Middeldorp Saskia
Department of Clinical Epidemiology, and Vascular Medicine Unit, Leiden University Medical Center, Leiden, The Netherlands.
Semin Hematol. 2007 Apr;44(2):93-7. doi: 10.1053/j.seminhematol.2007.01.005.
Heritable thrombophilia is associated with an increased risk for pregnancy failure, defined as sporadic and recurrent miscarriage, late fetal loss, and other vascular pregnancy complications such as preeclampsia and intrauterine growth retardation. The pathogenesis is likely to include effects on trophoblast differentiation and not solely hypercoagulability. This is in line with the observation that most recurrent miscarriages occur early. Therapeutic options include aspirin as well as low-molecular-weight heparin. However, in women with heritable thrombophilia and unexplained recurrent pregnancy loss, evidence is not available as published trials have not used an adequate comparator (no treatment or placebo). Currently, randomized controlled trials with no treatment or placebo are being carried out and results should be awaited before implementing a potentially harmful intervention in pregnant women with heritable thrombophilia and a history of pregnancy failure. Both infertility and pregnancy failure are extremely distressing for couples with the desire to have children. Pregnancy failure comprises (recurrent) early miscarriage, as well as late pregnancy loss. The role of heritable thrombophilia in pregnancy failure is reviewed, with a focus on recurrent miscarriage, in terms of epidemiology, etiology, and potential therapeutic implications.
遗传性血栓形成倾向与妊娠失败风险增加相关，妊娠失败定义为散发性和复发性流产、晚期胎儿丢失以及其他血管性妊娠并发症，如先兆子痫和胎儿宫内生长受限。其发病机制可能包括对滋养层分化的影响，而不仅仅是高凝状态。这与大多数复发性流产发生在早期的观察结果一致。治疗选择包括阿司匹林以及低分子量肝素。然而，对于患有遗传性血栓形成倾向且原因不明的复发性妊娠丢失的女性，由于已发表的试验未使用适当的对照（未治疗或安慰剂），因此尚无证据。目前，正在进行无治疗或安慰剂的随机对照试验，在对患有遗传性血栓形成倾向且有妊娠失败史的孕妇实施可能有害的干预措施之前，应等待结果。对于渴望生育的夫妇来说，不孕和妊娠失败都极其令人痛苦。妊娠失败包括（复发性）早期流产以及晚期妊娠丢失。本文从流行病学、病因学和潜在治疗意义等方面，对遗传性血栓形成倾向在妊娠失败中的作用进行了综述，重点关注复发性流产。
