Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Casa Sollievo dela Sofferenza, S. Giovanni R. (FG), Italy.
Semin Thromb Hemost. 2009 Oct;35(7):630-43. doi: 10.1055/s-0029-1242717.
A series of case-control studies in the last decade have shown the role of inherited thrombophilia in the occurrence of adverse obstetric outcomes. In small series of cases, it has been proven that rare inherited causes of thrombophilia such as natural anticoagulant deficiencies can be associated with fetal losses. The confirmed presence of antiphospholipid antibodies in plasma, representing an acquired thrombophilic condition, is also an established cause of fetal losses, although other studies with a smaller sample size have found an association with other obstetric complications, namely preeclampsia, fetal growth restriction, and abruption placentae. Case-control studies have been performed regarding the potential association between unexplained fetal losses and mild hyperhomocysteinemia. Although case-control and prospective studies are also available regarding hyperhomocysteinemia and other gestational vascular complications, published data are conflicting. Intervention studies have been performed to prevent adverse obstetric outcomes in women with inherited or acquired thrombophilia and previous adverse outcomes. There is much debate in the literature regarding the need for treatment of women with thrombophilia during pregnancy. Although in most cases these are not randomized controlled trials, all studies found significantly better outcomes in treated pregnancies compared with those of untreated pregnancies.
近十年来的一系列病例对照研究表明，遗传性血栓形成倾向在不良产科结局的发生中起作用。在一些小系列病例中，已经证明罕见的遗传性血栓形成倾向，如天然抗凝剂缺乏，可能与胎儿丢失有关。血浆中存在抗磷脂抗体，代表一种获得性血栓形成状态，也是胎儿丢失的既定原因，但其他样本量较小的研究发现与其他产科并发症有关，即子痫前期、胎儿生长受限和胎盘早剥。已经进行了关于不明原因胎儿丢失与轻度高同型半胱氨酸血症之间潜在关联的病例对照研究。尽管也有关于高同型半胱氨酸血症和其他妊娠血管并发症的病例对照和前瞻性研究，但已发表的数据存在矛盾。已经进行了干预研究，以预防遗传性或获得性血栓形成倾向以及先前不良结局的妇女的不良产科结局。文献中有很多关于在怀孕期间治疗血栓形成倾向妇女的必要性的争论。尽管在大多数情况下，这些都不是随机对照试验，但所有研究都发现，治疗组妊娠的结局明显优于未治疗组妊娠。
