Healthy pregnancies require normal placental blood flow.
Thrombophilia’s are associated with an increased risk of blood clotting Thrombophilia’s can adversely affect placental blood flow and increase fetal risks
Thrombophilia’s are blood-clotting disorders where blood has a greater tendency to clot. It is self evident that it is essential in pregnancy to maintain a normal blood flow through the placenta. Blood clotting disorders may impair placental blood flow and can limit the capacity of the placenta to accommodate the increasing demands of a growing pregnancy. They can have serious implications for fetal well-being.
It is always essential to take a comprehensive maternal and obstetric history as well as a family history. In many circumstances it is possible to suspect the presence of underlying risk factors and in these circumstances it would be essential to investigate the patient with a number of tests including investigations for Thrombophilia.
If a Thrombophilia should exist it is necessary to ensure that steps are taken to try and counter any tendency to coagulation with the use of blood thinning drugs. (oral Aspirin or Clexane injections.)
It is essential in the presence of a Thrombophilia to monitor fetal growth and well being with close obstetric supervision.
There will be an increased reliance on Ultrasound scans to assess fetal umbilical and fetal cerebral blood flow patterns. In addition it will be necessary to assess fetal liquor volume and fetal growth.
In the event of any deterioration in these factors it will be necessary to try and plan the appropriate timing of an earlier delivery to protect the fetus from potential harm.
There are certain well-recognised conditions such as the Antiphospholipid syndrome and other Connective tissue disorders. These are often associated with Thrombophilias and in turn with fetal growth restriction and ultimately with fetal distress. The tests which are usually performed in screening for Thrombophilias include:
- Anticardiolipin antibodies
- Lupus anticoagulant
- B1 Glycoprotein 2
- Factor V Leiden mutation
- Antithrombin III
- Prothrombin 20210 mutation
- Protein S & C deficiency
- Methylene tetrahydro folate reductase deficiency (MTHFR)
- Antinuclear antibody
- Extractable nuclear antigens (ENA)
There is never any reason to omit appropriate investigations to identify Risk Factors in Pregnancy. The sequence should be evident to all.
INVESTIGATE – IDENTIFY PROBLEMS – TREAT – MONITOR – PREVENT COMPLICATIONS