For years, attempts have been made to clarify the need to detect and treat thrombophilia in pregnancy. However, to date no consensus has been reached.
There are conditions in which there is a greater predisposition to suffer a thrombotic event, especially in the venous circulation. Because this risk increases with pregnancy, it has been proposed to investigate the influence of thrombophilia in pregnancy. The objective of these studies is to determine the risk factors involved in such vulnerability.
First of all, it is necessary to emphasize that the term thrombophilia encompasses those disorders that, in some way, increase the ability to produce blood clots. These conditions can be inherited or acquired (such as antiphospholipid syndrome). Although they are not very frequent, they cause conditions that require careful handling.
Thrombosis and embolism: what do they mean?
When a blood vessel is injured, a series of mechanisms are activated that try to repair the damage, in order to prevent possible bleeding. All these phenomena constitute hemostasis. In short, elements circulating in the blood clump together, covering the vascular lesion.
With this, a clot is formed, which is called thrombus. The adherence of the thrombus to the vessel wall is compromised by the blood circulation itself, and there is a risk of detachment. When this occurs, the clot is called plungerwith the ability to circulate through the bloodstream.
Therefore, the terms thrombosis y embolism refer to that pathology in which a clot occludes a blood vessel. The difference between the two is that, in thrombosis, the occlusion occurs in the same place where the thrombus was formed. While in the embolism, it detaches and travels through the circulation until it obstructs the vessel.
Thromboembolism and pregnancy
Pregnancy is considered a prothrombotic state. This is due to the hormonal changes that occur during the gestation period.
For this reason, some authors consider it vitally important to establish the risk of thrombophilia for each woman during her pregnancy. The purpose is to prevent any complications arising from this predisposition.
However, there is no consensus on this and the perspective has changed in recent years. In the first place, because thrombophilias are, in themselves, rare pathologies in the general population enough to establish a protocol for their investigation in each pregnant woman.
On the other hand, the studies available so far have various limits. This prevents the results from being accepted as undeniable. In the same way, as knowledge advances, the understanding of things changes. In fact, it is common to find contradictory conclusions among some investigations.
Is there a relationship between thrombophilia and pregnancy?
Various pregnancy pathologies have been associated with placental insufficiency. This means that the maternal-fetal blood flow is compromised in some way, producing a complication.
Among the conditions that are linked to circulatory disorders are the following:
For this reason, there are authors who consider it necessary to suspect the existence of thrombophilia in patients with a history of any of these complications. The justification for this is not based on a possible association between both conditions, but on reducing the uncertainty of a woman with previous bad experiences.
Is thrombophilia in pregnancy associated with pregnancy loss?
About 15% of pregnancies end in miscarriage; many of which go unnoticed. Of these women, an estimated 5% may experience another failed pregnancy again. Therefore, most women with a single history of miscarriage have a high chance of carrying a pregnancy to term.
This reality has led to the question of the need to exhaustively investigate the probable cause of the interruption of the pregnancy. Especially if it is a first attempt. Since despite being a traumatic event for women, it is far from being a synonym of infertility or predicting a future problem.
Recurrent loss and thrombophilia
However, The same does not happen if the experience is repeated. Recurrent pregnancy loss is considered if there are at least two consecutive losses. In any case, there are authors who prefer to set the limit at three.
Regardless of the definition, this is an extremely difficult situation for the couple, who often seek professional help. The purpose of this is not only to find a solution, but to obtain an explanation. In these cases, the literature does not provide a consensus in this regard.
Is there a pattern of thrombophilia and pregnancy loss?
The gestational age of previous losses is important to guide the investigation, which must be individualized. In early stages of pregnancy, an alteration in the constitution of the trophoblast may be involved. This structure will later help to form the placenta.
While in later stages, the losses may be associated with vascular complications that compromise blood flow. However, due to the low incidence in the population, the general consensus is that the existence of hereditary thrombophilia in pregnancy should not be systematically sought.
What are the risks?
Thrombotic events contribute to the development of pregnancy complications and They are the leading cause of maternal death in developed countries. More than half of the cases are associated with underlying thrombophilia, but most patients with thrombophilia have uncomplicated pregnancies.
So why this disparity? The answer is not simplified to an isolated predisposition for a thrombotic event, since pregnancy in itself is a risk condition, but to the superposition of several of these factors; among them, thrombophilia.
Some of the associated factors that increase the gestational risk in a woman with thrombophilia are the following:
- Obesity.
- smoking.
- Physical rest.
- Recent surgery.
- Advanced maternal age (over 35 years).
For this reason, the evaluation of the pregnant patient should focus on the identification of risk factors. So that the justification for investigating the possible existence of thrombophilia has a solid basis and not just responds to an unnecessary systematic practice.
Treatment of thrombophilia in pregnancy
For years there has been controversy about whether or not to treat patients with thrombophilia during pregnancy. The difficulty of this lack of consensus lies in the fact that the studies that are available are few and have several methodological drawbacks that limit their results.
However, various reviews do not attribute a real benefit to treatment with low molecular weight heparin (LMWH) or acetylsalicylic acid (aspirin) as a way to prevent a thrombotic event in a pregnant woman with thrombophilia. For the choice of this type of therapy it is necessary to individualize each patient.
Therefore, trust in the obstetrician who controls the pregnancy is essential. It will be the professional who defines, according to the risk factors, the best preventive approach to arrive at childbirth well.
You might be interested…