The disease can not be felt for a long time, and then manifest itself as thrombosis, pulmonary thromboembolism and more serious consequences. In order not to cause a threat to the fetus, it is necessary to start treatment on time.

What is the disease during pregnancy dangerous?

Blood coagulation in pregnant women is already great. This is necessary to reduce blood loss. But pathologically high blood coagulability may occur, which contributes to the formation of blood clots. The likelihood of complications is highest in the third trimester.

Thrombophilia during pregnancy can be asymptomatic up to 10 weeks. Then there are signs of the disease.

Dangerous effects of thrombophilia during pregnancy:

• preeclampsia;
• low water or polyhydramnios;
• vascular microthrombosis and placental ischemia;
• hypertension
• placental abruption;
• fetal hypoxia;
• slowdown of physical development, small weight of the child;
• fetal freezing followed by stillbirth;
• miscarriage;
• severe swelling;
• premature birth.

The most serious and deadly complications for a woman are the formation and separation of a blood clot, a blockage of the vessel. A pregnant woman may die from pulmonary embolism, heart attack, or stroke.

The most dangerous periods are 10-12 weeks and the third trimester.

In order not to encounter the consequences of thrombophilia in pregnant women, even at the planning stage, you need to undergo an examination. A high probability of the appearance of this disease with a hereditary predisposition.

Thrombophilia Pregnancy Planning

Thrombophilia is acquired and hereditary (congenital). This disease directly affects the ability to get pregnant and bear a child, so you first need to get rid of the disease.

Genetic thrombophilia during pregnancy can be recognized by the following symptoms:

• inability to bear a child (the woman had 2 or more unsuccessful attempts to bear a child);
• complications in previous pregnancies;
• blood clots while taking hormonal drugs;
• several unsuccessful IVFs.

Planning for pregnancy with thrombophilia is the key to having a healthy baby. Complications will be absent if a woman undergoes an examination and a course of treatment.

Preparing for pregnancy with thrombophilia is to take tests.

Which doctor treats thrombophilia during pregnancy?

Normal birth with thrombophilia is possible if the pregnant woman is observed by a gynecologist, hematologist and genetics.

Diagnostics

With hereditary thrombophilia during pregnancy, a phased examination is carried out, which consists of many tests. Diagnosis is complicated and expensive, therefore it is prescribed only in the case of several unsuccessful pregnancies, the cause of which could not be found.

Tests for thrombophilia during pregnancy are prescribed in such cases:

• the presence of relatives with thrombophilia;
• complicated pregnancies (placental abruption, fetal growth retardation);
• more than 2 pregnancies in the history of women who did not end in childbirth;
• the appearance of blood clots after treatment with hormonal drugs;
• symptoms of complications of thrombophilia in a pregnant woman;
• unsuccessful IVF.

If there is at least one factor, a woman must undergo a series of additional examinations.

Genetic abnormalities can reveal an analysis of gene polymorphism. It must be taken on an empty stomach. Results will be ready in 2 days. This analysis needs to be passed to women who plan to become pregnant.

Treatment

Pregnancy and thrombophilia are not incompatible concepts, but it is necessary to treat the disease despite the term of gestation.

After making a diagnosis, doctors immediately prescribe treatment. The scheme is approved by a geneticist, gynecologist and hematologist.

The treatment consists of:

• drug therapy;
• diet
• compliance with the regime.

To reduce blood coagulation, a woman needs to take anticoagulants. Dosage and drug individually for each patient.

Diet involves the use of foods that reduce blood coagulation. These are seafood, ginger root, dried fruits and berries. From the diet should be excluded:

• buckwheat;
• greens;
• white cabbage, red pepper, beets, turnips, radishes, legumes;
• walnuts;
• bananas and mangoes;
• rose hips, rowan berries;
• offal (liver, heart, kidneys);
• fats of animal origin.

Slow walks are useful for a woman, but prolonged sitting or standing in one place will only worsen the condition. Physiotherapy exercises and swimming are useful. With the permission of the doctor, you can wear compression underwear.

How is the birth?

Childbirth with thrombophilia takes place. A woman may well endure and give birth to a healthy baby. The percentage of complications with such a disease is small.

