The 8th Romanian "Ian Donald” Course
Al XII-lea Congres Națíonal de Medicină Perinatală
Concluzie: Studii recente ale endocanabinoizilor în sarcină au subliniat importanța lor în
sarcină și în apariția mecanismului nașterii premature sau la termen. Căile metabolice ale
eicosanoizilor și endocanabinoizilor sunt competitori ai aceluiași substrat și enzime însă au ca produs
Final metaboliți diferiți: prostaglandine, respectiv prostamide.
Inovații în sfera farmacologică care ar împiedica apariția travaliului prematur implicând
această nouă cale metabolică ar putea avea un impact major în scăderea mortalității și morbidității
perinatale.
R2
Prophylactic Low Molecular Weight Heparin in Perinatal
Medicine: To Whom & Why
M. Sinan Beksac
Division of Perinatology, Department of Obstetrics & Gynecology, Hacettepe University, Ankara, Turkey
Low Molecular Weight Heparin (LMWH) is used in perinatal medicine for different purposes.
There is a concensus about LMWH therapy in pregnancies having thromboembolic events. However,
the problem is it’s usage for prophylactic purposes when we are dealing with patients going together
with MTHFR polymorphisms, Factor V mutations, Prthrombine 20210A mutations, protein S & C
deFiciencies etc. The other problem is LMWH applications as a part of empirical therapy for patients
with “bad obstetrical history” especially for patients with previous early pregnancy losses.
We believe that prophylactic LMWH usage must be spared for selected cases going together
with endothelial tissue injury of vascular structures of placenta (placental inXlammation). This must be
done after careful evaluation of the patients and several tests ( endothelial tissue toxic aminoacid and
metabolite measurements, compleman system proteins, activated protein-c activity, protein-S activity,
antithrombin III activity, Lupus anticoagulants, von willebrand factor antigen, copper and
ceruloplasmin measurements, etc) are necessary before starting the LMWH applications.
Most critical candidates for prophylactic low dose LMWH usage are patients with amino acid
metabolism disorders (hyperhomocystinemia etc), autoimmune antibody positivity (with or without
clinical signs & symptoms), tendency for thrombophilia (Factor V Leiden & R2 mutations, prothrombin
20210 A mutation etc), toxicity with or without infection, maternal health problems which may effect
placental vascular system (chronic hypertension, preeclampsia, diabetes mellitus etc).
The main purpose is to eliminate the etiological factor and take necessary medical precautions
and to prevent endothelial injury of placental vascular structures and thrombus formation by low dose
LMWH. Or otherwise, endothelial cell degregates and activated compleman system components
(Membrane attack complex; MAC) together with the main fraims (autoantibodies, toxic material, toxic
aminoacids etc) will attack materno-fetal interface which is actually the chorionic villus structures.
Obstetrica și Ginecologia
15
27 - 30 Septembrie 2017