Abstract
Background Recurrent miscarriage, also referred to as recurrent spontaneous abortion (RSA),
affects 1 – 5% of couples and has a multifactorial genesis. Acquired and congenital
thrombophilia have been discussed as hemostatic risk factors in the pathogenesis of
RSA.
Method This review article was based on a selective search of the literature in PubMed.
There was a special focus on the current body of evidence studying the association
between RSA and antiphospholipid syndrome and hereditary thrombophilia disorders.
Results Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia and recurrent
miscarriage is one of its clinical classification criteria. The presence of lupus
anticoagulant has been shown to be the most important serologic risk factor for developing
complications of pregnancy. A combination of low-dose acetylsalicylic acid and heparin
has shown significant benefits with regard to pregnancy outcomes and APS-related miscarriage.
Some congenital thrombophilic disorders also have an increased associated risk of
developing RSA, although the risk is lower than for APS. The current analysis does
not sufficiently support the analogous administration of heparin as prophylaxis against
miscarriage in women with congenital thrombophilia in the same way as it is used in
antiphospholipid syndrome. The data on rare, combined or homozygous thrombophilias
and their impact on RSA are still insufficient.
Conclusion In contrast to antiphospholipid syndrome, the current data from studies on recurrent
spontaneous abortion do not support the prophylactic administration of heparin to
treat women with maternal hereditary thrombophilia in subsequent pregnancies. Nevertheless,
the maternal risk of thromboembolic events must determine the indication for thrombosis
prophylaxis in pregnancy.
Key words
loss of pregnancy - preeclampsia - pregnancy
