Kominiarek M A, Angelopoulos S M, Shapiro N L, Studee L, Nutescu E A, Hibbard J U
Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Medical Center at Chicago, IL 60607, USA.
J Perinatol. 2007 Jun;27(6):329-34. doi: 10.1038/sj.jp.7211745. Epub 2007 Apr 19.
To compare bleeding complications in pregnant patients treated with low-molecular-weight heparin (LMWH) to untreated controls.
A case-control study of patients from 2001 to 2005 who received prophylactic or therapeutic doses of LMWH during pregnancy was carried out. Indications for LMWH included current or prior thromboembolism, thrombophilia, or heart valve replacement. Controls were chosen in a 2:1 ratio to cases, matched for delivery route, and selected as the next two consecutive deliveries. The primary outcome was postpartum hemorrhage (PPH). Odds ratios (ORs) were calculated with 95% confidence intervals (CIs).
Forty-nine women treated with LMWH delivered 55 infants. Current or prior thromboembolic disease was the anticoagulation indication in 15/55 (27.3%) and 26/55 (47%) of pregnancies, respectively. There were more obese gravidas (OR 3.91, CI 1.70 to 9.09) and labor induction was more common in the LMWH group, 25/55 (45%) vs 29/110 (26%), P=0.01. There was no difference in estimated blood loss (295.7+/-145.7 vs 308.6+/-111.9 cm(3), P=0.62 vaginal; 687.5+/-251.8 vs 765.0+/-313.2 cm(3), P=0.34 cesarean), PPH (6/55, 11% vs 9/110, 8.2% OR 1.37, CI 0.16 to 11.5) or transfusion (3/55, 5.4% vs 4/110, 3.6% OR 1.50, CI 0.3 to 7.48) between the cases and controls. There were two cases of postpartum pulmonary emboli, one with a maternal mortality.
Bleeding complications, including PPH and transfusion, in patients treated with LMWH during pregnancy were not increased when compared to normal controls matched for delivery route.
比较接受低分子量肝素（LMWH）治疗的孕妇与未治疗的对照组孕妇的出血并发症情况。
对2001年至2005年期间在孕期接受预防性或治疗性剂量LMWH的患者进行病例对照研究。LMWH的应用指征包括当前或既往血栓栓塞、血栓形成倾向或心脏瓣膜置换。对照组与病例组按2:1的比例选取，根据分娩方式进行匹配，并选取接下来连续的两次分娩。主要结局为产后出血（PPH）。计算比值比（OR）及95%置信区间（CI）。
49例接受LMWH治疗的女性分娩了55名婴儿。当前或既往血栓栓塞性疾病分别是15/55（27.3%）和26/55（47%）次妊娠的抗凝指征。LMWH组肥胖孕妇更多（OR 3.91，CI 1.70至9.09），且引产在LMWH组更常见，分别为25/55（45%）和29/110（26%），P = 0.01。估计失血量无差异（阴道分娩：295.7±145.7对308.6±111.9 cm³，P = 0.62；剖宫产：687.5±251.8对765.0±313.2 cm³，P = 0.34），病例组与对照组在PPH（6/55，11%对9/110，8.2%，OR 1.37，CI 0.16至11.5）或输血（3/55，5.4%对4/110，3.6%，OR 1.50，CI 0.3至7.48）方面也无差异。有2例产后肺栓塞，1例产妇死亡。
与按分娩方式匹配的正常对照组相比，孕期接受LMWH治疗的患者包括PPH和输血在内的出血并发症并未增加。
