Thrombophilia and pregnancy

Thrombophilia is a condition that presents an increased risk of blood coagulation. It is not a recently discovered condition, however, with medical advances, it is now possible to detect several types of thrombophilia resulting in more accurate diagnosis and correct therapy. Predisposition to thrombophilia may either be inherited or acquired.

The causes of inherited thrombophilia include:

  • Mutations of the V Leiden factor. It is the most common cause of thrombophilia occuring in around 2 – 7% of the general population.
  • Mutation G20210A prothrombin mutation. It occurs in around 2% of the general population.
  • Protein C and S deficiency. It occurs in less than 1% of the general population.
  • Antithrombin deficiency (less than 1% of the general population).

The types of acquired thrombophilia are:

  • Antiphospholipid syndrome (APS). It is the most common type of thrombophilia among pregnant women, occuring in around 5% of them.
  • Lupus anticoagulant antibody.

Pregnancy is associated with an increased risk of clotting. For this reason, women with a family history of thrombophilia should be screened for the condition with the necessary tests. Furthermore, all women with previous miscarriages should be tested as well, even in the absence of family history.
Thrombophilia may be the cause of the following pregnancy complications:

  • Recurrent miscarriages usually occuring after the 10th week of pregnancy.
  • Death in utero during the 2nd or 3rd trimester of pregnancy.
  • Pre eclampsia
  • Delayed fetal development
  • Placental abruption before labour with the risk of hemorrhage.

Pregnant women with APS syndrome are more likely to present pre eclampsia, delayed fetal development and premature delivery (before 37 weeks gestation). Most of these complications are likely to be caused by clots that limit the blood flow into the placenta.

Thrombophilia is usuallly treated with low dose aspirin and anticoagulant therapy that is usually continued post delivery.

The thrombophilia screen that should be incorporated in the prenatal checks and include the following tests:

Thrombophilia table

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