Algorithm of diagnosis and treatment of thrombophilia in pregnancy – the experience of the obstetrics-gynecology department of the emergency university hospital Bucharest

Abstract

Thrombophilias defines a group of disorders associated with an increased tendency for thrombosis. They may also be seen as a heterogeneous group of conditions that have been associated during time with a variety of pregnancy complications, including early and late fetal loss, intrauterine fetal death, placental abruption, poor fetal growth (IUGR) and preeclampsia. Our clinical retrospective study was performed between 1st January 2006 and 30th June 2008. We evaluated 11518 pregnant women, who delivered in our Clinic, out of which 254 (2.20%) had different types of thrombophilias: antiphospholipid antibody syndrome (62.20%), factor V Leiden (16.93%), protein S deficiency (14.17%), protein C deficiency (3.94%), antithrombin III deficiency (2.76%). Preeclampsia was present at 27.17% of patients, out of which most cases were recorded in the APLS (36.08%), followed by APCR (30%) and the protein S deficiency (8.33%). There were mild forms of preeclampsia and they occurred in the patients who started treatment late (after the 26th week of pregnancy, due to the moment of diagnosis). Fetal pathology was represented by IUGR (20.47%) and premature birth (11.81%). The health condition of newborns, expressed by the Apgar index was very good in most of the cases (IA=10: 8.66%, IA=9: 71.26%, IA=8: 14.96%, IA=7: 3.94%, IA-6: 1.18%). The favorable evolution of the fetuses was due to the early diagnosis established and the proper treatment administrated. We had no fetal death in the group of diagnosed and treated thrombophilia patients, as well as no other thromboembolic complication. In a conclusion, we think that there are several important issues that should be taken into account when managing a pregnant thrombophilic woman. It is of great importance: • To think that pregnancy is a state of acquired hypercoagulability and that women hiding a thrombophilia may present with clinical symptoms for the first time during gestation or the puerperium – so think THROMBOPHILIA. 􀂃� To correctly select the patients for thrombophilia testing. 􀂃� To choose the correct moment for testing. 􀂃� To provide thromboprophylaxis before the occurrence of any obstetrical complication mentioned above. 􀂃� To judge correctly especially during the second half of pregnancy the ultrasonic appearance of the placenta, the growth curves of the fetus, and the placental circulation, elements that can modulate the management of that pregnancy (modifying the dosage of anticoagulant, establishing the right time for delivery).