This disease is not a sentence. If you follow all the recommendations of a doctor, the chances of making and giving birth to a healthy baby are very high.

Useful video about thrombophilia during pregnancy

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People who are far from medicine know little about blood pathologies. On hearing various oncological diseases and "imperial" disease -. However, this list of blood pathologies is not limited to. Moreover, many can live their lives without realizing that they are at risk.

Thrombophilia - what is it?

Thrombophilia is not a disease, not a diagnosis, but a condition of the body, characterized by an increased tendency to form blood clots. Actually, thrombosis is a consequence of thrombophilia. And this is a disease, not a predisposition.

During the centuries-old evolution of living organisms, including humans, a unique protective feature appeared - spontaneous stop of bleeding (hemostasis). Thanks to her, a living creature is protected from fatal blood loss in case of minor to moderate wounds. And this is the merit of the blood coagulation system.

On the other hand, the process of formation of protective “blockages” in the vessels must be controlled and restrained. Here anticoagulation factors come to the rescue.

Normally, the activity of the coagulation system is balanced by the activity of the anticoagulation system. However, when such a dynamic equilibrium shifts, disturbances in the hemostatic system occur. One of them is thrombophilia.

This pathological condition can be congenital or acquired. Hereditary thrombophilia develops due to mutations in the genes responsible for the synthesis of coagulation factors or their antagonists. The acquired form is associated with lifestyle features and health status:

• oncopathology;
• diabetes;
• obesity;
• pregnancy;
• postpartum and postoperative condition;
• dehydration;
• autoimmune pathologies;
• heart defects;
• taking certain medications (oral contraceptives, glucocorticoids, estrogens);
• prolonged catheterization of veins.

Most often, genetic thrombophilia and the above risk factors overlap and trigger thrombosis. However, in the absence of provocative features of increased thrombosis, even in individuals with a hereditary predisposition, there may not be.

Thrombophilia is often asymptomatic - its manifestations are associated with developed thrombosis and are determined by its localization. The deep veins of the lower extremities are usually affected. In this case, there are swelling, leg fatigue, a feeling of fullness, cyanosis or redness of the skin.

A dangerous complication is thromboembolism - separation of a thrombus with subsequent blockage of a smaller vessel. In this case, due to circulatory disorders, ischemia or tissue necrosis develops. Pulmonary thromboembolism is a fatal condition. Its symptoms are acute chest pain, shock, tachycardia, loss of consciousness and coma.

Blood clots often form in the veins. In addition to the vascular bed of the lower extremities and the pulmonary artery, mesenteric veins, the portal, hepatic, and renal veins, rarely are the veins of the upper extremities and the brain.

Hereditary Thrombophilia - Features

If the nearest blood relatives at a young age were diagnosed with thrombosis and its relapses, or the patient developed such a pathology against the background of hormone replacement therapy or taking oral contraceptives, it makes sense to exclude hereditary thrombophilia by performing a genetic analysis. It is carried out by PCR (polymerase chain reaction).

This method makes it possible to detect changes in the genes that control the process of hemostasis, and make a conclusion about the presence or absence of hereditary thrombophilia.

A genetic predisposition to increased blood coagulation is associated with dominant mutations. As you know, in the body of every person, all genes are present in double amount. If at least one copy is affected by a dominant mutation (heterozygous form), a pathological condition will manifest itself.

When both genes are changed (homozygous form), the severity of thrombosis and the severity of their consequences increase many times.

With hereditary thrombophilia, mutations can affect two groups of genes:

• responsible for the activity of coagulation factors;
• encoding the synthesis of anticoagulants.

In the first case, changes cause excessive activity of coagulation compounds: Leiden factor V and prothrombin (factor II). These mutations are already apparent at a young age. In women, the usual miscarriage of pregnancy is associated with them.

If genes for the synthesis of anticoagulants are damaged, a decrease in their concentration is noted. Hereditary thrombophilia is associated with a lack of proteins C and S, antithrombin III. Homozygous newborns (having 2 defective genes) have a high mortality rate of 90-100%. Heterozygous babies suffer from fulminant purpura, accompanied by ulceration of the skin and the appearance of zones of necrosis on it.

