Bar J, Mashiah R, Cohen-Sacher B, Hod M, Orvieto R, Ben-Rafael Z, Lahav J
Perinatal Division, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Peta Tiqva, Israel.
Thromb Res. 2001 Feb 15;101(4):235-41. doi: 10.1016/s0049-3848(00)00413-8.
The aim of this study was to investigate the effect of thromboprophylactic therapy on fetal and maternal Doppler flow parameters in pregnant women with severe complications in previous pregnancies and evidence of acquired or congenital thrombophilia in the current pregnancy.
Sixty-five patients with a history of recurrent abortions, intrauterine fetal death, intrauterine growth restriction (IUGR), and severe early-onset preeclampsia were tested for the presence of acquired or congenital thrombophilia. Those with positive findings were prescribed low-dose aspirin plus low-molecular-weight heparin (LMWH) (enoxaparin); the remainder received low-dose aspirin only. A Doppler flow study was performed before and after treatment and in the third trimester of pregnancy.
Of the 65 pregnancies, four ended in spontaneous abortion and were excluded from the analysis. Of the 61 women with completed pregnancies, 37 (61%) had evidence of acquired or congenital thrombophilia: 22 (36%) protein S deficiency; 1 (2%) protein C deficiency; 2 (3%) activated protein C resistance (APC-R); 2 (3%) IgG for antiphospholipid antibodies; 1 (2%) circulating anticoagulant; and 9 (15%) a combined defect. This group showed a significant decrease in mean uterine artery pulsatility index (PI) before and after treatment (1.32+/-0.36 vs. 1.04+/-0.23, P=.006), whereas the remaining 24 patients treated with low-dose aspirin only had nonsignificant changes. Pearson's correlation test yielded no correlations of the pregnancy outcome parameters with Doppler flow values in the umbilical or uterine arteries.
Thromboprophylactic therapy transiently improves maternal circulation parameters in patients with thrombophilia at risk of fetal loss and other severe complications of pregnancy, but not in correlation with their pregnancy outcome. Therefore, Doppler examination of maternofetal circulation in the second trimester is not predictive of pregnancy outcome.
本研究旨在探讨血栓预防治疗对既往妊娠有严重并发症且本次妊娠有获得性或先天性血栓形成倾向证据的孕妇胎儿和母体多普勒血流参数的影响。
对65例有复发性流产、宫内胎儿死亡、宫内生长受限（IUGR）和重度早发型子痫前期病史的患者进行获得性或先天性血栓形成倾向检测。检测结果呈阳性的患者给予低剂量阿司匹林加低分子量肝素（LMWH）（依诺肝素）治疗；其余患者仅接受低剂量阿司匹林治疗。在治疗前后及妊娠晚期进行多普勒血流研究。
65例妊娠中，4例以自然流产告终，被排除在分析之外。在61例妊娠结束的妇女中，37例（61%）有获得性或先天性血栓形成倾向证据：22例（36%）蛋白S缺乏；1例（2%）蛋白C缺乏；2例（3%）活化蛋白C抵抗（APC-R）；2例（3%）抗磷脂抗体IgG；1例（2%）循环抗凝物；9例（15%）合并缺陷。该组治疗前后平均子宫动脉搏动指数（PI）显著降低（1.32±0.36对1.04±0.23，P = 0.006），而其余仅接受低剂量阿司匹林治疗的24例患者则无显著变化。Pearson相关检验显示，妊娠结局参数与脐动脉或子宫动脉的多普勒血流值无相关性。
血栓预防治疗可暂时改善有胎儿丢失和其他严重妊娠并发症风险的血栓形成倾向患者的母体循环参数，但与妊娠结局无关。因此，孕中期母胎循环的多普勒检查不能预测妊娠结局。
