Outcome of Treated Pregnancies in Women With Antiphospholipid Syndrome: An Update of the Utah Experience
Outcome of Treated Pregnancies in Women With Antiphospholipid Syndrome: An Update of the Utah Experience
复制标题
抗磷脂综合征女性妊娠治疗的结果：犹他州经验的更新
作者：
D. Branch;R. Silver;J. Blackwell;J. Reading;J. Scott
目的探讨抗磷脂综合征孕妇经治疗后的妊娠结局。方法我们回顾了54例抗磷脂综合征患者的82例连续妊娠，这些患者在妊娠期间接受了以下治疗：1）泼尼松和低剂量阿司匹林; 2）肝素和低剂量阿司匹林; 3）泼尼松，肝素和低剂量阿司匹林;或4）这些药物或免疫球蛋白的其他组合。结果新生儿总存活率为73%，不包括自然流产，但所有治疗组均发生治疗失败（胎儿和新生儿死亡）。成功治疗妊娠的患者比未成功治疗妊娠的患者有更少的先前胎儿死亡。四个治疗组之间的结局无显著差异。先兆子痫和胎儿窘迫发生在所有妊娠的一半，胎儿生长障碍发生在近三分之一。37%的孕妇因母体或胎儿适应症而需要早产。4例妊娠在治疗期间还并发了产后血栓形成。结论抗磷脂综合征妇女的妊娠情况似乎可以通过治疗得到改善，但即使治疗仍可能发生胎儿丢失。先兆子痫，胎儿窘迫，胎儿生长障碍和早产是常见的。由于血栓形成发作的临床显著风险，应考虑在这些患者中预防血栓形成。
Objective To determine the outcome of treated pregnancies in women with well–characterized antiphospholipid syndrome. Methods We reviewed 82 consecutive pregnancies in 54 women with antiphospholipid syndrome who were treated during pregnancy with the following:1) prednisone and low–dose aspirin; 2) heparin and low–dose aspirin; 3) prednisone, heparin, and low–dose aspirin; or 4) other combinations of these medications or immunoglobulin. Results The overall neonatal survival rate was 73%, excluding spontaneous abortions, but treatment failures (fetal and neonatal deaths) occurred in all treatment groups. Patients with successful treated pregnancies had fewer previous fetal deaths than those with unsuccessful treated pregnancies. There were no significant differences in outcome among the four treatment groups. Preedampsia and fetal distress occurred in half of all pregnancies, and fetal growth impairment occurred in nearly one–third. Preterm delivery due to maternal or fetal indications was required in 37% of the pregnancies. Four pregnancies were also complicated by postpartum thrombosis during treatment. Conclusions Pregnancy in women with antiphospholipid syndrome appears to be improved by treatment, but fetal loss may occur despite treatment. Preeclampsia, fetal distress, fetal growth impairment, and premature delivery are common. Because of the clinically significant risk of thrombotic episodes, thrombosis prophylaxis should be considered in these patients.