In addition, hereditary thrombophilia is often determined by mutations of genes encoding the course of other physiological processes.

A pathological tendency to the formation of blood clots is noted with congenital hyperhomocysteinemia, dysfibrinogenemia, violations of the fibrinolysis process (destruction of blood clots).

Is thrombophilia during pregnancy dangerous?

Very often, thrombosis develops against the background of increased loads attributable to the body. Pregnancy is also a kind of stressful situation. This condition in a woman’s life is accompanied by a colossal restructuring in the functioning of all organs and systems. Including changes in blood composition.

Compensatory, in order to protect the expectant mother from excess blood loss during childbirth, the body increases the concentration of coagulation factors. This condition increases the risk of placental vascular thrombosis in women with hereditary thrombophilia by 6 times, and can lead to consequences such as a miscarriage or a frozen pregnancy.

The most dangerous is a period of 10 weeks. If this boundary was successfully overcome, it should be remembered that in the 3rd trimester of pregnancy the risk of thrombosis will increase again.

In this case, premature birth or placental abruption may occur with massive bleeding that threatens the life of the mother and fetus. Babies in the prenatal period show signs of developmental delay and placental insufficiency.

However,   giving birth to a healthy baby with diagnosed thrombophilia is possible. Women with such a heritable predisposition should take a responsible approach to pregnancy planning. If a history of miscarriages, a missed pregnancy, thrombosis due to hormonal drugs, failed IVF attempts, or someone from blood relatives suffered from this, the expectant mother should undergo an analysis for thrombophilia.

This is an expensive, comprehensive diagnostic procedure and it is not shown to everyone, but if the doctor offers to perform it, you should not refuse. Thrombophilia, controlled by medication, makes it possible to endure and give birth to a strong baby without developmental disabilities.

However, the success of such a pregnancy is in the doctor’s careful monitoring of the state of the future mother and her strict adherence to all medical recommendations.

Diagnosis of thrombophilia + tests

Diagnosis of thrombophilia is a multi-stage and complex process. Its purpose is to identify a specific link that can fail, and determine the severity of the pathological condition.

Even a general blood test can prompt a specialist to think about a possible thrombophilia with these results:

• increased viscosity;
• an increase in the concentration of red blood cells and platelets;
• increased ratio of the volume of formed elements to the volume of blood plasma (increased hematocrit);
• eSR reduction.

To find out in which link of hemostasis the malfunction allows the laboratory determination of such indicators:

• thrombin time;
• D-dimer;
• indicators of APTT (activated partial thromboplastin time) and INR (international normalized ratio);
• anti-Ha (inhibition of the coagulation factor Stuart-Praer);
• proteins C and S;
• antithrombin III;
• coagulation and bleeding time;
• factor VIII;
• soluble fibrin-monomer complexes;
• von Willebrand factor;
• blood calcium;
• plasma recalcification time (activated);
• lupus anticoagulant.

The list of defined parameters is extensive, but in each case, the hematologist prescribes the study of only certain characteristics. So, during pregnancy and its planning, APTT, thrombin time and prothrombin index, fibrinogen content are important. The same tests are done before surgery.

Anticoagulant treatment requires control of APTT, INR, anti-Xa. If you suspect the autoimmune nature of the pathology - lupus anticoagulant, INR, APTT, prothrombin index, fibrinogen. And after vein thrombosis, all the same tests, except for the lupus marker, and proteins C and S, D-dimer, factor VIII and homocysteine \u200b\u200bare additionally studied.

If a hereditary predisposition is suspected, PCR is detected genetic markers of thrombophilia:

1. Mutations in the genes of anticoagulant proteins C and S;
2. Defects causing a lack of antithrombin III;
3. Leiden mutation;
4. Prothrombin (II) mutation;
5. Mutation in the methylene tetrahydrofolate reductase gene;
6. Defective platelet receptor gene for glycoprotein IIIa;
7. Abnormal fibrinogen gene.

Thrombophilia treatment - drugs

The treatment of diagnosed thrombophilia is determined by its cause. If the pathological condition is genetically determined, a complete cure cannot be achieved. In this case, replacement therapy is used.

