Desfechos materno-fetais das gestações subsequentes à intervenção com enoxaparina em gestantes com marcadores séricos para trombofilias e antecedente de complicações obstétricas

Abstract

Thrombophilias during pregnancy have been associated with maternal thrombotic events and obstetric complications. Due to the serious complications involved, interest in the treatment of thrombophilias during pregnancy and puerperium has risen considerably. In view of this, the aim of the present study was to evaluate--using a scoring system--maternal-fetal outcomes following an intervention with low molecular weight heparin - enoxaparina - in women with serum markers for thrombophilias and a history of obstetric complications. A retrospective study was undertaken based on the review of medical records of pregnant women managed under the care protocol for thrombophilia in pregnancy of the Gynecology and Obstetrics Clinic at the University Hospital of the Federal University of Mato Grosso do Sul from November 2009 through December 2013. The number of miscarriages, fetal/perinatal deaths, live births, preterm births, term births, and cases of preeclampsia in pregnancies pre- and postintervention with enoxaparin were compared using the chi-square test (χ2) with Yates correction or Fisher's exact test, with statistical significance set at P < 0.05. The study included 109 patients with 254 pre-intervention pregnancies of which 48.8% (124/254) ended in miscarriages, 20.5% (52/254) resulted in fetal/perinatal deaths, and 14.2% (36/254) cases of preeclampsia. Live births amounted to 30.7% (78/254), with 11.8% (30/254) of preterm births and 18.9% (48/254) of term births. Regarding the 109 post-intervention pregnancies, 36.7% (40/109) of the pregnant women used low molecular weight heparin alone; 41.3% (45/109) associated low molecular weight heparin with aspirin (100 mg/day); 12.8% (14/109) used LMWH and supplementation with folic acid in addition to vitamin B6 and B12 in doses of 10 mg/day and 0.1 mg/day, respectively, and 9.2% (10/109) received low molecular weight heparin in combination with aspirin and folic acid supplementation in addition to vitamin B6 and B12 at the doses described above. The most commonly used (76.2% of cases) dose of low molecular weight heparin was 40 mg/day. Of the 109 treated pregnancies, 0.9% (1/109) ended in miscarriage, 2.7% (3/109) in fetal/perinatal deaths, and preeclampsia developed in 15.6% (17/109) of cases. Live births totaled 96.4% (105/109) of the pregnancies, of which 68.0% (74/109) were at term and 28.4% (31/109) preterm. There was a significant reduction in miscarriages and fetal/perinatal deaths (P < 0.0001) and a significant increase in live births (P < 0.0001) after the intervention. The results of the present study suggest that therapy with enoxaparin during pregnancy in women with serum markers for thrombophilia and previous obstetric complications was effective and contributed to improved obstetric outcomes.