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Thrombophile Gerinnungsstörungen als Risikofaktoren für habituelle Aborte

Thrombophilic coagulation disorders as risk factors for recurrent spontaneous abortions

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Der Gynäkologe Aims and scope

Zusammenfassung

Als Ursachen für habituelle Aborte – drei und mehr konsekutive Fehlgeburten in einer Partnerschaft – wurden neben genetischen, anatomischen, immunologischen, endokrinen und fraglich infektionsbedingten Faktoren in den letzten Jahren zunehmend hämostaseologische Veränderungen etabliert. Insbesondere eine maternale Thrombophilie kann dabei mit einem signifikant erhöhten Fehlgeburtsrisiko einhergehen. Neben hereditären Veränderungen des Gerinnungssystems (z. B. Faktor-V-Leiden-, Prothrombin-Mutation, Protein-S-Mangel) stellt insbesondere das Antiphospholipid-Syndrom als erworbene Thrombophilie einen bedeutenden Risikofaktor für Schwangerschaftskomplikationen dar. Letzterer kann durch eine antikoagulatorische Kombinationstherapie adäquat behandelt werden. Zusammengefasst wird der aktuelle Kenntnisstand in Hinblick auf Diagnostik und Therapieoptionen bei habituellen Aborten und maternaler Thrombophilie.

Abstract

Recurrent spontaneous abortions – three or more consecutive miscarriages of the same couple – are traditionally associated with genetic, anatomic, immunologic, endocrine, and questionable infectious factors. However, there is growing evidence that changes in the haemostaseologic maternal pathway may play a role in the development of pregnancy complications. Maternal thrombophilic disorders, whether hereditary or acquired, can be associated with a significantly elevated risk for miscarriage. Besides hereditary changes of the coagulation system (e.g. factor V Leiden mutation, prothrombin mutation, protein S deficiency), it is the acquired thrombophilic disorder of the antiphospholipid syndrome that especially symbolizes a major risk factor for recurrent miscarriages; however, it can be treated adequately with combination anticoagulant therapy. This review summarizes the current knowledge concerning the diagnosis and therapeutic options in patients with recurrent abortions and maternal thrombophilic disorders.

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Interessenkonflikt

Die Universitäts-Frauenkliniken Lübeck und Jena beteiligen sich als Studienzentren an der laufenden EThIG-II-Studie zur Effektivität von niedermolekularem Heparin bei habitueller Abortneigung. Prof. Dr. F. Schleussner ist der Leiter der klinischen Prüfung.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M.K. Bohlmann, D.W. Luedders, J. Weichert, K. Baumann, M. Thill, K. Diedrich & A. Hornemann

  2. Abteilung Geburtshilfe, Klinik für Frauenheilkunde und Geburtshilfe, Klinikum der Friedrich- Schiller-Universität Jena, Jena, Deutschland

    E. Schleussner

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  1. M.K. Bohlmann
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Bohlmann, M., Luedders, D., Weichert, J. et al. Thrombophile Gerinnungsstörungen als Risikofaktoren für habituelle Aborte. Gynäkologe 42, 17–24 (2009). https://doi.org/10.1007/s00129-008-2226-5

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