Thromb Haemost 1996; 75(03): 387-388
DOI: 10.1055/s-0038-1650282
Original Article
Schattauer GmbH Stuttgart

The Risk of Abortion and Stillbirth in Antithrombin-, Protein C-, and Protein S-deficient Women

Bernd Jan Sanson
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
3   The Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands
,
Philip W Friedrich
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
3   The Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands
,
Paolo Simioni
2   Istituto di Semeiotica Medica University of Padua, Padua, Italy
,
Sandra Zanardi
2   Istituto di Semeiotica Medica University of Padua, Padua, Italy
,
Menno V Huisman
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
,
Antonio Girolami
2   Istituto di Semeiotica Medica University of Padua, Padua, Italy
,
Jan Wouter ten Cate
1   The Centre for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands
,
Martin H Prins
3   The Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received: 04 August 1995

Accepted after resubmission05 December 1995

Publication Date:
26 July 2018 (online)

Summary

Hereditary deficiencies of the naturally occurring anticoagulants are well recognized conditions predisposing to recurrent venous thromboembolism. Since thrombotic phenomena have been implied as a cause of abortion and stillbirth, we hypothesized that these deficiencies increase the risk of fetal demise.

A group of 129 female subjects who had been pregnant at least once and who had a family member with documented venous thrombosis associated with a deficiency of AT, PC or PS were studied. We first assessed the obstetric history and subsequently determined the deficiency status. In the 60 deficient subjects 42 (22.3%) of the 188 pregnancies resulted in miscarriage or stillbirth as compared to 23 (11.4%) of the 202 pregnancies in the 69 non-deficient subjects. The relative risk of abortion and stillbirth per pregnancy for deficient women as compared to non-deficient women was 2.0 (95% C.I. 1.2-3.3).

 
  • References

  • 1 Hoak H. Disorders associated with thrombosis. In: Textbook of internal medicine Kelly WN. ed Philadelphia: J. B. Lippincott Company; 1992. 2nd edition 248 1285-1293
  • 2 van Hinsberg V, Bertina R, van Wijngaarden A, van Tilburg N, Emeis JJ, Haverkate F. Activated protein C decreases plasminogen activator-inhibitor activity in endothelial cell-conditioned medium. Blood 1985; 65: 444-451
  • 3 Dahlback B. The protein C anticoagulant system: inherited defects as basis for thrombosis. Thromb Res 1995; 77: 1-43
  • 4 Hirsh J, Prins MH, Samama M. An approach to the thrombophilic patient. In: Thromb Haemost. Basic principles and practice Colman RW, Hirsh J, Marder VL, Salzman EW. eds Philadelphia: J. B. Lippincott Company; 1994. 3rd edition 80 1543-1562
  • 5 Tharakan T, Baxi LM, Diuguid D. Protein S deficiency in pregnancy: A case report. Am J Obstet Gynecol 1993; 168: 141-142
  • 6 Conard J, Horellou MH, van Dreden P, Lecompte T, Samama M. Thrombosis and pregnancy in congenital deficiencies in ATIII, protein C or protein S: A study of 78 women. Thromb Haemost 1990; 63: 319-320
  • 7 Carp HJA, Frenkel Y, Many A, Menashe Y, Mashiach S, Nebel L, Toder V, Serr DM. Fetal demise associated with lupus anticoagulant: clinical features and results of treatment. Gynecol Obstet Invest 1989; 28: 178-184
  • 8 Healy AM, Rayburn HB, Rosenberg RD, Weiler H. Absence of the blood-clotting regulator thrombomodulin causes embryonic lethality in mice before development of a functional cardiovascular system. Proc Natl Acad Sci USA 1995; 92: 850-854
  • 9 Bieber FR, Driscoll SG. Evaluation of early pregnancy loss. In: Diseases of the fetus and newborn Reed GB, Claireaux AE, Cockbum F. eds London; Chapman & Hall Medical: 1995. 2nd edition 14 175-186