Kupferminc Michael, Rimon Eli, Many Ariel, Maslovitz Sharon, Lessing Joseph B, Gamzu Ronni
Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Blood Coagul Fibrinolysis. 2011 Mar;22(2):123-6. doi: 10.1097/MBC.0b013e328343315c.
Low molecular weight heparin (LMWH) treatment has been recommended for pregnant women with previous adverse pregnancy and who were diagnosed as having a thrombophilia. We now examined the effect of LMWH on pregnant women without thrombophilias who had severe pregnancy complications and placental vasculopathy in an earlier pregnancy. Seventy-two women with a history of severe preeclampsia, fetal growth restriction (FGR) less than fifth percentile, severe placental abruption and/or stillbirth after 20 weeks, whose thrombophilia workup was negative, were enrolled. Placental vasculopathy was defined as villous infarcts, fibrinoid necrosis of decidual vessels, fetal vessel thrombosis, evidence of placental abruption and perivillous fibrin deposition. The study group consisted of 32 pregnant women who were treated with LMWH and 40 pregnant women who were not treated with LMWH (control group) in their ensuing pregnancy in our institution between 2003 and 2007. The incidences of severe preeclampsia, FGR, placental abruption and stillbirth in the previous pregnancies were similar for both groups. The incidences of severe preeclampsia and placental abruption in the study group in the index pregnancy were significantly lower than the control group (3.13 versus 20%, P = 0.03; and 0 versus 15%, P = 0.03, respectively). The respective incidence of FGR was 6.25 versus 22.5%, and of overall adverse outcome was 9.4 versus 60% (P = 0.001). Treatment with LMWH may reduce the rate of the recurrence of severe pregnancy complications and significant placental vasculopathy in women without thrombophilias.
对于有不良妊娠史且被诊断为血栓形成倾向的孕妇，推荐使用低分子量肝素（LMWH）治疗。我们现在研究了LMWH对先前妊娠有严重妊娠并发症和胎盘血管病变但无血栓形成倾向的孕妇的影响。招募了72名有重度子痫前期、胎儿生长受限（FGR）低于第5百分位数、严重胎盘早剥和/或孕20周后死产病史且血栓形成倾向检查为阴性的女性。胎盘血管病变定义为绒毛梗死、蜕膜血管纤维蛋白样坏死、胎儿血管血栓形成、胎盘早剥证据和绒毛周围纤维蛋白沉积。研究组由2003年至2007年期间在我们机构随后妊娠中接受LMWH治疗的32名孕妇和未接受LMWH治疗的40名孕妇（对照组）组成。两组先前妊娠中重度子痫前期、FGR、胎盘早剥和死产的发生率相似。研究组本次妊娠中重度子痫前期和胎盘早剥的发生率显著低于对照组（分别为3.13%对20%，P = 0.03；0对15%，P = 0.03）。FGR的发生率分别为6.25%对22.5%，总体不良结局的发生率分别为9.4%对60%（P = 0.001）。LMWH治疗可能会降低无血栓形成倾向女性严重妊娠并发症和显著胎盘血管病变的复发率。