It is aimed at replenishing the missing coagulation factors by injection or plasma transfusion. With hyperaggregation, plasmapheresis and drip administration of plasma are indicated.

Acquired forms of thrombophilia are treated with anticoagulants. An indication for their purpose is a combination of 3 or more risk factors. With thrombophilia, the same drugs are used as for the treatment of thrombosis:

• aspirin;
• warfarin;
• chimes;
• pradaxa;
• heparin and its derivatives (dalteparin, enoxaparin, fraxiparin).

People with thrombophilia are shown the use of folk remedies that thin the blood. Ginger, fresh grape juice, cranberry tea, dried fruits, and seafood are especially useful. Fatty and fried foods should be excluded from the diet, since the lipids in its composition thicken the blood.

During pregnancy, you should definitely wear compression underwear: stockings and tights. Expectant mothers should not be neglected by exercise therapy, massage, daily slow walking or swimming.

Forecast

Thrombophilia is not a disease, but a predisposition to it. If you adhere to the basic rules of prevention, thrombosis and related complications (thromboembolism, ischemia, heart attack, stroke) will not develop.

First of all, you need to follow the principles of proper nutrition: include fresh vegetables, fruits, berries, seafood, low-fat varieties of meat and fish, whole grain bread in the diet. No need for stagnation of blood in the veins, which contributes to a sedentary lifestyle.

All chronic pathologies and acute infectious processes should be treated immediately or controlled. Systematic administration of hormonal drugs and replacement therapy for thrombophilia involve regular studies of blood coagulation ability.

Thrombophilia is not a sentence. On the contrary, knowing about such a feature of the body, an intelligent person who takes care of his health will take all possible measures to prevent the development of life-threatening complications.

Thrombophilia: occurrence, genetic component, types, treatment, risks

Thrombophilia is characterized by increased thrombosis where it is not needed at all.. This can lead to quite serious conditions that can lead to the death of the patient. For example, (pulmonary embolism) may result from thrombophilia.

It is known that during normal functioning and anticoagulation, our blood remains in a liquid state, flows through the vessels, enriches the tissues of all organs with necessary substances and carries away metabolic products. If everything is safe in the body, both systems work smoothly, their factors are at the right level, then the state of aggregation of blood is in optimal mode and intravascular coagulation does not occur as well as uncontrolled bleeding.

Damage to the vascular wall during injuries, operations, as well as conditions that occur without violating the integrity of the endothelium, but with increased blood coagulation for another reason, include a coagulation system that provides education. However, having done its work in case of bleeding, the coagulation system should transfer work to the anticoagulation system, which will remove unnecessary clots and normalize the vessel wall. And in a normal state, blood should not coagulate at all inside the vessel, but for some reason this is not always the case. Why? Here it is time to recall thrombophilia - the culprit of periodically arising, dangerous to human life.

Thrombophilia may be programmed.

It is known that many forms of this disease are congenital in nature, therefore, they were originally identified by the genetic code before the birth of a person, where, however, it should be distinguished:

• A genetic predisposition when a disease may not manifest itself if there are no factors that trigger the mechanism of its development;
• A disease that occurs for the first time as a result of a gene mutation at an early stage of embryonic development subsequently becomes hereditary and can be transmitted to offspring;
• An inherited disease caused by the genomic and structural mutation of chromosomes in previous generations and transmitted to the offspring by inheritance. However, it plays a role in what condition the disease gene is: dominant or recessive (gene polymorphism). In the dominant - pathology will come out in any case, whether it be a homo- or heterozygous. The recessive state of a gene is able to manifest itself only when two weak alleles are found that form a homozygous.

As for heterozygous organisms having a pathological gene in a recessive state, in most cases they not only do not suffer from this, but sometimes they are more stable and viable compared to normal individuals. However, gene polymorphism (alternative variants of genes - pathological and normal) in different diseases manifests itself in different ways and in each case requires study. Regarding thrombophilia, scientists have conducted and continue to conduct studies to calculate the degree of risk of thrombosis with polymorphism of a particular gene.

In order for the reader to better understand the mechanism of the formation of congenital thrombophilia, some genetic aspects should be considered in more detail, such as the concept of “gene mutation”.

