Risikoschwangerschaften und deren Therapie

Summary

Recurrent abortions are a common problem. A therapy with low-molecular-weight heparin is usual in deep vein thrombosis with thrombophilia, in woman with recurrent abortions or other risks, like EPH-gestosis or HELLP-Syndrom. Patients, method: The efficacy of a mono-therapy with LMWH (3000–16 000 daily) in women with risk pregnancies has been examined prospectively. The dates of 676 pregnant women have been analysed and compared to the current literature about live birth rates without therapy and tot he results of other, similar studies. The live birth rate has been the target variable. Results: We obtained main a live birth rate of 98.6%.There has been no record of serious adverse effects. We obtained a live birth rate of 95.8% if NMH therapy starts early, and a live birth rate of 100% if NMH therapy starts between week 20 and 25. For the live birth rate the existence of thrombophilic gene polymorphisms is irrelevant. Conclusion: The high live birth weight is depended on early starting the therapy with NMH. For the late risk it is favourable to start the therapy with heparin between week 20 and 25 week of pregnancy.

Zusammenfassung

Risikoschwangerschaften sind relativ häufig. Die Therapie mit niedermolekularem Heparin ist eine Behandlungsoption bei Thrombophilie mit abgelaufenen tiefen Venenthrombosen, rezidivierenden Aborten und anderen Risikokonstellationen, wie Plazentainsuffizienz, EPH-Gestose, Notches oder HELLP-Syndrom. Patientinnen, Methode: Die Wirksamkeit einer Therapie mit NMH (3000–20 000 I.E. täglich) bei Risikoschwangerschaften wurde prospektiv untersucht. Dazu wurden die Daten von 676 Schwangerschaften ausgewertet. Zielvariable war die Lebendgeburtenrate. Ergebnisse: Es wurde eine mittlere Lebendgeburtsrate von insgesamt 98,6% erreicht. Es sind keine schwerwiegenden unerwünschten Arzneimittelwirkungen des Heparins aufgetreten. Bei frühem Einsatz von Heparin wurde eine Lebendgeburtenrate von 97,8% erreicht. Bei den Indikationen, bei denen Heparin ab der 20. und 25. Schwangerschaftswoche eingesetzt worden war, wurde sogar eine Lebendgeburtsrate von 100% erreicht. Für die Lebendgeburtsrate ist es unwesentlich, ob die Frauen Träger thrombophiler Genpolymorphismen sind oder nicht. Schlussfolgerung: Die hohe Lebendgeburtsrate ist die Folge des frühzeitigen Beginns der Heparinisierung zur Verhinderung von Frühaborten. Bei den Spätkomplikationen scheint der Beginn der Heparinisierung zwischen 20. und 25. SSW günstig zu sein.

Keywords

Low-molecular weight heparin - risk pregnancy

Schlüsselwörter

Niedermolekulares Heparin - Risikoschwangerschaft

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