The Importance of Thrombophilic Factors in Early Pregnancy Losses

Year 2013, Volume: 18 Issue: 2, 88 - 93, 01.04.2013

Serdar Şen Deniz Hızlı Yasemin Taşçı Serdar Dilbaz

Abstract

Objective: The aim of the present study was to investigate the role of thrombophilic factors in fetal losses at 10-16 gestational weeks. Materials and Methods: Between April 2003 and May 2004, 50 women who were hospitalized due to fetal loss at 10-16 gestational weeks were defined as study group and 50 women with at least 1 healthy term infant and had no previous miscarriage history were defined as control group. Activated protein C resistance, anti-thrombin III deficiency, protein S deficiency and the presence of anticardiolipin antibodies were evaluated. Chisquare test and independent sample t-test were used for statistical analysis. The cut-off value for statistical significance was set at p 10 gestational weeks suggests that thrombophilia screening should be a part of the management of these patients.

Keywords

Anticardiolipin antibodies, Thrombophilia, Fetal loss.

Erken Gebelik Kayıplarında Trombofilik Faktörlerin Önemi

Abstract

Amaç: 10-16 gebelik haftası arası meydana gelen fetal kayıplarda kalıtımsal ve kazanılmış trombofilik faktörlerin rolünün incelenmesi. Gereç ve Yöntem: Nisan 2003-Mayıs 2004 tarihleri arasında 10-16 gebelik haftasında fetal kayıp nedeniyle Ankara Etlik Zübeyde Hanım Doğumevi Erken Gebelik Servisine yatırılan 50 hasta çalışma grubu olarak, daha önce gebelik kaybı öyküsü olmayan ve en az bir sağlıklı doğum yapmış 50 kadın kontrol grubu olarak kabul edildi. Tüm hastalarda aktive protein C resistansı, protein S ve antitrombin 3 eksikliği ve antikardiyolipin antikor pozitifliği araştırıldı. Her iki grup arasında bu parametreler açısından fark olup olmadığı bağımsız T testi, ki-kare testi kullanılarak incelendi. P

Keywords

Antikardiyolipin antikorlar, Trombofili, Fetal kayıp.