Gene mutation

In fact, the genes were not so stable, given once and for all. Genes change at different frequencies (from 10 -2 to 10 -5 on average), which leads to the appearance of new signs, by the way, which are not always useful. This is a mutation, and in the case of thrombophilia, it is rightly considered harmful.

Some factors, the concentration of which has recently been noticeably increasing, may lead to gene mutations, and, consequently, to an increased incidence of hereditary diseases. The appearance of alleles that adversely affect the health of the body, contributes to the activity of the person himself:

1. Man-made disasters:
2. Environmental pollution (pesticides, various types of fuel, household chemicals);
3. The use of drugs, food additives, genetically modified foods;
4. Radiation

Mutagenesis is a random process, since it is impossible to predict in advance which gene will change under adverse (or favorable?) Conditions. And which direction is also unknown. The mutation process occurs on its own, changing hereditary properties and, for example, thrombophilia, it can be argued that it is not always for the better.

Gene polymorphism and its significance in obstetric practice

A condition such as pregnancy noticeably provokes thrombogenic changes, especially if there is a predisposition or hereditary disease, therefore when planning replenishment in a family, it would be good for a woman to find out her pedigree.   Currently, thrombophilia genes have been found that contribute to the development of thrombosis during pregnancy, childbirth and the postpartum period, where the following are considered the most significant:

• Factor gene polymorphism (G20210A) leads to infertility, impaired intrauterine development and even fetal death, thromboembolism and thrombosis, myocardial infarction (MI) and;
• The polymorphism of the genes of Leiden factor FV (G1691A) during pregnancy is of great importance, since it can provoke miscarriages and adversely affect the fetus, and, in addition, can cause MI; thromboembolism;
• Mutation of the PAI-1 genes (SERPINE1) reduces the activity of the entire anticoagulant system, therefore it is considered one of its main components;
• The specific role of the MTHFR C677T gene mutation in thrombus formation has not been fully understood, although they have been dealing with this problem for more than 10 years, but the fact that it affects the vessels, damages them and thereby contributes to the formation of a clot, has already been confirmed in scientific circles.

These and other factors (genes ITGA2, ITGB3, the mutation of which determines enhanced platelet aggregation, FGB anomalies, deficiency, deficiency of proteins C and S) are classified as hereditary pathologies and are considered markers of thrombophilia.

Thrombosis and thromboembolism - a very scary thing during pregnancy, they give a high percentage of maternal mortality and fetal death,   therefore, measures taken in advance will be useful. Childbirth with thrombophilia, as a rule, is always premature (35-37 weeks).

Having your genetic card would be beneficial for other people. At least for the prevention of complications of increased blood clots (heart attacks, pulmonary embolism, etc.). However, while the definition of genetic markers is widespread in cardiology and obstetric practice, where the basis for the appointment of an analysis for thrombophilia are:

1. Pregnancy planning;
2. Thrombosis in the past;
3. The presence of thrombosis, thromboembolism and death from them in the family;
4. Miscarriages, infertility.

In addition to obstetrics, where there is the highest risk of developing pathology, creating extreme conditions and requiring urgent measures, cardiogenetics avoids thrombotic complications in surgery (trauma, surgery), oncology (chemotherapy) and, of course, in cardiology itself (IHD, myocardial infarction and headache brain), where in addition to this, an additional risk group may comprise:

• Patients having;
• Fairly well-fed people;
• Women taking hormonal oral contraceptives;
• People engaged in hard physical work.

Cardiogenetics allows you to find genetic abnormalities of the genes of the hemostatic system, their polymorphism, and, therefore, a predisposition to thrombosis by conducting a complex analysis at the molecular genetic level, which is usually done using PCR diagnostics (polymerase chain reaction).

Forms and groups of thrombophilia

In addition to congenital pathology, it’s clear that there is also acquired one, the reasons for which lie in the same adverse environmental factors, the use of certain drugs, the passion for bio-additives and the very large and beautiful gifts of gardens and orchards (and simply genetic engineering) brought from individual countries far abroad, where they are not prohibited.

