Mütterliche Thrombophilie und wiederholte Fehlgeburten – gibt es eine evidenzbasierte Indikation für Heparin als Rezidivprophylaxe?

Zusammenfassung

Hintergrund Wiederholte Fehlgeburten, auch wiederholte Spontanaborte (WSA) genannt, werden von 1 – 5% der Paare erlebt und weisen eine multifaktorielle Genese auf. Erworbene und angeborene Thrombophilien werden als hämostaseologische Risikofaktoren in der Pathogenese diskutiert.

Methode Die Übersichtsarbeit basiert auf einer selektiven Literaturrecherche in PubMed. Auf die aktuelle Evidenzlage zu WSA beim Antiphospholipidsyndrom und den hereditären Thrombophilien wird besonders hingewiesen.

Ergebnisse Das Antiphospholipidsyndrom (APS) ist eine erworbene, autoimmun-vermittelte Thrombophilie, bei der wiederholte Fehlgeburten zu den klinischen Klassifikationskriterien gehören. Von den serologischen Kriterien hat sich der Nachweis des Lupusantikoagulans als wichtigster Risikofaktor für die Entwicklung von Schwangerschaftskomplikationen herauskristallisiert. Der kombinierte Einsatz von niedrigdosiertem ASS mit Heparin zeigte einen deutlichen Vorteil hinsichtlich des Schwangerschaftsausgangs bei APS-bedingten Fehlgeburten. Bei einigen angeborenen Thrombophilien besteht auch eine erhöhte Risikoassoziation mit der Entstehung von WSA, wenn auch geringer als beim APS. Der Analogschluss zum Antiphospholipidsyndrom bezüglich des Einsatzes von Heparin zur Abortprophylaxe wird durch die aktuellen Analysen nicht hinreichend unterstützt. Daten zu seltenen, kombinierten bzw. homozygoten Thrombophilien bez. Fehlgeburten sind unzureichend.

Schlussfolgerung Anders als beim Antiphospholipidsyndrom stellen wiederholte Spontanaborte für sich bei mütterlicher hereditärer Thrombophilie nach aktueller Studienlage keine Indikation zur prophylaktischen Heparingabe in einer Folgeschwangerschaft dar. Unabhängig davon bestimmt das maternale Risiko für thromboembolische Ereignisse die Indikation für eine Thromboseprophylaxe in der Schwangerschaft.

Schlüsselwörter

Abort - Präeklampsie - Schwangerschaft

^* geteilte Letztautorenschaft

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