Antiphospholipid-Antikörper und Schwangerschaft

Zusammenfassung

Patientinnen mit Antiphospholipidsyndrom (APS) haben eine gesteigerte Rate an Schwangerschaftskomplikationen. Neben Wachstumsretardierung der Frucht, Frühgeburten und einer gesteigerten Gestoseneigung kommt es insbesondere im 2. und 3. Trimenon häufig zu Aborten. Wie auch bei anderen klinischen Manifestationen des APS sind hierfür Gefäßverschlüsse verantwortlich, die zu plazentaren Infarkten und damit zur Minderperfusion der Frucht führen. Da eine Antikoagulation mit Thrombocytenaggregationshemmern und Heparin in der Lage zu sein scheint, die plazentare Durchblutung zu verbessern, ist das Erkennen gefährdeter Patientinnen, deren Beratung, Behandlung und engmaschige Überwachung in der Schwangerschaft Voraussetzung, um mehr dieser Hochrisikoschwangerschaften erfolgreich zu Ende zu führen. Zur Vermeidung postpartaler Komplikationen beim APS (Thrombosen im Wochenbett, HELLP-Syndrom) ist auch nach der Entbindung eine Antikoagulation und genaue Überwachung zu empfehlen. Abraten wird man von einer Schwangerschaft daher bei APS-Patientinnen inzwischen nur bei aktiver Grunderkrankung (SLE), insbesondere bei Nierenbeteiligung, schlecht einstellbarer Hypertonie und bei schweren zentralnervösen Komplikationen in der Vorgeschichte.

Abstracts

Female patients with antiphospholipid syndrome (APS) suffer from an increased rate of pregnancy complications. Not only is the growth of the fetus retarded; there is also a tendency to premature birth and an increased tendency to gestosis. In particular, abortions are frequent in the second or third trimenon. Vascular occlusions are responsible for these and other clinical manifestations of APS, resulting in placental infarctions and hence deficient perfusion of the fetus. For a successful management of a greater proportion of these high-risk pregnancies it is essential to recognise such risks at an early date and to advise and treat the patients, for it appears that anticoagulation with thrombocyte aggregation inhibitors and heparin can improve the placental blood flow. Even after birth we recommend anticoagulation and close follow-up to avoid postpartal complications in APS (thromboses during childbed, HELLP syndrome). Hence, we would now discourage pregnancy in APS patients only in case of an active underlying disease (SLE), especially with kidney involvement, maladjustable hypertonia and severe central nervous complications in the patient’s previous history.

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