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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2018; 78(03): 274-282
DOI: 10.1055/s-0044-100919
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Maternal Thrombophilia and Recurrent Miscarriage – Is There Evidence That Heparin is Indicated as Prophylaxis against Recurrence?

Article in several languages: English | deutsch
Ana-Luisa Stefanski
1   Zentrum Innere Medizin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Berlin, Berlin, Germany
2   Rheumatologie, klinische Immunologie und Allergologie, Inselspital Universitätsspital Bern, Bern, Switzerland
,
Christoph Specker
3   Krankenhaus St. Josef, Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Essen, Essen, Germany
,
Rebecca Fischer-Betz
4   Poliklinik für Rheumatologie, Schwangerschaftsambulanz, Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät, Düsseldorf, Germany
,
Wolfgang Henrich
5   Klinik für Geburtsmedizin, Charité Berlin, Berlin, Germany
,
Ekkehard Schleussner   *   *
6   Klinik für Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
,
Thomas Dörner   *   *
1   Zentrum Innere Medizin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Berlin, Berlin, Germany
› Author Affiliations
Further Information

Publication History

received 23 October 2017
revised 15 January 2018

accepted 15 January 2018

Publication Date:
21 March 2018 (online)

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Abstract

Background Recurrent miscarriage, also referred to as recurrent spontaneous abortion (RSA), affects 1 – 5% of couples and has a multifactorial genesis. Acquired and congenital thrombophilia have been discussed as hemostatic risk factors in the pathogenesis of RSA.

Method This review article was based on a selective search of the literature in PubMed. There was a special focus on the current body of evidence studying the association between RSA and antiphospholipid syndrome and hereditary thrombophilia disorders.

Results Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia and recurrent miscarriage is one of its clinical classification criteria. The presence of lupus anticoagulant has been shown to be the most important serologic risk factor for developing complications of pregnancy. A combination of low-dose acetylsalicylic acid and heparin has shown significant benefits with regard to pregnancy outcomes and APS-related miscarriage. Some congenital thrombophilic disorders also have an increased associated risk of developing RSA, although the risk is lower than for APS. The current analysis does not sufficiently support the analogous administration of heparin as prophylaxis against miscarriage in women with congenital thrombophilia in the same way as it is used in antiphospholipid syndrome. The data on rare, combined or homozygous thrombophilias and their impact on RSA are still insufficient.

Conclusion In contrast to antiphospholipid syndrome, the current data from studies on recurrent spontaneous abortion do not support the prophylactic administration of heparin to treat women with maternal hereditary thrombophilia in subsequent pregnancies. Nevertheless, the maternal risk of thromboembolic events must determine the indication for thrombosis prophylaxis in pregnancy.

Key words

loss of pregnancy - preeclampsia - pregnancy

* Shared last authorship


 

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