Nevertheless, both hereditary and congenital pathologies of the anticoagulant system have one essence - a change in the properties of blood, which violates hemostasis and leads to thrombosis and thromboembolism. In this regard, forms are distinguished in the group of hematogenous thrombophilia, the causes of which are various changes in the ratio of coagulants and inhibitors, as well as other factors affecting the hemostatic system.

Violation of the rheological properties of blood is characterized by a decrease in blood flow in the capillary bed, an increase in red blood cells over 5.5 x 10 12 / l and a pathological condition of red blood cells. This group of diseases includes:

1.   (polycythemia), erythrocytosis;
2. Blood clotting and other cases of increase;
3. Paraproteinemia (and others), accompanied by, or hyperfibrinogenemia, arising for the same reason and very dangerous for pregnant women and the fetus;
4. Heart attacks and thrombotic crises caused by impaired blood movement due to the altered structure and appearance of red blood cells.

Pathological changes, impaired functional abilities and an increased content of blood platelets combine inherited hypertrombocytosis and hyperaggregation acquired in the course of life. They arise against the background:

• Malignant tumors;
• Excessive production in the vascular walls;
• The reduced content of the stimulator for the production of prostacyclin, which is a powerful inhibitor of platelet aggregation;
• Oversaturation with stimulating plasma components or, conversely, their deficiency ().

The deficiency or abnormal state of natural anticoagulants (proteins C and S, antithrombin III, components of the fibrinolytic system) or the high content of their inhibitors also represent a separate form of hematogenous thrombophilia.

In addition, congenital fibrinogen abnormalities (dysfibrinogenemia) and thrombophilia of immunohumoral origin, to which antiphospholipid syndrome (APS), due to the high concentration of antibodies to phospholipids (anticardiolipin, "lupus" anticoagulant) in the blood, are distinguished into separate groups.

Stand alone iatrogenic thrombophiliathat are directly related to treatment (uncontrolled or uncompensated).

When AT III or Proteins C and S are Not Enough

Not enough antithrombinIII, the proportion of which normally makes up about 80% of all anticoagulant (antithrombin) activity, is inherited by the autosome or acquired a second time as a result of inhibition of its production or excessive consumption during coagulation (or excessive activation). This can be observed in cases:

1. Pregnancy, especially with toxicosis, and in carriers of the second system AB0 - A (II);
2. After surgical interventions, in which, one way or another, but the integrity of the vascular wall is violated;
3. Some types of neoplasms;
4. Long-term anticoagulant therapy;
5. Acceptance of combined oral contraceptives (COCs).

The main symptoms of AT III deficiency, of course, are thromboses, manifested in different ways. Extremely severe form   deficiency does not survive even to adolescence. It is characterized by:

• Constant relapse of blood clots in the peripheral and visceral venous bed, in the vessels of the heart and brain;
• Thromboembolism (pulmonary artery).

Looks a little better heavy, but still unfavorable, the form that occurs later, by the years 15-25, which, however, also occurs with heart attacks in any organs, and in the lungs and myocardium in the first place;

For border form   thromboses that occur spontaneously are not characteristic, but under certain circumstances (body immobility, shortly before and after childbirth, the postoperative period, injuries) there is a high risk of developing pulmonary embolism.

Potential form   virtually no spontaneous thrombosis, and its manifestation is always associated with conditions predisposing to the disease. For example, the same pregnancy with this variety will cause the debut of the disease.

The main treatment for this form of thrombophilia is substitution. In this capacity, transfusions of AT III-concentrate and plasma fresh frozen are best suited, since heparin gives a very weak effect. In addition, hormones, thrombolytics, and anti-inflammatory drugs (prothrombin index) are prescribed.

Lack of protein C andS, which are produced in the liver with the participation of vitamin K, in its characteristics is very similar to a deficiency of AT III. It can be hereditary or secondary (liver disease, obstructive jaundice, vitamin K deficiency, prolonged use of anticoagulants in large doses). Symptoms of polythrombotic syndrome are characteristic of this pathology (thrombosis occurs in both venous and arterial vessels).

The clinical manifestations of protein deficiency are expressed:

1. Skin necrosis;
2.   localized in any place, sometimes not connected to each other (from lips and ears to the scrotum and mammary glands);
3. Malignant purpura of newborns, the start of which was DIC syndrome with congenital lack of protein C.

