Thrombophilia-associated pregnancy wastage

Objective: To critically review the literature regarding inherited thrombophilia and recurrent fetal loss. Design: English-language literature review. Patient(s): Women who experienced repeated pregnancy wastage. Intervention(s): Aspirin, glucocorticoids, heparin, and IV immunoglobulin for the prevention of miscarriage. Main Outcome Measure(s): Live birth, miscarriage, preeclampsia, and pregnancy loss. Result(s): Recurrent fetal loss and other placental vascular pathologies of pregnancy have long been associated with antiphospholipid syndrome, an acquired autoimmune thrombophilic state. The number of known heritable thrombophilic disorders has grown rapidly in recent years with the identification of activated protein C resistance, factor V Leiden mutation, and hyperhomocysteinemia as major causes of thrombosis. Data accumulated over the past 2 years suggest that heritable thrombophilia is associated with an increased risk of fetal loss and preeclampsia. The present review discusses potential pathogenetic mechanisms for this association and evaluates reported therapeutic regimens for the prevention of fetal loss in women with thrombophilia. Conclusion(s): placental thrombosis may be the final common pathophysiologic pathway in most women with habitual abortions and repeated pregnancy wastage. Prophylactic antithrombotic therapy is indicated in women with heritable thrombophilia and antiphospholipid syndrome and probably is more effective than the previously used modalities of prednisone, aspirin, and IV immunoglobulin. (Fertil Steril(R) 1999,72:765-74. (C) 1999 by American Society for Reproductive Medicine.).