Thrombophilia in future moms
The cause of many complications of pregnancy (preeclampsia, placental insufficiency, detachment of normally situated placenta, etc.), As well as miscarriage, is a violation of the blood coagulation system of the future moms – so-called thrombophilia. How to identify an abnormal state of blood clotting and prevent its negative impact on pregnancy?
- Preeclampsia during pregnancy
- Olga Pankov Gynecologist
- thrombophilia treatment
- preeklampsiigomotsistein markers and stilled beremennostkak clotting effect on pregnancy
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Pregnancy and thrombophilia
Thrombophilia is a tendency to the development of thromboms (blood clots). It can develop as the intake of certain drugs (chemotherapy, hormones, etc.) And due to a mutation (change) of the genes responsible for the activity of blood coagulation factors.
Pregnancy is an exam for the presence of "hidden" thrombophilia. In this delicate period, the state of high coatability is in normal. These changes are designed to support normal pregnancy, since the introduction of the embryo and the placenta growing into his.
However, if there are mutations and polymorphisms (varieties) of some genes, these changes are of pathological nature and do not contribute to the progression of pregnancy, but rather, on the contrary, lead to complications.
In pregnant women with thrombophilia, the risk of thrombosis increases sharply. This applies to all vital bodies, including the mother-placenta-fruit system. Disturbance of uterine-placental and fruit-placental blood flow due to thrombosis, inflammation of vessels and infarction placenta may be the cause of spontaneous miscarriage, underdeveloped pregnancy, growth delays and intrauterine death of the fetus, detachment of a normally located placenta, premature genera, gestosis, preeclampsia and eclampsia.
When thrombophilia decreases the depth of the introduction of the embryo, and implantation becomes defective, which is often the cause of infertility and loss of the embryo before attaching it to the maternal place, as well as ineffective eco
Who is in the risk group?
Thrombophilia, in addition to pregnancy complications, can also cause thrombotic complications when using hormonal drugs (contraceptives and menopausal therapy), as well as after surgical operations.
In this regard, I recommend to conduct a genetic examination to all women who have:
– In the past, a frozen pregnancy was detected;
– The usual unbearable in different times is noted;
– There were heavy complications of pregnancy (preeclampsia and eclampsia, intrauterine fetal death, delay in the development of the fetus);
– unsuccessful attempts eco;
– an increase in the level of antiphospollipid antibodies and / or homocysteine was detected;
– The relatives under the age of 50 were detected by the thrombosis of deep veins, pulmonary artery thromboembolism, stroke, myocardial infarction, sudden death;
– Gynecological operations are planned;
– It is assumed to use hormone therapy.
The following types of thrombosis are suspicious about hereditary thrombophilia (including the nearest relatives):
– idiopathic (unfortunate, without previous intervention);
– repeating, especially aged less than 50 years;
– Unusual localization: Badda Kiari syndrome, Pedge-Schreter syndrome, intestinal mesenteric vessel thrombosis, cerebral veins;
– arising against the background of taking oral contraceptives or substitution hormone therapy.
We reveal "bad" genes
If the future motley is included in a group of increased risk on the development of thrombophilia, it is necessary to determine mutations / polymorphism of the following genes before conception or conducting ECO:
– V Leiden
– fibrinogen (G455A);
– plasminogen fabric activator;
– Antithrombin III;
– protein s;
– protein C;
– platelet receptors (GP IA 807C / T; GP IIIA 1565T / s; GP ID 434 s / t);
– Some enzymes: methylene etchidrofolate reductase (MTHFR), methionine synthetase (MTR), methionine synthease-reductase (MTRR).
Their presence can cause thrombophilia and development of pregnancy complications, including non-leaving.
Prevention of formidable complications
Prevention of thrombophilia manifestation is carried out, starting with preparation for conception! Early therapy provides normal implantation processes of the embryo and placentating. The appointment of this treatment in a later date of pregnancy, after the completion of the process of invasion of trophoblast and placentating, significantly reduces the chance to make pregnancy without complications.
In preparation for conception, patients with thrombophilia need to implement the following preventive measures:
– Sanation of foci of the cavity of the oral cavity, genitals and etc., Since its presence contributes to thrombosis;
– Appointment of anticoagulants after surgical interventions, including minimally invasive manipulations: Endometrial biopsies, separate diagnostic scraping, laparoscopy, etc.;
– Conducting anticoagulant therapy during pregnancy and in the postpartum period for at least 6 weeks.
Preventive treatment includes the following drugs:
– Low molecular weight heparin (NMG).
– Foliic acid.
– Vitamins Group B.
