Early detection of congenital and acquired thrombophilia in pregnant women and prevention of abortion

Thrombophilia is not a disease in itself. It is a different set of inherited and acquired coagulation disorders associated with a tendency to thrombosis.

Pregnancy is a condition in which the tendency to blood clotting is increased (increased production of fibrinogen, increased number of blood clotting factors – FII, FVII, FVIII, FX, FXII, increased level of PAI-1, decreased fibrinolysis, significantly reduced level of protein S, and acquired resistance to activated protein C) also occurs.

Congenital and acquired thrombophilia are associated with the risk of impaired pregnancy.

Known obstetric complications of thrombophilia include intrauterine fetal death, recurrent miscarriages, intrauterine fetal growth retardation, preeclampsia, placental abruption, and preterm birth.

Early pregnancy loss is the most common complication in pregnancy.

About 15% of all clinically recognized pregnancies end in miscarriage, and recurrent miscarriages occur in 1% of couples.

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According to present knowledge, for women with specific hereditary thrombophilia, treatment recommendations include the following:

For low-risk thrombophilia without prior VTE (venous thromboembolism), antepartum monitoring without anticoagulation or NMH prophylaxis is recommended.

Postpartum monitoring requires monitoring without anticoagulants or anticoagulation therapy if there are additional risk factors.

For low-risk thrombophilia and one previous episode of VTE in women who do not have long-term anticoagulant therapy, prenatal treatment means giving prophylactic doses or a medium dose of NMH or monitoring without anticoagulants.

After childbirth, anticoagulation therapy or medium doses of NMH are required.

For high-risk thrombophilia without prior VTE, prophylactic dose of NMH in pregnancy and postpartum anticoagulation therapy are given.
High-risk thrombophilias with one previous episode of VTE in women who are not on continuous anticoagulant therapy receive prophylactic intermediate doses or adjusted doses of NMH during pregnancy.

Postpartum, these women receive anticoagulation therapy or intermediate or adjusted doses of NMH for 6 weeks, and the dose is the same as the antepartum.

Women without thrombophilia but with a previous episode of VTE associated with one transient risk factor that is no longer present (other than pregnancy or other estrogen-related risk factors) should be monitored without anticoagulant antepartum and anticoagulation therapy postpartum.
Women without thrombophilia with one previous episode of pregnancy-related VTE or estrogen-related risk factors should receive prophylactic doses of NMH and anticoagulant therapy postpartum.
Women without thrombophilia who have had one episode of idiopathic VTE unrelated to risk factors and who are not receiving long-term anticoagulation therapy are receiving NMH antepartum and anticoagulant therapy postpartum
Regardless of whether they have thrombophilia, women who have had 2 or more episodes of VTE and are not receiving long-term anticoagulant therapy should receive prophylactic or therapeutic dose of NMH antepartum and anticoagulation therapy postpartum.

If they are already receiving long-term anticoagulant therapy, then they should receive antepartum therapeutic doses of NMH and keep their anticoagulation therapy after delivery.

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Who should be tested?

any patient with a history (personal or family) of venous thrombosis who is pregnant or planning to become pregnant
a woman with a history of fetal death in pregnancy, fetal growth retardation, preeclampsia, placental abruption, habitual abortions

Antiphospholipid syndrome is the only thrombophilia that has been reliably determined to directly affect pregnancy loss, and when treated, the prognosis of pregnancy is good.

In contrast, discussions about the treatment of hereditary thrombophilia continue.

So far, low molecular weight heparin (NMH), aspirin, unfractionated heparin, corticosteroids and intravenous immunoglobulin have been used in therapy.

Pregnancy outcomes in women with hereditary thrombophilia are generally good, even without therapeutic interventions.

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