Mikolaiczik Katrin, Praetner Marc, Rüth Michael, Mark Karlheinz
Rottal-Inn-Kliniken Krankenhaus Eggenfelden, Simonsöder Allee 20, 84307, Eggenfelden, Germany.
Walter Brendel Centre for Experimental Medicine, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.
J Med Case Rep. 2019 Jan 19;13(1):16. doi: 10.1186/s13256-018-1943-1.
For the past decades the mean age of primiparae in Western societies is constantly increasing. At the same time, there is a growing demand for assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection. Subsequently, a higher prevalence of pregnancy-associated diseases such as gestational hypertension and preeclampsia is observed. To improve pregnancy rates after in vitro fertilization/intracytoplasmic sperm injection and to reduce the risk of pregnancy-associated diseases with a cardiovascular pathophysiology, two anticoagulants are the focus of current research: low molecular weight heparin and acetylsalicylic acid (aspirin).
A 41-year-old white woman, gravida 3, para 0, received low molecular weight heparin to reduce the risk of abortion after five unsuccessful intracytoplasmic sperm injections and two miscarriages. She autonomously discontinued the medication with low molecular weight heparin at 12 weeks and 2 days of gestation and took aspirin instead until 24 weeks and 2 days of gestation as preeclampsia prophylaxis. However, the pregnancy ended with an urgent cesarean section at 27 weeks and 4 days of gestation due to a fast progressing hemolysis, elevated liver enzyme levels, and low blood platelet count syndrome, a potentially life-threatening variant of preeclampsia.
Based on the current demographic trend toward late-in-life pregnancy it is mandatory to establish clear guidelines concerning preventive treatment options of preeclampsia for patients with risk factors. The establishment of a special first-trimester screening for these women should be discussed. Moreover, it is necessary to raise the awareness among physicians of these contemporary issues to guarantee the best possible medical care.
在过去几十年里，西方社会初产妇的平均年龄持续上升。与此同时，对体外受精和胞浆内单精子注射等辅助生殖技术的需求也在不断增加。随后，观察到妊娠相关疾病如妊娠期高血压和先兆子痫的患病率更高。为了提高体外受精/胞浆内单精子注射后的妊娠率，并降低具有心血管病理生理学的妊娠相关疾病的风险，两种抗凝剂成为当前研究的重点：低分子量肝素和乙酰水杨酸（阿司匹林）。
一名41岁的白人女性，孕3产0，在经历了5次胞浆内单精子注射失败和2次流产后，接受低分子量肝素以降低流产风险。她在妊娠第12周零2天时自行停用了低分子量肝素，转而服用阿司匹林直至妊娠第24周零2天，作为先兆子痫的预防措施。然而，妊娠在第27周零4天时因快速进展的溶血、肝酶水平升高和血小板计数低综合征（一种潜在的危及生命的先兆子痫变体）而以紧急剖宫产告终。
基于当前晚育的人口趋势，必须为有风险因素的患者制定关于先兆子痫预防治疗方案的明确指南。应讨论为这些女性建立特殊的孕早期筛查。此外，有必要提高医生对这些当代问题的认识，以确保提供尽可能好的医疗护理。
