Merlin T, Mundy L, Dekker G, Hiller J; International Society of Technology Assessment in Health Care. Meeting (19th : 2003 : Canmore, Alta.).
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2003; 19: abstract no. 47.
Department of Public Health, University of Adelaide, Adelaide, SA 5005 Australia Tel: 61-8-83033575, Fax: 61-8-82234075, E-mail: tracy.merlin@adelaide.edu.au
OBJECTIVES: Antenatal screening for heritable thrombophilia in unselected and high-risk women (history of obstetric complications) was assessed to determine whether Australian government funding would be justified. METHODS: Several medical bibliographic databases, the internet and reference lists were searched from 1966-2001. Study selection followed a protocol and evidence was assessed and classified using specific criteria. RESULTS: There were no studies available that compared a group of women screened antenatally for heritable thrombophilia with a group of unscreened women. Factor V Leiden (FVL), prothrombin and homozygous MTHFR mutations are relatively common in unselected women, while anti-coagulant deficiencies are rare. Limited evidence suggests that unselected FVL carriers are 8 times more likely to suffer venous thromboembolism during pregnancy than non-carriers - an absolute increase in risk of only 1%. There is no association between either FVL or MTHFR in these women and intrauterine growth restriction (IUGR). High-level evidence on test accuracy is lacking. There is no substantive evidence indicating prophylaxis is effective at preventing maternal adverse events in high-risk women. Limited evidence suggests that heparinisation of these women will reduce fetal loss at clinically significant levels. Data on the impact of prophylaxis on perinatal mortality, gestational age and IUGR are inconclusive. Limited but good quality evidence revealed that heparinisation is associated with nearly 4 times the risk of increased blood loss during delivery and of postpartum anaemia. DISCUSSION: Public funding is not recommended for systematic screening of all pregnant women. Screening of high-risk women will be reviewed in two years.
Publication Types:
Keywords:
- Factor V
- Female
- Fetal Growth Retardation
- Humans
- Mass Screening
- Methylenetetrahydrofolate Reductase (NADPH2)
- Pregnancy
- Prothrombin
- Thromboembolism
- Thrombophilia
- factor V Leiden
- hsrmtgs
Other ID:
UI: 102275965
From Meeting Abstracts