Уважаемые коллеги!
Недавнее описание весьма большой группы пациенток с привычным невынашиванием и ПОСЛЕ исключения др. анатомических, гормональных или хромосомальных нарушений (тезизы разбиты мной для простоты восприятия):
Clin Appl Thromb Hemost. 2005 Jan;11(1):1-13. Recurrent miscarriage syndrome and infertility due to blood coagulation protein/platelet defects: a review and update.
Bick RL, Hoppensteadt D.
Clinical Professor of Medicine and Pathology, University of Texas Southwestern Medical Center, Director, Dallas Thrombosis Hemostasis and Vascular Medicine Clinical Center, Dallas, Texas.
351 women were referred for thrombosis and hemostasis evaluation after suffering recurrent miscarriages. All patients were referred by a high-risk obstetrician or reproductive medicine specialist after anatomic, hormonal or chromosomal defects had been ruled out. These patients were assessed over a three year period. The mean patient age at referral was 34 years and the mean number of miscarriages was 2.9 (2-9). All patients underwent a thorough evaluation for thrombophilia and, when indicated, a hemorrhagic disorder.
Of the 351 patients, 29 (8%) had no defect.
Of the remaining 322 patients, 7 (2%) had a bleeding disorder: 3 with platelet dysfunction, 1 with Factor XIII deficiency, 3 with von Willebrand's and 3 with Osler-Weber-Rendu diseases.
The remainder (90%) of the patients had a thrombophilia as follows:
195 (60%) had antiphospholipid syndrome,
64 (20%) had Sticky Platelet Syndrome,
38 (12%) had MTHFR mutation, 23 (7.1%) had PAI-1 polymorphism,
12 (3.7%) had Protein S deficiency,
12 (3.7%) had Factor V Leiden,
3 (1%) had antithrombin deficiency,
3 (1%) had Heparin-Cofactor II deficiency,
3 (1%) had TPA deficiency,
6 (2%) had Protein C deficiency.
There were a total of 364 defects found in the 312 patients harboring thrombophilia; thus, several harbored 2 and a few harbored 3 separate defects.
All patients with thrombophilia were treated with preconception ASA at 81 mg/day with the immediate post-conception addition of heparin or LMW heparin (Dalteparin). Both ASA and heparin/LMW heparin were used to term.
The first 120 patients were treated with unfractionated heparin at 5,000 U every 24 hours, subcutaneously and the last 192 have been treated with Dalteparin at 5,000 U/day subcutaneously.
The patients with MTHFR were also treated with folate at 5 mg/day + pyridoxine at 50 mg/day. All patients were carefully monitored with CBC and platelet counts, anti-Xa levels, frequent ultrasounds and physical exams.
Only 2 of the thrombophilia patients suffered another miscarriage; all others had a normal term delivery. There were no pregnancy-related thromboses, no delivery complications and no episodes of post-partum thrombosis. The only bleeding consisted of 1-4 cm bruises at injection sites. No episodes of thrombocytopenia (HIT) were noted. In our experience,
thrombophilia is a common cause of recurrent miscarriage and all patients with no anatomical, hormonal or chromosomal defect should be evaluated for thrombophilia or a bleeding disorder.
The success rate of normal term delivery in these 312 patients was 94% using ASA + heparin or Dalteparin. In addition, side effects of therapy were minimal.
, сказала, что кровь у меня тут же свернулась - "первый раз,-говорит, такое вижу" 