Thrombophilia and Pregnancy Complications

Maternal serum soluble CD30 is increased in normal pregnancy, but decreased in preeclampsia and small for gestational age pregnancies

“…That are characterized by: (1) multiple etiologies; (2) chronicity; (3) fetal involvment; (4) clinical manifestations that can be adaptive in nature; and (5) susceptibility to gene-environmetn interaction. Both entities share risk factors, such as advanced maternal age [2][3][4], chronic hypertension [5][6][7][8], renal disease [9][10][11], thrombophilia [12][13][14], and systemic lupus erythematous (SLE) [15,16]. In addition, mechanisms of disease shared by the two conditions include: (1) abnormal physiologic transformation of the spiral arteries [17][18][19][20][21][22][23][24]; (2) chronic uteroplacental ischemia [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]; (3) endothelial cell dysfunction [41][42][43][44]…”

Combined Thrombophilia and Obstetric Complications

“…These adverse pregnancy outcomes affect up to 15% of gestations and are the major cause of maternal and fetal morbidity and mortality [3]. In one study, at least one thrombophilic defect was found in 96/145 (66%) of woman with recurrent fetal loss compared to 41/145 (28%) in controls (or=5.0, 95/5 ci: 3.0-8.5 p <0.0001) [4].…”

“…Inherited thrombophilia is common and can be found in 15% to 25% of Caucasian populations. Thus, a combination of thrombophilic risk factors is not rare and can be detected, regarding Israel, in up to 5% of women with pregnancy loss [4,5].…”

“…For example, factor V Leiden existing concomitantly with protein C or protein S deficiency, or factor V Leiden or prothrombin 20210A paired with hyperhomocysteinemia carry relative risks of venous thrombosis greater than any of these factors alone. Regarding patients with a history of thrombotic disease from the European Prospective Cohort on Thrombophilia (EPCOT) study, the highest odds for a stillbirth (odds ratio [OR], 14.3; 95% CI, 2.4-86.0) occurred in women with combined thrombophilia defects [4,7,8].…”

Thrombophilia and anticoagulation in pregnancy: indications, risks and management

“…Women with thrombophilia show an increased risk for pregnancy loss at the end of the first and in the second trimester [31,32] and those with FVL or prothrombin gene variant show a higher risk of late pregnancy loss (424 weeks) [4,13]. Recurrent pregnancy loss has been linked to inherited thrombophilia, particularly with protein C and S deficiency, FVL and a prothrombin gene variant [29,37,38], but the evidence is limited. A significant association with increased risk for placental abruption was only observed with heterozygous FVL and the prothrombin gene variant [13,39].…”