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Mütterliche Gerinnungsstörungen

Pathologie im zweiten und dritten Trimenon

Maternal coagulopathy

Pathology in the second and third trimesters

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Der Gynäkologe Aims and scope

Zusammenfassung

Die in retrospektiven Fall-Kontroll-Studien vielfach beschriebene Assoziation von Thrombophilien mit plazentabedingten Schwangerschaftskomplikationen wie Präeklampsie, intrauterine Wachstumsrestriktion, Intrauteriner Fruchttod und vorzeitiger Plazentalösung bestätigt sich in neueren prospektiven Studien nicht. Dennoch scheint der Einsatz von niedermolekularem Heparin im Risikokollektiv günstige Effekte zu haben – allerdings unabhängig davon, ob eine Thrombophilie nachgewiesen wurde. Mit Ausnahme beim Antiphospholipid-Antikörper-Syndrom fehlen jedoch ausreichend verlässliche Studienergebnisse, um den unlimitierten Einsatz von Heparinen bei Frauen mit oder ohne nachgewiesener Thrombophilie nach vorangegangenen plazentabedingten Schwangerschaftskomplikationen derzeit zu befürworten.

Abstract

Previously described associations of thrombophilia with placenta-related pregnancy complications, such as pre-eclampsia, intrauterine growth restriction, intrauterine fetal demise and placental abruption, could not be confirmed in prospective cohort studies. Nevertheless, low molecular weight heparins seem to reduce the risk of recurrence of such complications, but independently from thrombophilia in this at risk population. With the exception of antiphospholipid syndrome there is as yet no strong evidence for an unrestricted anticoagulant prophylaxis with heparins in thrombophilic and non-thrombophilic women with prior placenta-mediated pregnancy complications.

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Interessenkonflikt

Der korrespondierende Autor ist Koordinator der ETHIG-II-Studie, die von der Firma Pfizer finanziell unterstützt wird, und war als Referent für Pfizer tätig.

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  1. Abteilung Geburtshilfe, Klinik für Frauenheilkunde und Geburtshilfe, Klinikum der Friedrich-Schiller-Universität Jena, Bachstr. 18, 07740, Jena, Deutschland

    E. Schleußner

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Correspondence to E. Schleußner.

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Schleußner, E. Mütterliche Gerinnungsstörungen. Gynäkologe 44, 515–520 (2011). https://doi.org/10.1007/s00129-010-2735-x

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