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Low Molecular Weight Heparin as Thromboprophylaxis Throughout Pregnancy in Heritable Thrombophilic Women

fetal loss in women with heritable thrombophilia. The risks were greatest for women with antithrombin deficiency and for those with combined defects. In women with factor V factor Leiden the results suggested the possibility of increased risk of stillbirth (1.2% vs. 0.6% of controls) but there was no excess of miscarriages (1). Others found second trimester pregnancy loss associated with activated protein C resistance (2). Heritable deficiencies of the vitamin K-dependent physiological anticoagulants protein C and protein S have recently been associated with an increased risk for gestational abnormalities. The increased risk was significant in particular for intrauterine death (3). Patients with a deficiency of antithrombin, protein C, or protein S have a 70%, 33%, and 17% incidence of thrombosis during pregnancy, respectively (4). Coumarol therapy should be avoided throughout pregnancy. Its use during the first trimester has been associated with a characteristic embryopathy. Pathologic effects on the fetus, like central nervous system and ophthalmologic abnormalities, have been associated with exposure to warfarin in any trimester. Warfarin readily crosses the placenta and can result in fetal and neonatal