Branch D W, Silver R M, Blackwell J L, Reading J C, Scott J R
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City.
Obstet Gynecol. 1992 Oct;80(4):614-20.
To determine the outcome of treated pregnancies in women with well-characterized antiphospholipid syndrome.
We reviewed 82 consecutive pregnancies in 54 women with antiphospholipid syndrome who were treated during pregnancy with the following: 1) prednisone and low-dose aspirin; 2) heparin and low-dose aspirin; 3) prednisone, heparin, and low-dose aspirin; or 4) other combinations of these medications or immunoglobulin.
The overall neonatal survival rate was 73%, excluding spontaneous abortions, but treatment failures (fetal and neonatal deaths) occurred in all treatment groups. Patients with successful treated pregnancies had fewer previous fetal deaths than those with unsuccessful treated pregnancies. There were no significant differences in outcome among the four treatment groups. Preeclampsia and fetal distress occurred in half of all pregnancies, and fetal growth impairment occurred in nearly one-third. Preterm delivery due to maternal or fetal indications was required in 37% of the pregnancies. Four pregnancies were also complicated by postpartum thrombosis during treatment.
Pregnancy in women with antiphospholipid syndrome appears to be improved by treatment, but fetal loss may occur despite treatment. Preeclampsia, fetal distress, fetal growth impairment, and premature delivery are common. Because of the clinically significant risk of thrombotic episodes, thrombosis prophylaxis should be considered in these patients.
确定患有明确抗磷脂综合征的女性经治疗后的妊娠结局。
我们回顾了54例患有抗磷脂综合征的女性的82次连续妊娠，这些女性在孕期接受了以下治疗：1）泼尼松和小剂量阿司匹林；2）肝素和小剂量阿司匹林；3）泼尼松、肝素和小剂量阿司匹林；或4）这些药物的其他组合或免疫球蛋白。
排除自然流产后，总体新生儿存活率为73%，但所有治疗组均出现治疗失败（胎儿和新生儿死亡）。治疗成功的妊娠患者既往胎儿死亡次数少于治疗失败的患者。四个治疗组的结局无显著差异。所有妊娠中有一半发生子痫前期和胎儿窘迫，近三分之一发生胎儿生长受限。37%的妊娠因母体或胎儿指征需要早产。4例妊娠在治疗期间还并发产后血栓形成。
抗磷脂综合征女性的妊娠似乎通过治疗有所改善，但尽管进行了治疗仍可能发生胎儿丢失。子痫前期、胎儿窘迫、胎儿生长受限和早产很常见。由于血栓形成事件具有临床显著风险，这些患者应考虑进行血栓预防。
