Der Einfluss thrombophiler Faktoren auf thromboembolische und andere Schwangerschaftskomplikationen[1]

Zusammenfassung

Das Thromboserisiko in der Schwangerschaft ist um das 4,2fache erhöht, wobei die lnzidenz zwischen 0,05 und 0,1 % liegt. Angeborene und erworbene thrombophile Faktoren spielen bei ca. 50 % der Schwangeren mit venöser Thrombose eine Rolle und können gleichzeitig mit dem Auftreten wiederholter Spontanaborte, eines intrauterinen Fruchttodes und der frühen schweren Präeklampsie in Verbindung stehen.Zum gegenwärtigen Zeitpunkt gibt es keine generelle Übereinstimmung darüber, alle Schwangeren mit thrombophilen Risiken einer antithrombotisch-medikamentösen Prophylaxe zuzuführen. Auf alle Fälle sollte bei anamnestischen Hinweisen auf eine tiefe Beinvenenthrombose, auf einen wiederholten Spontanabort, auf eine schwere Präeklampsie einschließlich HELLP-Syndrom, bei Patientinnen mit intrauterinem Fruchttod unklarer Ursache und bei schwerer Plazentainsuffizienz eine Untersuchung der thrombophilen Faktoren durchgeführt werden. Als präventive Maßnahmen stehen die niedermolekularen Heparine allein oder in Kombination mit low-dose-Azetylsalizylsäure (ASS, Aspirin®) zur Verfügung.

Pulmonary embolism and/or deep vein thrombosis are a major cause of maternal mortality. In a number of adverse pregnancy outcome including preeclampsia, recurrent spontaneous abortion, restricted fetal growth and fetal death a role for thrombophilia (acquired and hereditable) has been postulated. Monitoring of acquired factors such as antiphospholipid-antibodies and hereditable factors (factor V Leiden, prothrombin mutation) may help predict the occurrence of pregnancy complications.Low molecular weight heparins (LMWH), since their introduction well established during pregnancy, and the rate of adverse fetal outcomes are related to co-morbidity maternal conditions rather than to the treatment itself. The use of LMWH is recommended for all moderate risk and high-risk pregnant patients.

Schlüsselwörter

Schwangerschaft - Thrombophilie - Thrombose - Präeklampsie - wiederholter Abort

Key words

Pregnancy - thrombophilia - deep vein thrombosis - preeclampsia - recurrent abortion

1 Eingang: 19. 2. 2001
Angenommen nach Revision: 29. 3. 2001

Literatur

1 Eingang: 19. 2. 2001
Angenommen nach Revision: 29. 3. 2001

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