Thrombophilia in pregnant women

Thrombophilia in pregnant women is a congenital disease caused by the lack of anticoagulant proteins and coagulation molecules in the human body. Therefore, this type of pregnant women is relatively dangerous during pregnancy, which may endanger the lives of mother and child, and pregnant women need to be mentally prepared. The main cause of thrombophilia in pregnant women is a genetic deficiency that causes the inability to synthesize coagulation factors normally. Pregnant women need to take relevant treatment and maintenance measures during pregnancy.

Thrombophilia

Thrombophilia refers to a disease state in which thromboembolism is prone to occur due to congenital genetic or acquired defects in the human body's anticoagulant proteins, coagulation factors, plasminogen, etc., or the presence of acquired risk factors.

More and more studies have found that thrombophilia during pregnancy can endanger the life and health of mother and child, and is the root cause of many pregnancy complications and comorbidities. Actively preventing and treating complications can prevent and treat adverse maternal and fetal outcomes to a large extent, and it is worthy of the attention and participation of obstetricians and gynecologists and pregnant women. Let’s talk about thrombosis during pregnancy.

1Why does thrombophilia occur?

Thrombophilia can be divided into congenital hereditary and acquired.

The occurrence of congenital hereditary thrombophilia is mainly related to the patient's own genes. It refers to a thrombotic state caused by gene mutations leading to anticoagulant protein deficiency, coagulation factor deficiency, fibrinolytic protein deficiency or metabolic defect.

Acquired thrombophilia refers to a state in which thromboembolism is prone to occur due to the presence of acquired risk factors for thrombosis or acquired abnormalities of anticoagulant proteins, coagulation factors, plasminogen, etc., and there are often predisposing factors.

2Do all thrombophilias need to be treated during pregnancy?

Not all thrombophilias will develop into thrombosis, so the treatment of thrombophilia during pregnancy also requires certain indications. The following thrombophilias require treatment during pregnancy:

Patients with a history of hereditary thrombophilia, a family history of venous thrombosis and pulmonary embolism, a history of adverse pregnancy and delivery, SLE, APS, obstetric complications such as diabetes or preeclampsia, or after heart valve replacement.

3Who is more susceptible to thrombophilia?

Elderly people (age > 35 years), those with a history of previous surgery or trauma, those who have been immobilized for a long time, those taking hormone replacement therapy such as oral contraceptives, and pregnant women with antiphospholipid antibody syndrome (APS) are all at high risk of developing thrombophilia during pregnancy and require close monitoring.

4How does thrombophilia affect pregnant women?

A good pregnancy depends on having sufficient blood supply in the placental circulation. The persistent, abnormally high coagulability in patients with thrombophilia can lead to thrombotic tendency in the placental tissue, causing the deposition of fibrin in the intervillous spaces of the placenta and the formation of small thrombi in the placental vessels, decreased placental perfusion, and insufficient blood supply to the fetus, which can lead to miscarriage, gestational hypertension, placental abruption, and oligohydramnios.

5. What is the impact of thrombophilia on the fetus?

Pregnant women with thrombophilia are very likely to suffer from fetal nutrient supply disorders due to insufficient fetal blood supply, which can lead to fetal growth restriction, fetal distress, premature birth, fetal loss in early pregnancy, fetal death in late pregnancy, and the occurrence of fetal hereditary thrombophilia.

How to treat thrombophilia during pregnancy?

For pregnant women with thrombophilia who have indications for treatment, individualized treatment should be carried out according to the specific situation of the pregnant woman.

For patients who require long-term anticoagulant treatment (such as after artificial valve replacement), antiphospholipid syndrome, and pregnant women with a history of thrombosis, high-dose anticoagulants can be used throughout the course.

Pregnant women who may have thrombophilia (antithrombin deficiency, abnormal procoagulant factors) can be given moderate-dose anticoagulant therapy. Patients with thrombophilia who have a tendency to thrombosis, such as when they are injured or bedridden for a long time, should be given high-dose anticoagulant therapy; pregnant women with a history of unexplained thrombosis should be given low-dose anticoagulant therapy.

Low-dose or moderate-dose therapy is used for pregnancy complications related to hypercoagulable disorders. Low molecular weight heparin combined with low-dose aspirin (25 mg per day) is the best treatment for preventing miscarriage in pregnant women with thrombophilia.

7. Mode of delivery after anticoagulation therapy for thrombophilia?

For pregnant women with thrombophilia who receive anticoagulant treatment, the risk of postpartum hemorrhage increases during delivery. Pregnant women who undergo cesarean section may also experience intraoperative bleeding and hematoma at the anesthesia puncture site. Elective cesarean section to terminate pregnancy can control the metabolism of anticoagulant drugs in the body during delivery and monitor coagulation function. Therefore, in China, elective cesarean section is still the main method of terminating pregnancy for pregnant women who receive anticoagulant treatment.

8How should pregnant women with thrombophilia choose anticoagulants appropriately?

Heparin and low molecular weight heparin are used for the prevention and treatment of thrombosis; warfarin is mainly used to assist in the prevention of thrombosis after mechanical heart valve replacement surgery; aspirin is used to prevent and assist in the treatment of thrombosis in people at high risk of hypercoagulation.

9How to adjust anticoagulant drugs during peripartum period?

Discontinue warfarin 3 days before elective surgery and switch to low molecular weight heparin, and adjust the INR to around 1.0; stop aspirin 1-2 weeks before surgery; restart low molecular weight heparin 12-24 hours after delivery; for those who take prophylactic anticoagulation, anticoagulation should be continued for 1 week after delivery; for those who take therapeutic anticoagulation, anticoagulation treatment should be continued for 6-12 weeks after delivery; patients at high risk of thrombosis can continue for more than 12 weeks, up to more than 6 months.