Visible manifestations of thrombophilia

Diagnosis of pathology consists in determining the plasma concentration of the corresponding proteins (C and S).

Therapeutic tactics: eliminating the causes of pathology, transfusion of freshly frozen plasma, the introduction of heparin and concentrates of these proteins.

Abnormal conditions of prothrombin, Leiden factor (FV) and fibrinogen, impaired fibrinolysis

Pathology resulting from hereditary anomalies leiden factor   (resistance of activated FV to protein C), is often found and is expressed by a tendency to thrombosis (recurring).

Fibrinogen abnormalitiesarising at the molecular level also belong to hereditary pathology and also manifest increased thrombosis, however, they are characterized by a combination of two seemingly opposite phenomena: thrombophilia and hypocoagulation with prolonged coagulation and / or delayed fibrinolysis.

Fibrinolysis Disorders   can also be presented in the form of two options: hereditary (a violation of the production of plasminogen activator or himself, molecular anomalies) and acquired or secondary deficiency inherent in disseminated intravascular coagulation, massive thrombosis, treatment with drugs that stimulate fibrinolysis. Provocateurs of this form of thrombophilia can be:

• Damage to the endothelium as a result of injuries and surgical interventions;
• Pregnancy in a woman with a predisposition or, for other reasons, childbirth.

Plasma replacement treatment, combined with infusions of heparin and plasminogen, activation of fibrinolysis. For the prevention of thrombosis - the appointment of anabolic hormones.

APS - a syndrome that deserves special attention

Relatively recently about antiphospholipid syndrome (AFS) knew almost nothing. It is hardly recognized, it often accompanies viral and immune processes, although the primary one can occur from scratch without any prerequisites.

The appearance of "lupus" anticoagulants in the blood leads to damage to the phospholipid membranes of the cell membranes (vascular wall, platelets) and a violation of the mutual influence of coagulation factors. In addition, the "lupus" anticoagulants belong to the ability:

1. Affect the anti-aggregation properties of the walls of blood vessels and thrombotic resistance, reducing them;
2. Inhibit thrombin inactivation by thrombomodulin;
3. Reduce the production of fibrinolysis and prostacyclin activators in the vascular wall;
4. Strengthen spontaneous aggregation of blood platelets.

Due to such changes, a hemostasis response occurs, which is manifested by the simultaneous presence of completely different symptoms: bleeding and thromboembolism, which leads to DIC, impaired blood circulation in the brain or other organs (kidneys).

At present, gynecologists attach particular importance to the antiphosphoric syndrome, since, as it turned out, it is the cause of many troubles of women trying to have a baby for several years. However, attempts often end in miscarriages or stillbirth due to thrombosis of the placental vessels. In addition, the APS is often manifested by a positive reaction to syphilis, which makes a person pretty worried.

The leading symptoms of antiphospholipid syndrome can be represented as follows:

• Recurrent thrombosis that occurs in the vessels of organs (lungs, kidneys, liver, brain) and the main vessels;
• Violation of microcirculation with bleeding;
• Strengthening the spontaneous aggregation abilities of blood platelets, which may manifest thrombocytopenia or go without it;
• Violation of blood flow in the microvasculature of the brain, causing cerebral and neuropsychiatric disorders (frequent headache, partial loss of limb mobility, focal cerebral ischemia, neurasthenia);
• Change in blood (and immunological parameters).

Now, many women are prescribed a test in order to detect APS, and those with a burdened obstetric history are shown all the more. Diagnosis of APS is based on determining the titer of specific antibodies and parameters.

Therapeutic measures depend on the form of antiphospholipid syndrome (primary or secondary) and include: plasma replacement, appointment (aspirin, chimes), (heparin), hormones (prednisone), etc.

Gynecologists treat pregnant women with APS, adhering to the developed schemes for each month of pregnancy. In addition, a special diet is prescribed that allows you to affect blood coagulability and reduce it.

