Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin
Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin
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DOI：
10.1111/j.1471-0528.1999.tb08208.x
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发表时间：
1999-02-01
期刊：
影响因子：
--
通讯作者：
Regan, L
中科院分区：
文献类型：
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作者：
Backos, M;Rai, R;Regan, L
目的探讨小剂量阿司匹林和小剂量肝素治疗与抗磷脂抗体、狼疮抗凝剂和抗心磷脂抗体相关的反复流产史的产科经过，设计前瞻性观察研究。设置大学为基础的第三转诊clinic.Population一百五十孕妇与反复流产的历史与持续阳性的抗磷脂antibiotic.Methods测试狼疮抗凝剂检测使用稀释罗素蝰蛇毒液时间连同血小板中和程序。使用标准化酶联免疫吸附试验检测IgG和IgM抗心磷脂抗体。免疫球蛋白抗心磷脂水平大于或等于5每升单位和IgM抗心磷脂水平大于或等于3每升单位被认为是积极的。在妊娠试验阳性时开始使用阿司匹林（75 mg/天），在超声显示胎心活动时开始使用肝素（5000单位皮下注射，12小时一次，或依诺肝素20 mg/天）。治疗停止在流产的时间或在34周的pregnancy.Results一百零七怀孕（71%）导致活产。41例妊娠（27%）流产，大多数发生在妊娠早期。一名妇女死产，一名早产儿在新生儿期死亡。1例妊娠因胎儿异常终止。妊娠期高血压并发症占17%（18/108），产前出血占7%（8/108）。26名婴儿（24%）在妊娠37周之前分娩。50名妇女（46%）通过剖腹产分娩。所有活产婴儿的中位出生体重为3069克（范围531-4300），但15%（16/108）的婴儿是小的胎龄。结论联合治疗阿司匹林和肝素导致高活产率的妇女反复流产和抗磷脂抗体。然而，成功的怀孕在所有三个月期间都有很高的并发症风险。这些孕妇应在设有产科和新生儿重症监护设施的单位进行密切的产前监测和计划分娩。
Objective To study the obstetric course of women with a history of recurrent miscarriage associated with antiphospholipid antibodies, lupus anticoagulant and anticardiolipin antibodies, treated with low dose aspirin and low dose heparin.Design prospective observational study. Setting University based tertiary referral clinic.Population One hundred and fifty pregnant women with a history of recurrent miscarriage associated with persistently positive tests for antiphospholipid antibodies.Methods Lupus anticoagulant was detected using the dilute Russell's viper venom time together with a platelet neutralisation procedure. IgG and IgM anticardiolipin antibodies were detected using a standardised enzyme linked immunosorbent assay. An Ige anticardiolipin level greater than or equal to 5 per litre units and an IgM anticardiolipin level greater than or equal to 3 per litre units was considered positive. Aspirin (75 mg daily) was commenced at the time of a positive pregnancy test and heparin (5000 units subcutaneously 12 hourly, or enoxaparin 20 mg daily) was started when fetal heart activity was demonstrated on ultrasound. Treatment was stopped at the time of miscarriage or at 34 weeks of gestation.Results One hundred and seven pregnancies (71%) resulted in a live birth. Forty-one pregnancies (27%) miscarried, the majority in the first trimester. One woman had a stillbirth, and one a premature baby who died in the neonatal period. One pregnancy was terminated for a fetal anomaly. Gestational hypertension complicated 17% (18/108) of ongoing pregnancies and antepartum haemorrhage 7% (8/108). Twenty-six babies (24%) were delivered before 37 weeks of gestation. Fifty women (46%) were delivered by caesarean section. The median birthweight of all live born infants was 3069 g (range 531-4300); however 15% (16/108) of the infants were small for gestational age.Conclusion Combination treatment with aspirin and heparin leads to a high live birth rate among women with recurrent miscarriage and antiphospholipid antibodies. However, successful pregnancies are prone to a high risk of complications during all trimesters. Close antenatal surveillance and planned delivery of these pregnancies in a unit with specialist obstetric and neonatal intensive care facilities are indicated.