Thromboprophylaxis during pregnancy

CILJ: Cilj ovog rada bio je istražiti i utvrditi moguću korist profilakse niskomolekulskim heparinom tijekom trudnoće kod trudnica s indikacijama za tromboprofilaksu u smislu povećanja postotka poroda u terminu i živorođenosti, smanjenja broja spontanih pobačaja te smanjenja učestalosti mogućih maternalnih i fetalnih komplikacija povezanih s protrombotskim stanjima. ----- METODE: Ovo retrospektivno istraživanje temeljilo se na prikupljanju osobnih i obiteljskih anamnestičkih podataka trudnica s naglaskom na tromboembolijske bolesti, spontane gubitke trudnoće te maternalne i fetalne komplikacije u trudnoći. Također su prikupljeni podaci o faktorima trombofilije kod svake trudnice. Trudnice su razvrstane u šest grupa prema indikacijama za tromboprofilaksu te su primale niskomolekulski heparin tijekom trudnoće i puerperija. ----- REZULTATI: Istraživanje je uključivalo 58 trudnica s 61 trudnoćom te su zabilježeni ishodi trudnoća kod svih ispitanica. Rezultati su pokazali da se, u usporedbi s neliječenim trudnoćama u anamnezi, postotak poroda u terminu u trudnoćama liječenim niskomolekulskim heparinom povisio, i to u pet od šest grupa: u grupi A za 23,08 %, u grupi C za 71,11%, u grupi D za 64,96%, u grupi E za 77,38 % te u grupi F za 66,67%. U grupi B 100% liječenih trudnoća rezultiralo je porodom u terminu, ali to su ujedno bile i prve trudnoće tih ispitanica te usporedba nije moguća. Također, niti jedna trudnica nije dobila vensku tromboemboliju tijekom trudnoće i puerperija. ----- ZAKLJUČAK: Rezultati podupiru hipotezu o pozitivnom učinku tromboprofilakse niskomolekulskim heparinom na ishod trudnoće, ali potrebna su daljnja istraživanja koja bi uključila veći broj ispitanica te kontrolnu skupinu. Tijekom analize rezultata ovog istraživanja također je važno uzeti u obzir brojne faktore koji utječu na ishod trudnoće, a nisu bili predmet istraživanja ovog rada, kako se ne bi precijenio učinak profilakse niskomolekulskim heparinom te moguće došlo do neispravnih zaključaka.
OBJECTIVE: The aim of this study was to explore and determine possible benefit of LMWH use during pregnancy in women with thromboprophylaxis indications, regarding increase in rate of term deliveries and live births, decrease in miscarriages number and decrease in maternal and fetal complications due to prothrombotic states. ----- METHODS: This retrospective study was based on collecting personal and family history data of pregnant women, especially data on thromboembolic events, miscarriages and maternal and fetal complications during pregnancy. Thrombophilia factors data also were collected for each pregnant woman. All examinees received LMWH during pregnancy and puerperium. They were categorized in six groups according to the indication for thromboprophylaxis. ----- RESULTS: This study included 58 pregnant women with 61 pregnancies. All pregnancy outcomes were noted. The results demonstrated an increase in the rate of deliveries after pregnancies treated with LMWH, when compared with earlier untreated pregnancies. Five out of six groups registered an increase in number of successful pregnancies as follows: group A for 23.08%, group C for 71.11%, group D for 64.96%, group E for 77.38% and group F for 66.67%. 100% of pregnancies in group B resulted in term delivery, however, as these were the first pregnancies of this women, the comparison could not be made. None of examinees experienced venous thromboembolism during pregnancy and puerperium. ----- CONCLUSION: The results support the thesis of positive effect of thromboprophylaxis during pregnancy on pregnancy outcome in the specific groups of pregnant women. However, further studies including more examinees and the control group would be crucial for drawing correct conclusions regarding the influence of LMWH on pregnancy outcomes. Furthermore, a number of factors not included in this study could have an influence on pregnancy outcome and possible maternal and fetal complications, and should be considered when making conclusions about this study results in order not to overestimate possible benefit of LMWH prophylaxis in pregnancy.