Inherited and acquired thrombophilias and poor pregnancy outcome: should we be treating with heparin?
OBJECTIVE
The most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002.


RESULTS
Only one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management.


CONCLUSIONS
There is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established.
Gebhardt
Gabriel S
GS
Department of Obstetrics and Gynaecology, Paarl Hospital, Stellenbosch University Faculty of Health Sciences, South Africa. gsgeb@sun.ac.za
Hall
David R
DR
D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000276:immunology; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011256:Pregnancy Outcome; D019851:Thrombophilia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000235:genetics / Q000276:immunology
D000925:Anticoagulants; D006493:Heparin