References

• Kupferminc MJ. Thrombophilia and pregnancy. Reprod Biol Endoc 2003; 1: 111.
• Jordaan DJ, Schoon MG, Badenhorst PN. Thrombophilia screening in pregnancy. Obstet Gynecol Surv 2005; 60: 39440
• Preston FE, Rosendaal FR, Walker ID, et al. Increased fetal loss in women with heritable thrombophilia. Lancet 1996; 348: 913de Vries JI, Dekker GA, Huijgens PC, Jakobs C, Blomberg BM, van Geijn HP. Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies. Br J Obstet Gynaecol 1997; 104: 1248-54. van der Molen EF, Verbruggen B, Nováková I, Eskes TK, Monnens LA, Blom HJ. Hyperhomocysteinemia and other thrombotic risk factors in women with placental vasculopathy. BJOG 2000; 107: 785-91.
• Martinelli I, Taioli E, Cetin I, et al. Mutations in coagulation factors in women with unexplained late fetal loss. N Engl J Med 2000; 343: 1015-8.
• Many A, Elad R, Yaron Y, Eldor A, Lessing JB, Kupferminc MJ. Third-trimester unexplained intrauterine fetal death is associated with inherited thrombophilia. Obstet Gynecol 2002; 99: 684-7.
• Kupferminc MJ, Fait G, Many A, Gordon D, Eldor A, Lessing JB. Severe preeclampsia and high frequency of genetic thrombophilic mutations. Obstet Gynecol 2000; 96: 45-9.
• Brown HL. Antiphospholipid antibodies and recurrent pregnancy loss. Clin Obstet Gynecol 1991; 34: 1-17.
• Tal J, Schliamser LM, Leibovitz Z, Ohel G, Attias D. A possible role for activated protein C resistance in patients with first and second trimester pregnancy failure. Hum Reprod 1999; 14: 1624-7.
• Rai R, Shlebak A, Cohen H, et al. Factor V Leiden and acquired activated protein C resistance among 1000 women with recurrent miscarriage. Hum Reprod 2001; 16: 961-5.
• Roqué H, Paidas MJ, Funai EF, Kuczynski E, Lockwood CJ. Maternal thrombophilias are not associated with early pregnancy loss. Thromb Haemost 2004; 91: 290-5.
• Burton GJ, Jauniaux E, Watson AL. Maternal arterial connections to the placental intervillous space during the first trimester of human pregnancy: the Boyd collection revisited. Am J Obstet Gynecol 1999; 181: 718-24.
• Oshiro BT, Silver RM, Scott JR, Yu H, Branch DW.Antiphospholipid antibodies and fetal death. Obstet Gynecol 1996; 87: 489-93.
• Alonso A, Soto I, Urgellés MF, Corte JR, Rodríguez MJ, Pinto CR. Acquired and inherited thrombophilia in women with unexplained fetal losses. Am J Obstet Gynecol 2002; 187: 1337
• Mello G, Parretti E, Martini E, et al. Usefulness of screening for congenital or acquired hemostatic abnormalities in women with previous complicated pregnancies. Haemostasis 1999; 29: 197-20
• Younis JS, Brenner B, Ohel G, Tal J, Lanir N, Ben-Ami M. Activated protein C resistance and factor V Leiden mutation can be associated with first-as well as second-trimester recurrent pregnancy loss. Am J Reprod Immunol 2000; 43: 31-5.
• Regan L, Rai R. Thrombophilia and pregnancy loss. J Reprod Immunol 2002; 55: 163-80.
• Dizon-Townson DS, Nelson LM, Easton K, Ward K. The factor V Leiden mutation may predispose women to severe preeclampsia. Am J Obstet Gynecol 1996; 175: 902-5.
• Eitzman DT, Westrick RJ, Bi X, et al. Lethal perinatal thrombosis in mice resulting from the interaction of tissue factor pathway inhibitor deficiency and factor V Leiden. Circulation 2002; 105: 2139-42.
• Karadeniz RS, Altay MM, Ensari TA, Erol AO, Özdoğan S, Haberal A. Tekrarlayan Gebelik Kaybı Sayısı ile Trombofilik Faktörler Arasında İlişki Yoktur. Turkiye Klinikleri J Med Sci 2012; 32: 376-81.
• Öner G, Müderris İİ, Saatçi Ç. Tekrarlayan gebelik kaybında aktive protein C direnci, endojen antikoagülanlar ve koagulasyon parametreleri. Türk Jinekoloji ve Obstetrik Derneği Dergisi 2011; 8: 244-8.
• Brenner B. Inherited thrombophilia and pregnancy loss. Best Pract Res Clin Haematol 2003; 16: 311-20.
• Sanson BJ, Friederich PW, Simioni P, et al. The risk of abortion and stillbirth in antithrombin-, protein C-, and protein Sdeficient women. Thromb Haemost 1996; 75: 387-8.
• Raziel A, Kornberg Y, Friedler S, Schachter M, Sela BA, Ron-El R. Hypercoagulable thrombophilic defects and hyperhomocysteinemia in patients with recurrent pregnancy loss. Am J Reprod Immunol 2001; 45: 65-71.
• Berntorp E, Svensson P, Zöller B, Lethagen S, Dahlbäck B. (Resistance to activated protein C. A common genetic risk factor in venous thrombosis). Lakartidningen 1995; 92: 3587-90.
• Sarig G, Younis JS, Hoffman R, Lanir N, Blumenfeld Z, Brenner B. Thrombophilia is common in women with idiopathic pregnancy loss and is associated with late pregnancy wastage. Fertil Steril 2002; 77: 342-7.
• Brenner B, Sarig G, Weiner Z, Younis J, Blumenfeld Z, Lanir N. Thrombophilic polymorphisms are common in women with fetal loss without apparent cause. Thromb Haemost 1999; 82: 6
• Finazzi G, Brancaccio V, Moia M, et al. Natural history and risk factors for thrombosis in 360 patients with antiphospholipid antibodies: a four-year prospective study from the Italian Registry. Am J Med 1996; 100: 530-6.
• Scott JR, Rote NS, Branch DW. Immunologic aspects of recurrent abortion and fetal death. Obstet Gynecol 1987; 70: 645-5
• Barbui T, Cortelazzo S, Galli M, et al. Antiphospholipid antibodies in early repeated abortions: a case-controlled study. Fertil Steril 1988; 50: 589- 92.
• Kutteh WH, Park VM, Deitcher SR. Hypercoagulable state mutation analysis in white patients with early first-trimester recurrent pregnancy loss. Fertil Steril 1999; 71: 1048-53.
• Grandone E, Margaglione M, Colaizzo D, et al. Factor V Leiden is associated with repeated and recurrent unexplained fetal losses. Thromb Haemost 1997; 77: 822-4.
• Balasch J, Reverter JC, Fábregues F, et al. First-trimester repeated abortion is not associated with activated protein C resistance. Hum Reprod 1997; 12: 1094-7.
• ACOG practice bulletin. Management of recurrent pregnancy loss. Number 24, February 2001. (Replaces Technical Bulletin Number 212, September 1995). American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2002; 78: 179-90.