SBA — Single Best Answer · Review
Question 193
Delivery suite → Haemorrhage
Classification
Question
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A woman planning pregnancy has heterozygous factor V Leiden and a previous placental abruption. She asks whether prophylactic low-dose aspirin plus low-molecular-weight heparin should routinely be prescribed specifically to prevent recurrent abruption. Which response best reflects the available evidence?
Question Stem
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Options
A
Combined antithrombotic therapy is proven to prevent recurrent abruption in women with thrombophilia
B
Low-molecular-weight heparin is mandatory because factor V Leiden is a direct causal mechanism for abruption
C
There are insufficient good data to support routine antithrombotic therapy specifically for prevention of abruption in women with thrombophilia
D
Aspirin alone is contraindicated because it increases the incidence of abruption
E
Thrombophilia has no reported association with placental abruption
Explanation
An association between some maternal thrombophilias and placental abruption does not establish that treatment prevents the event. Although observational and earlier systematic-review data suggested associations with factor V Leiden and prothrombin mutations, later prospective data showed weaker and uncertain associations. There are no good data supporting low-dose aspirin with or without LMWH specifically to prevent abruption in women with thrombophilia. A small pilot study of enoxaparin after previous abruption was considered preliminary rather than practice-changing evidence.
Option Validity
A) This strategy is not established as proven preventive therapy.
B) Association does not demonstrate a direct causal pathway or mandate LMWH.
D) Aspirin is not contraindicated on the basis that it increases abruption.
E) Thrombophilias have been reported in association with abruption, although the strength and causality are uncertain.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.