Ogueh O, Chen M F, Spurll G, Benjamin A
Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Quebec, Montreal, Canada.
Int J Gynaecol Obstet. 2001 Sep;74(3):247-53. doi: 10.1016/s0020-7292(01)00447-7.
The aims of this study are to review the outcome of pregnancy in women with thrombophilia, and investigate the possible beneficial effect of heparin therapy in these women.
We reviewed the hospital records of 126 women who were referred to the high-risk obstetrical hematology clinic between June 1996 and December 1999. The placental histology and outcome of 39 pregnancies in 24 women with hereditary thrombophilia were studied, and pregnancies which were treated with heparin were compared with those without treatment.
An adverse pregnancy outcome occurred in 54% of the pregnancies. All seven miscarriages (18%) occurred in pregnancies that were not treated with heparin. However, heparin treatment did not prevent the development of obstetric complications in later pregnancies (odds ratio=0.955, 95% C.I.=0.255-3.577, Fisher's exact test). Excluding miscarriages, 28% of the placentas had thrombotic lesions, and the pregnancies with placental thrombotic lesions were more likely to have complications than those pregnancies without placental abnormalities (P=0.023, C.I.=1.257-5.197, Fisher's exact test).
Pregnancy complications in cases of hereditary thrombophilia may be related to placental abnormalities. Heparin therapy is likely to be useful in preventing miscarriage in cases of hereditary thrombophilia.
本研究旨在回顾血栓形成倾向女性的妊娠结局，并调查肝素治疗对这些女性可能产生的有益效果。
我们回顾了1996年6月至1999年12月间转诊至高危产科血液科门诊的126名女性的医院记录。研究了24名遗传性血栓形成倾向女性的39次妊娠的胎盘组织学和结局，并将接受肝素治疗的妊娠与未接受治疗的妊娠进行了比较。
54%的妊娠出现不良妊娠结局。所有7次流产（18%）均发生在未接受肝素治疗的妊娠中。然而，肝素治疗并不能预防后期妊娠产科并发症的发生（优势比=0.955，95%置信区间=0.255 - 3.577，Fisher精确检验）。排除流产情况，28%的胎盘有血栓形成病变，有胎盘血栓形成病变的妊娠比无胎盘异常的妊娠更易出现并发症（P = 0.023，置信区间=1.257 - 5.197，Fisher精确检验）。
遗传性血栓形成倾向病例中的妊娠并发症可能与胎盘异常有关。肝素治疗可能有助于预防遗传性血栓形成倾向病例中的流产。
