2 неразвивающиеся беременности - крик помощи

[Ирина_А]

1 ая замершая беременность в 1995г на сроке 13 недель (по данным врачей - 8 недель).Сейчас вновь замершая беременность в таком же сроке.Эту беременность планировали с врачом,обследовалась на что только возможно, в том числе и на инфекцию.Инфекции обнаружено не было.Врач дал добро на беременность,предварительно подготовив меня - клостельбегит+дюфастон.

Было 3 чистки (2 выкидыша+1 полип эндометрия железисто фиброзный).Что еще проверять уже и не знаю,я в отчаянии,мне уже 31 год,детей нет.Помогите, что делать.

Заранее спасибо.

[АленаЛ]

Уважаемая YBLOKO!

Не знаю, поможет ли это Вам, но иногда внутриутробная остановка развития плода (как и множество других проблем при беременности) связаны с наличием у пациентки склонности к тромбозу (тромбофилией). Существует большое количество обьяснений этого, да и не меньшее количество причин, на которые не всегда есть возможность обследоваться даже в Москве. Суть проблем заключается в микротромбировании плаценты, что ведет к нарушению кровоснабжения плода, поэтому назначение прямых антикоагулянтов на весь период беременности (лучше низкомолекулярный гепарин) позволяет увеличить сохранение беременности с прим. 19-20% до 70-75%. При наличии антифосфолипидных антител к НМГ добавляется аспирин в малых дозах, при наличии гомоцистеинемии - фолиевая кислота. Если Вы опять надумаетесь планировать беременность с врачем, то могу Вам выслать англ. оригиналы статей по теме для более детального ознакомления.

И 31 год это не критический возраст: похоже певица Мадонна страдала аналогичными проблемами (привычный выкидыш), но с появлением новых знаний к концу 90-х смогла родить и не одного в возрасте под 40.

Кое-что по теме

Hypertens Pregnancy 2001;20(1):35-44

Low-molecular-weight heparin for the prevention of obstetric complications in women with thrombophilias.

Kupferminc MJ, Fait G, Many A, Lessing JB, Yair D, Bar-Am A, Eldor A.

The Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel-Aviv University, Tel-Aviv, Israel. tmcobgyn@tasmc.health.gov.il

OBJECTIVE: To evaluate the benefit of combined low-molecular-weight (LMW) heparin and aspirin for prophylaxis in women carriers of thrombophilia who had previously suffered from severe obstetric complications. METHODS: The 33 studied women had an earlier pregnancy complicated by severe preeclampsia, abruptio placentae, intrauterine growth retardation, or intrauterine fetal death. All were subsequently diagnosed as carrying inherited thrombophilias. In their subsequent pregnancy, prophylactic therapy consisting of LMW heparin 40 mg/day (Enoxaparin, Rhone-Poulenc-Rorer, France) and aspirin was administered. Patients who were found to be homozygotes for the methylenetetrahydrofolate reductase mutation also received folic acid supplementation throughout their pregnancy. RESULTS: Low-molecular-weight heparin was well tolerated and none of the women or the newborns developed any hemorrhagic complications. Only three (9.1%) of the women developed pregnancy complications. The mean gestational age and the mean birth weight at delivery in the previously complicated pregnancies were 32.1 +/- 5.0 weeks and 1175 +/- 590 g, respectively, compared to 37.6 +/- 2.3 weeks and 2719 +/- 526 g, respectively, in the treated pregnancies (p < 0.001). CONCLUSIONS: This uncontrolled trial suggests that patients with obstetric complications and an inherited thrombophilia may benefit from treatment with combined LMW heparin and aspirin in subsequent pregnancies. However, this needs to be verified by controlled trials before considering clinical application.



[Abstr.2765, Blood 2002] Efficacy and Safety of Two Doses of Enoxaparin in Pregnant Women with Thrombophilia and Recurrent Pregnancy Loss. The LIVE-ENOX Study.

Benjamin Brenner, for the LIVE-ENOX Investigators. Thrombosis and Hemostasis Unit, Rambam Medical Center, Haifa, Israel

Objectives: Thrombophilia in women is associated with pregnancy loss. Enoxaparin may improve gestational outcome in women with thrombophilia and a history of pregnancy loss. However, the optimal dose of enoxaparin in these patients has not been determined. The aims of this study are to evaluate the efficacy and safety of two doses of enoxaparin in pregnant women with thrombophilia and a history of pregnancy loss. Methods: LIVE-ENOX is a prospective, open-label randomized multicenter trial comparing subcutaneous enoxaparin 40 mg/day with 80 mg/day (40 mg b.i.d.) in women with thrombophilia and previous pregnancy loss (3 losses in first trimester, 2 losses in second trimester or 1 loss in third trimester). Women were included in this study at 5–10 weeks of gestation and treatment with enoxaparin is given throughout gestation and the post-partum period. Women with antiphospholipid syndrome also receive aspirin 75 mg/day. Patients are followed-up at monthly intervals to check maternal safety, fetal growth and development, and anti-Xa levels; and at bimonthly intervals for placental perfusion by Doppler velocimetry studies. The primary outcome is delivery of a live healthy infant. The secondary outcome is prevention of gestational vascular complications. The study includes 180 evaluable gestations, 90 in each treatment arm and is being conducted in 12 centers in Israel. Results: The first patient was enrolled in March 2000, the last in March 2002. The study groups are similar regarding type of thrombophilia, the number of previous pregnancies and the timing of previous pregnancy losses.

results (40 mg/day /Enoxaparin/ 80 mg/day):

Mean neonatal weight of babies(g): 2,973±702 / 2,957±608

Pre-eclampsia(%): 2 / 4

Placental abruption(%): 6 / 2

No thrombotic episodes or major bleeding episodes were recorded. None of the patients developed heparin-induced thrombocytopenia.