Нискомолекуларен хепарин со или без аспирин во превенција на матернални и перинатални компликации кај ризична бременост

Abstract

Introduction: Placenta mediated pregnancy complications, as preeclampsia, stillborn, intrauterine growth restriction, abruptio placentae and recurrent miscarriages are the most common risk factors for maternal and fetal morbidity and mortality in the developed countries. Women with previous placenta mediated pregnancy complications are at increased risk of recurrence in a future pregnancy. The aim of the study is to investigate how much antenatal thromboprophylaxis with low molecular weight heparin (LWH) and aspirin will increase the rate of live births compared with antenatal thromboprophylaxis only with LWH and control group. Secondary goals also derive from the primary goal, investigate how much antenatal thromboprophylaxis will reduce the percentage of adverse pregnancy outcomes: preeclampsia, stillbirths, intrauterine growth restriction, placental abruption, and recurrent miscarriages. To determine the safety of the use of LWH and aspirin: to detecting bleeding, thrombocytopenia, an allergic reaction, pain at the injection site of LWH and osteoporotic fracture. Material and Methods: The study is a prospective, controlled comparative study and was performed in the Department of Gynecology and Obstetrics at the Clinical Hospital Tetovo for the five-year period, from 2012-2017. The study included 100 patients over 18 years of age who met the inclusion criteria of the study. Patients were in the first trimester of pregnancy with previous pregnancies with preeclampsia, stillbirths, intrauterine growth restriction, and recurrent miscarriage. All patients were divided in two groups: The first group consisted of 31 patients who were treated with low-molecular weight heparin (Nadroparin 0.3 ml) / 24h. The second group consisted of 33 patients treated with lowmolecular- weight heparin (Nadroparin 0.3 ml) / 24h and Aspirin 100 mg per os. The control group consisted of 36 patients who were not treated with antenatal thromboprophylaxis, but had previous pregnancies with adverse outcome. They were included in the study when they were delivered to our hospital. Results: The total number of pregnant women examined was 100. The basic demographic characteristics and obstetric past were similar among the examined groups. A significant difference was found in the rate of live birth among the three groups, 31/31 (100%) in the group treated with NMH, 32/33 (97%) in the group treated with NMH and Aspirin and 29/36 (80.60%) in the control group of patients, p = 0.006. Control group / group of LWH, p = 0.01, (OR = 0.81 / 95% CI: 0.69-0.95), Control group / group of NMH and aspirin, p = 0.06, (OR = 0.83 / 95% CI: 0.83-49.52). There was no significant difference in the occurrence of a adverse pregnancy outcome between the three groups in relation to the occurrence of preeclampsia (p = 0.43), intrauterine growth restriction (p = 0.70), abruption placentae (p = 1.00). A significant difference was found in relation to the occurrence of recurrence miscariages (p = 0.005). In the LWH treated group of 31 patients 3 (9.70%) had bleeding, 1 (3.20%) had an allergic reaction to LWH, pain had 5 (16.10%). In the group of treated patients with LWH and Aspirin from 33 patients, 5 (15.20%) had bleeding, 5 (15.20%) had pain and one patient (3.00%) had pain and bleeding. There was no significant difference between the two groups of patients in the findings concerning the adverse effects of the therapy. Conclusion: Antenatal thromboprophylaxis with LWH significantly increases the rate of live birth in pregnant women with previous pregnancy with adverse outcome. Treatment with LMWH and Aspirin proved to be less effective in increasing the rate of live birth from treatment with LMWH alone. Antenatal thromboprophylaxis does not reduce the negative outcomes of pregnancy, such as preeclampsia, intrauterine growth restriction, and abruptio placentae. LMWH significantly reduces the number of recurrent abortions. LMWH and Aspirin are safe in pregnancy with no significant difference between the two groups of patients in the findings of bleeding, thrombocytopenia, allergic reaction, and pain at the injection site of the drug.