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Low molecular weight heparin: the answer to adverse outcomes in obstetrics?

Obstetricians like all of us are a mixed group. Some are early adopters, picking up on trends and anecdotes and adapting them to their practice, with or without appropriate evidence. Others are more considered, awaiting high-quality evidence or endorsed Guidelines and Recommendations before changing their practice. One of the areas of obstetrics where this pattern has been most obvious is the area of thrombophilias and pregnancy outcome. From the first publications linking antiphospholipid syndrome and recurrent miscarriage, a burgeoning literature has evolved associating congenital and acquired thrombophilic disorders and the late pregnancy clinical sequelae of preeclampsia, fetal growth restriction and placental abruption. The putative common mechanism is placental ischaemia and infarction although other mechanisms may also occur. In response to this association, obstetricians started to adopt antithrombotic prophylaxis in women considered at risk of events because of any history of late pregnancy complications’. This was driven by a lack of alternative therapies and the hope that evidence would emerge showing benefit similar to those demonstrated for antithrombotic interventions in women with antiphospholipid syndrome.