Combined hereditary thrombophilias are responsible for poor placental vascularization development and low molecular weight heparins (LMWH) prevent adverse pregnancy outcomes in these patients.

Autor:	Gojnic MG; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Dugalic SV; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Stefanovic AO; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Stefanovic KV; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Petronijevic MA; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Vrzic Petronijevic SM; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Pantic IV; School of Medicine, University of Belgrade, Belgrade, Serbia.; Laboratory for Cellular Physiology, School of Medicine, Institute of Medical Physiology, University of Belgrade, Belgrade, Serbia., Perovic MD; School of Medicine, University of Belgrade, Belgrade, Serbia.; Clinic for Gynaecology and Obstetrics Narodni Front, Belgrade, Serbia., Vasiljevic BI; Department of Maternal and Child Services, NMC Royal Hospital DOP Dubai, Dubai, United Arab Emirates., Milincic NM; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.; School of Medicine, University of Belgrade, Belgrade, Serbia., Zaric MM; School of Medicine, University of Belgrade, Belgrade, Serbia., Todorovic JS; School of Medicine, University of Belgrade, Belgrade, Serbia.; School of Medicine, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia., Macura M; Clinic for Gynaecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.
Jazyk:	angličtina
Zdroj:	The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2022 Nov; Vol. 35 (22), pp. 4346-4353. Date of Electronic Publication: 2020 Nov 18.
DOI:	10.1080/14767058.2020.1849116
Abstrakt:	Background: Even though thrombophilias are associated with negative pregnancy outcomes (PO), there is not a consensus of when thrombophilias should be screened for, or how they affect placental vascularization during pregnancy. Therefore, the main aim of this study was to discover inherited thrombophilias (IHT) in the first trimester in women with otherwise no indications for thrombophilia screening, based on their vascularization parameters. LMWH treatment in improvement of placental vascularization and PO was also assessed. Finally, the classification of thrombophilias based on observed obstetric risks was proposed. Methods: Women were included in study based on their poor gestational sac and later utero-placental juncture vascularization signal and screening for inherited thrombophilias. LMWH were then initiated and Resistance index of Uterine artery (RIAU) was followed alongside PO (preterm birth, preeclampsia, placental abruption, intrauterine growth reduction). Study group consisted of women with combined inherited thrombophilias. Control group consisted of patients with inherited thrombophilias who have received LMWH therapy since pregnancy beginning. Findings: Out of 219 women, 93 had IHT, and 43 had combined IHT. All pregnancies both in both groups ended up with live births. Vaginal birth was more present in the control group ( p  < .001), and all women in study group delivered by CS. Premature birth was present in 8.4% of patients in control group, and in 32.55% of the patients in the study ( p  < .001). PE wasn't noted, and only 1 case of PA in control group. In the control group, 6.5% patients had IUGR, and 32.55% in the study group ( p  < .05). Based on RIAU and PO, thrombophilia categories were established: S (severe), MO (moderate), MI (mild) and L (low). Higher risk thrombophilias had higher RIAU later in the pregnancy, earlier pregnancy termination and Intrauterine Growth Reduction (IUGR). Conclusions: Thrombophilias should be considered and screened when poor vascularization is noted early in the pregnancy with Doppler sonography. Intervention with LMWH prevents adverse PO in these patients.
Databáze:	MEDLINE
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