â�?�?The TEAM Projectâ�? Results on Management of Placenta-Mediated Pregnancy Complications (PMC): The Impact of Thrombophilia Test and Thromboprophylaxis with Low-Molecular-Weight-Heparin on Recurrences of PMC

Aim: In placenta-mediated pregnancy complications, evidence-based guidelines are based on studies with controversial results or expert opinion. In this context, the implementation of those guidelines is quite different among physicians. Our aim was to analyze the management of PMC in a real-world scenario. Methods: From 2010 until 2016, we started the “TEAM Project” as a nested project within a working group of the Spanish Society of Thrombosis and Hemostasis (SETH : Sociedad Espanola de Trombosis y Hemostasia). Results: We included 666 women with PMC, including recurrent pregnancy loss (50%), fetal death (25%), preeclampsia- eclampsia (20%), intrauterine growth restriction (5%) and placental abruption. Although a thrombophilia test was indicated in more than 80% of these patients, antiphospholipid antibodies were tested in less than 70% cases. The presence of PT20210A mutation and positive antiphospholipid antibodies were the most common findings observed. Among the 257 women with previous PMC who were assessed for thrombotic risk, 88.7% received antithrombotic prophylaxis, most frequently (46.8%) low molecular weight heparin (LMWH)+aspirin (AAS) and recurrence was observed in 14% of women. Conclusion: This is the first observational, multicentric and multidisciplinar phase IV study analyzing the real-life clinical management of PMC and other hemostatic/thrombotic events in women from Spain and Uruguay. Our results evidence a lack of homogeneity in the management of these complications as a result of the wide discordance among the existing guidelines, as well as a need for a call to action in fetal-maternal medicine.