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Rezidivierende Spontanaborte (RSA) bei hereditärer Thrombophilie

Thrombotic disorder and recurrent pregnancy loss

  • Leitthema
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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Thrombophile Veränderungen werden bei RSA-Patientinnen mit einer deutlich erhöhten Prävalenz diagnostiziert und stellen in der Schwangerschaft eine besondere Bedrohung für die Mutter und das ungeborene Kind dar. Eine erfolgreiche Schwangerschaft benötigt eine ausgewogene Balance zwischen Blutgerinnung und Fibrinolyse, zum einen, um die Fibrinpolymere der Basalplatte zu stabilisieren, und zum anderen, um eine adäquate Perfusion von intervillösem Raum und plazentaren Stammgefäßen zu gewährleisten. Bei entsprechender Anamnese ist im Rahmen einer Ursachenabklärung vor allem der Nachweis der Faktor-V-Leiden-Mutation und des Faktor-II-20210-Dimorphismus ratsam. Die Untersuchung auf thrombophile Risikofaktoren im Rahmen von habituellen Aborten ist hauptsächlich angesichts der Möglichkeit einer frühzeitigen Behandlung relevant. Therapeutisch scheint der Einsatz von niedermolekularen Heparinen (NMH) bei Frauen mit RSA und nachgewiesener Thromboseneigung zu einem deutlichem Anstieg des Prozentsatzes an Lebendgeburten zu führen.

Abstract

Haemorheological disorders in pregnancy represent a specific risk for the mother and the unborn child. Successful pregnancies require fine tuning of fibrinolytic activities to secure fibrin polymerization and stabilization of the placental basal plate as well as to prevent excess fibrin deposition in placental vessels and intervillous spaces. Among inherited thrombophilias, the factor V Leiden mutation and factor II 20210 dimorphism appear to play a significant role in recurrent pregnancy loss and other pregnancy-related disorders. Testing for these mutations might be prudent in light of potential therapeutic options. In patients with recurrent miscarriages and established inherited thrombophilias the use of low molecular weight heparin seems to significantly improve live birth rates.

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Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der LMU München Großhadern

    N. Rogenhofer, B. Toth & C. J. Thaler

  2. Gemeinschaftspraxis für Gynäkologie, Drs. Buchholz und Summerer-Moustaki, Praxis für Humangenetik, Zentrum für Polkörperdiagnostik, München

    T. Buchholz

  3. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München-Großhadern, Marchioninistraße 15, 81377, München

    N. Rogenhofer

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  1. N. Rogenhofer
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  2. T. Buchholz
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  3. B. Toth
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  4. C. J. Thaler
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Correspondence to N. Rogenhofer.

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Rogenhofer, N., Buchholz, T., Toth, B. et al. Rezidivierende Spontanaborte (RSA) bei hereditärer Thrombophilie. Gynäkologische Endokrinologie 3, 32–39 (2005). https://doi.org/10.1007/s10304-004-0098-x

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  • DOI: https://doi.org/10.1007/s10304-004-0098-x

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