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss. N Engl J Med 1997; 337: 148.
    CrossrefPubMedGoogle Scholar
  • 36 Lima F, Khamashta MA, Buchanan NMM. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheum 1996; 14: 131.
    PubMedGoogle Scholar
  • 37 Lindoff C, Ingemarson I, Martinsson G, Segelmark M, Thysell H, Astedt B. Preeclampsia is associated with reduced response to activated protein C. Am J Obstet Gynecol 1997; 176: 457.
    CrossrefPubMedGoogle Scholar
  • 38 Lockshin MD, Druzin ML, Qamar T. Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am J Obstet Gynecol 1989; 160: 439.
    CrossrefPubMedGoogle Scholar
  • 39 Lowe GDO. Haemostatic risk factors for arterial and venous thrombosis. In: Poller L, Ludlam CA. Blood coagulation. Churchill Livingstone; 1997
    Google Scholar
  • 40 Lubbe WF, Liggins GC. Lupus anticoagulant and pregnancy. Am J Obstet Gynecol 1985; 153: 322.
    CrossrefPubMedGoogle Scholar
  • 41 Lynch NA, Mariar R, Murphy J. Antiphospholipidantibodies in predicting advers pregnancy outcome. Ann Int Med 1994; 120: 470.
    CrossrefPubMedGoogle Scholar
  • 42 Macklon NS, Greer IA. Venous thrombembolic diseaese in obstetrics and gynaecology. The Scottish experience. Scot Med J 1996; 41: 83-6.
    PubMedGoogle Scholar
  • 43 McColl ND, Ramsay J, Tait R, Walker JD, McCall F, Conkie JA, Carty MI, Greer IA. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997; 78: 1183-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Öhlin AK, Norlund L, Marlar RA. Thrombomodulin gene variations and thromboembolic disease. Thromb Haemost 1997; 78: 396.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Out HJ, Bruinse HW, Christiaens GCML. A prospective, controlled multicenter study on the obstetric risks of pregnant women with antiphospholipid antibodies. Am J Obstet Gynecol 1992; 167: 26.
    CrossrefPubMedGoogle Scholar
  • 46 Pampus MG, Dekker GA, Wolf H. High prevalence of hemostatic abnormalities in women with a history of severe preeclampsia. Am J Obstet Gynecol 1999; 180: 1146.
    CrossrefPubMedGoogle Scholar
  • 47 Pampus van MG, Koopman MMW, Wolf H. Lipoprotein (a) concentrations in women with a history of severe preeclampsia – a case control study. Thromb Haemost 1999; 82: 10.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Poort SR, Rosedaal FR, Reimtsa PH, Bertina RM. A common genetic variation in the 3’-´ untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 1996; 88: 3698.
    PubMedGoogle Scholar
  • 49 Preston FE, Rosendaal FR, Walker ID, Berntorp E, van der Meer F, Conard J, Andres JCS, Lutetzky A, Arcieri P, Pabinger I, Legnani C, Scharrer I. Thromboprophylaxis in pregnancy reduces fetal loss in women with heretable thrombophilia: a prospective EPCOT study. Thromb Haemost 1999; 82 (Suppl I): 227.
    PubMedGoogle Scholar
  • 50 Preston FE, Rosendaal FR, Walter ID. Increased fetal loss in women with heritable thrombophilia. Lancet 1996; 348: 913.
    CrossrefPubMedGoogle Scholar
  • 51 Rai R, Regan L, Hadley E, Dave M, Kohen H. Second trimester pregnancy loss is associated with activated protein C resistance. Br J Hematol 1996; 92: 489.
    PubMedGoogle Scholar
  • 52 Rand JH, Wu XX, Guller S. Reduction of annexin V (placental anticoagulant protein I) on placental villi of women with antiphospholipid antibodies and recurrent spontaneous abortion. Am J Obstet Gynecol 1994; 171: 1566.
    CrossrefPubMedGoogle Scholar
  • 53 Rosendaal FR. Risk factors for venous thrombotic disease. Thromb Haemost 1999; 82: 610-19.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Sarig G, Hoffmann R, Youmis J, Lanir N, Blumenfeld Z, Brenner B. Thrombophilia is common in women with pregnancy loss associated with late pregnancy wastage. Thromb Haemost 1999; 82 (Suppl. I): 226.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Schneider DM, Heilmann L, von Tempelhoff GF, Kuse S, Knirsch K, Vogel W. Antiphospholipid antibodies and haematological defects in women with a history of preeclampsia/HELLP and outcome of IVIG treated pregnancies. Ann Haematol 1999; 78 (Suppl. I): 455.
    PubMedGoogle Scholar
  • 56 Schneider DM, von Tempelhoff GF, Hoppenstaedt D, Fareed J, Heilmann L. Die erworbene Resistenz gegen aktiviertes Protein C in der Schwangerschaft. Z Geburtsh Neonatol 1998; 202: 107.
    PubMedGoogle Scholar
  • 57 Triplett DA. Obstetrical complications associated with antiphospholipid antibodies. In: Coulam CB, Faulk WP, McIntyre JA. Immunological Obstetrics. Norton Medical Books; 1992
    Google Scholar
  • 58 Valensise H, Vaquero E, de Carolis C. Normal fetal growth in women with antiphospholipid syndrome treated with high-dose intravenous immunoglobulin (IVIG). Prenat Diag 1995; 15: 509.
    CrossrefPubMedGoogle Scholar
  • 59 Vincente V, Rodriguez C, Soto I, Fernandez M, Moraleda JM. Risk of thrombosis during pregnancy and postpartum in hereditary thrombophilia. Am J Haematol 1994; 46: 151-2.
    CrossrefPubMedGoogle Scholar
  • 60 Walker MC, Smith GM, Perkins SL. Changes in homocystein levels during normal pregnancy. Am J Obstet Gynecol 1999; 180: 660.
    CrossrefPubMedGoogle Scholar
  • 61 Yasuda M, Takakuwa K, Tokunaga A, Tanaka K. Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy. Obstet Gynecol 1995; 86: 555.
    CrossrefPubMedGoogle Scholar