When we talk about thrombophilia we are talking about a group of diseases in which there is an abnormal tendency to thrombosis, that is, a greater facility to form clots, to form thrombi in the blood, obstructing the adequate arterial and venous blood flow. Thrombus embolic disease can occur in 10-15% of the general population, but also during pregnancy. These are the risks and diagnosis of thrombophilia in a woman's pregnancy.
Pregnancy is a pro-coagulant state due to hormonal effect, so pregnant women with thrombophilia have an increased risk of presenting thromboembolic diseases such as: pulmonary embolism thrombus, deep vein thrombosis (lower limbs), arterial thrombosis (cerebrovascular accident), both in the period of pregnancy and in the puerperium.
They are also at increased risk of recurrent miscarriage, premature delivery, pre-eclampsia, intrauterine growth restriction, and even fetal death in utero. It is important to note that this it does not mean that all women with thrombophilia will develop thrombosis or complications in pregnancy, since half of the patients with thrombophilia go through the pregnancy without problems.
We can make a classification into hereditary and acquired:
They are associated with gene mutations, which produce alterations in the coagulation system or the fibrinolytic system, resulting in an increase or predisposition to form clots. Women with a higher risk of thrombosis in labor and the puerperium are those with Antithrombin III deficiency, activated protein C resistance, protein C deficiency, and protein S deficiency.
When hereditary thrombophilia occurs, a family study is recommended to confirm the genetic origin of the alteration and in addition to taking preventive measures against exposure to risk factors such as pregnancy, the puerperium, taking oral contraceptives, etc.
They are represented by the anti-phospholipid antibody syndrome (SAAF). It is an autoimmune disorder in which the immune system does not recognize parts of the body as its own and attacks them, thus triggering the formation of arterial or venous thrombi or obstetric complications. This disorder can occur at any time in life, including after previous normal pregnancies.
When the causes of thrombophilias in pregnancy are due to acquired reasons, a series of tests must be performed and a clinical criterion and a positive laboratory criterion must be established, confirmed on two occasions, at least 12 weeks apart. The clinical criteria would:
- Vascular thrombosis
One or more clinical episodes of arterial, venous or small vessel thrombosis, in any organ or tissue.
- Obstetric complications
One or more unexplained deaths of normal fetuses over 10 weeks of pregnancy, with normal fetal morphology as visualized by ultrasound or direct examination of the fetus. Another may be one or more preterm births of normal babies before the 34th week of gestation due to severe eclampsia or preeclampsia or confirmed findings of placental insufficiency.
And finally, three or more consecutive unexplained spontaneous abortions before week 10 of pregnancy, excluding maternal anatomical or hormonal abnormalities and maternal and paternal chromosomal abnormalities.
Regarding the laboratory criteria, that is, tests indicated by your treating doctor, confirmed on two occasions, at least 12 weeks apart, we find:
- Presence of lupus anticoagulant.
- Presence of IgG and / or IgM anticardiolipin antibodies.
- Presence of anti-βeta-2-Glycoprotein-1 IgG and / or IgM antibodies.
For the women with thrombophilia, pregnancy can create a lot of uncertainty. Many are diagnosed after having repeated spontaneous abortions for no apparent reason or complications in previous pregnancies, but being a mother with thrombophilia is possible with adequate treatment, which generally includes low-molecular-weight heparin and low-dose aspirin.
For all this, it is very important to have a preconception consultation (before pregnancy) or to go to the prenatal consultation early for adequate control, monitoring and medical treatment, established by a multidisciplinary medical team that includes your obstetrician-gynecologist, the specialist in maternal medicine- fetal, autoimmune disease specialist and hematologist.
In addition, as explained in the report 'Thrombophilias and pregnancy: incidence, risk factors and perinatal outcomes' carried out by Gutiérrez-Castañeda MR and Font-López KC, from the Hospital General Fernando Quiroz Gutiérrez, Mexico City,' the birth of a newborn A healthy, live birth and a mother without sequelae are feasible if both receive a strict surveillance protocol and treatment is established in a timely manner. '
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