– Polyunsaturated fatty acids omega-3.
– Natural progesterone (micronized).
Against the background of treatment in preparation for conception, as well as during pregnancy, regular control of efficiency, safety and adequacy of antithrombotic therapy is needed once every 2-3 weeks, and if necessary, more often.
Standard coagulogram for full analysis is not enough. The most effective functional methods for assessing the severity of thrombophilia are the following markers:
– Complex of thrombin-antithrombin (tat).
– Fragment Protrombina F1 + 2.
– Fibrin / Fibrinogen degradation products (PDF).
– D-dimer (in dynamics).
– Soluble complexes of Fibrin monomers (RKMF).
– The number of platelets and indicators of the aggregation activity of platelets.
– Test for resistance to activated protein C (APC-R).
When changing markers of thrombophilia during pregnancy against the background of the treatment, it is individually solved by the question of the appointment of antitrombocytic disaggregants, anticoagulants, fibrinolysis inhibitors.
Preventive treatment in patients with thrombophilia, started before conception, and strict control of laboratory indicators are a key to success, as they allow you to prevent the child’s loss and other formidable complications of pregnancy.
Pregnancy under thrombophilia
Future mothers with diagnosed thrombophilia require special observation in this delicate period. Essential importance should be given to data from various periods of pregnancy, as well as the study of blood flow (Dopplerometry) in the placenta. In thrombophilia in the I trimester, there is a decrease in vascularization in various placenta areas, which is a prerequisite for the formation of chronic placental insufficiency.
Pregnant with trimmbophilia in the first trimester Up to 8 weeks can produce three-dimensional uterine-placental blood flow. It is a highly informative method of detecting in the early stages of gestation complications in women with thrombophilia. In II and III, trimesters are needed to monitor the state of the fetus according to fetometry, dopplerometry and fruit cardiographics (CTG).
The main place in the prevention of thromboembolic complications during pregnancy occupies counter-tomb therapy, safe for mother and fetus. The drug selection is currently low molecular weight heparin, which does not penetrate the placenta, creates a low risk of bleeding and heparin-induced thrombocytopenia (GIT), and also convenient for use (1 injection per day).
Therapy is considered effective if there are no thrombosis and heavy forms of gestosis on the background of pregnancy, there is no threat of pregnancy interruption, signs of pairing placenta and fetoplazent failure.
Additional therapy includes:
– Polyvitamins for pregnant women;
– antioxidants (microhydrin, vitamin E);
– Iron preparations, preferably tribal (Faltum, Faltum Foul), since it can remove free radicals, damaging endothelium vessels and embryos.
Against the background of adequate therapy and maintaining pregnant women with thrombophilia, the indicators of thrombophilia markers are normalized. In the future, there is a preservation of these parameters at the level characteristic of physiological pregnancy.
Preparation for childbirth
In women with the greatest risk of complications (genetic forms of thrombophilia, antiphospholipid syndrome, syndrome thrombosis, recurrent thrombosis) Anticoagulant therapy is shown throughout pregnancy.
NMG is canceled 24 hours before the cesarean section of the section or with the beginning of the generic activity. The prevention of thromboembolic complications resume 6-8 hours after childbirth and are carried out for at least 6 weeks of the postpartum period, and while maintaining elevated thrombophilia markers – for a longer time with the translation, if necessary for tableted anticoagulants (warfarin).
Helping anesthesia during childbirth in patients with thrombophilia possible. The final decision takes a anesthesiologist.
Pregnant, suffering thrombophilia requires strict control of hemostasis and fetal states up to delivery, as well as after them. In order to avoid unpleasant complications, in particular, bleeding in the last period, the migration of pregnancy is not desirable. The question of the stimulation of generic activities and the implementation of the cesarean section is decisive.
Natural labor during thrombophilia is possible. However, more often (approximately 70% of the birthrooms with such a diagnosis) perform the cesarean section, since the pathology of the hemostasis system most often appear to show it: gestosis of severe severity; Premature detachment of a normally located placenta; acute hypoxia of the fetus; chronic fetoplacentage failure (violation of blood circulation between the placenta and the fruit) and.
In addition, preference to the operational delivery is given in the presence of a long-term infertility, the usual non-pending pregnancy, as well as if this pregnancy is the first, and the age of the future mother exceeds 30 years.
Thrombophilia is a serious diagnosis that can cause a lot of trouble during pregnancy. But thanks to the achievements of modern medicine, almost any complications can be prevented. It is important to start the right treatment in a timely manner and be under the supervision of experienced professionals! And then, I’m sure nothing will prevent a long-awaited meeting with your baby!