Wat is het nut van trombofilieonderzoek na een gecompliceerde zwangerschap :gegevens verzameld van 632 vrouwen die zijn bevallen in de Isala Klinieken Zwolle

Introduction Some pregnancy complications, of which preeclampsia is the most important, are related to an inadequate function of the placenta. These complications make a big contribution to maternal and perinatal mortality and morbidity. There is discussion whether these placenta related complications are associated with thrombophilia. The purpose of this study is to determine to what extent thrombophilia and placenta related complications are associated with each other. In addition the number of recurrences of complications in subsequent pregnancies will be investigated. Material and methods In this retrospective study all women who delivered at the Isala Klinieken between 1990 and 2010 after a pregnancy complicated by preeclampsia, HELLP-syndrome, eclampsia, intrauterine growth restriction, abruptio placentae, intrauterine fetal death or another placenta related complication were included. At least 3 months after delivery all patients were tested for both inherited and acquired thrombophilias. Any following pregnancies were also documented. Results Thrombophilia was diagnosed in 34.6% of all women. Protein S deficiency and hyperhomocysteinemia, and in lesser extent factor V Leiden and factor II mutation, were significantly more often diagnosed than would be expected based on the national prevalence rates. In the first subsequent pregnancy, 27% had once more a complicated pregnancy. This number decreased in the next subsequent pregnancy to 12.7% Conclusion Placenta related complications and thrombophilia are associated. Protein S deficiency and hyperhomocysteinemia, and in lesser extent factor V Leiden and factor II mutation, were seen significantly more often. Screening for these thrombophilias in high risk pregnancies seems to be indicated, especially because another study has shown that low-molecular-weight heparin has a beneficial effect on the reduction of recurrent early-onset preeclampsia in women with previous early-onset preeclampsia and an associated heritable thrombophilia.