Future mothers should limit the use of other foods that are useful in other cases, such as cabbage, bananas, rosehip berries, cranberries and mountain ash, walnuts, spinach, dill and parsley. It is better to forget about fat and fat meat altogether. And it should be remembered that seafood, beets, pomegranates, lemons, tomatoes, cherries, raspberries reduce blood coagulation. It will be useful to use folk recipes. They say that honey with sunflower oil (1 teaspoon of oil + 1 tbsp.spoon of honey every day) also prevent increased thrombosis.

Metabolism and Thromboembolism

For many diseases, the doctor prescribes a coagulogram, although some patients are completely unclear about such actions. And, meanwhile, most of the chronic pathological processes are caused by hereditary or acquired metabolic disorders, which, ultimately, can lead to rather serious complications. Why is the increased value of lipid metabolism - cholesterol and lipid spectrum () paid so much attention? Why is diabetes in a special position among other diseases? And all because they indicate a high risk of developing cardiovascular disease, for which the result is thrombosis, thromboembolism, heart attacks, obliterating arterial diseases.

In addition to these indicators, a violation of the exchange of sulfur-containing amino acids, which include homocysteine \u200b\u200band methionine, is considered very dangerous. The metabolic disorder of these protein builders is called hyperhomocysteinemia (GHC), which can be primary (genetically determined) or secondary (acquired, symptomatic). Congenital GHC is manifested in childhood or adolescence, while acquired is characteristic of older people.

It is scientifically proven that the presence of hyperhomocysteinemia always indicates a significant risk of the occurrence and progressive course of obliterating diseases of arteries and vascular thrombosis.

The main diagnostic method for metabolic thrombophilia is to determine the homocysteine \u200b\u200bvalues \u200b\u200bin the patient’s blood and urine. The level of this indicator increases markedly if a test is carried out with a load of methionine, which is rich in dairy products. In addition, diagnostic measures include a comprehensive examination of the patient (ECG, ultrasound, blood chemistry and other studies, depending on the clinical picture of the disease).

Treatment of metabolic thrombophilia should begin with a diet that restricts the intake of foods containing large amounts of sulfur-containing amino acids, and first of all, milk and all that can be made from it, then meat, fish, legumes, and soy. With all this, the patient should tune in to the long-term intake of B vitamins, combination preparations (Magne-B 6) and folic acid.

Does treatment lead to thrombosis?

A side effect of many drugs is manifested in the development of a tendency for blood to increase the formation of blood clots. For example, estrogen contraceptives and certain groups of cytostatics possess similar qualities. Paradoxically, this list can be replenished with heparin, which in some patients stimulates spontaneous gluing of blood platelets (heparin thrombophilia with ricochet thrombosis), and thrombolytics (in large doses), which deplete the plasmin system and enhance thrombosis due to aggregation.

Thrombocytopenia that occurs on day 2-3 of heparin treatment is called early. Late appears after about 1-1.5 weeks, it has more vivid symptoms (bleeding and thrombosis at the same time), reminiscent of thrombotic thrombocytopenic purpura.

In order to avoid the undesirable consequences of such therapy, one should remember about prevention and combine the use of heparin and thrombolytics with antiplatelet agents (acetylsalicylic acid, ticlide, etc.). It is important to remember that with a combination of these drugs it is impossible to act blindly, therefore, control of the aggregatogram and coagulogram should be mandatory.

Video: the role of thrombophilia and immune disorders in miscarriage

Thrombophilia in itself does not harm, it is pathological when creating ideal conditions for its exacerbation. Such conditions occur after minimally invasive operations, exacerbation of chronic diseases, and even pregnancy. And in order not to lose a child in the prenatal period or a mother in the postpartum period of recovery with hereditary thrombophilia, it is important to begin preparation even before childbirth. And you need to start with the analysis. Doctors will evaluate all degrees of risk and select the necessary therapy for successful gestation.

What is thrombophilia, causes of increased thrombosis

Thrombophilia is an increased predisposition to the development of vascular thrombosis (mainly venous) of various localization due to genetic defects of the hemostatic system. The process of thrombosis is a natural reaction of the body with damage to blood vessels, aimed at stopping bleeding. With thrombophilia, the formation of a clot provokes a decrease in blood flow (in the artery) or outflow (in the vein). If a blood clot detaches from the wall of an artery or vein, an embolus is formed - a particle that moves with the blood stream and can adhere to the walls of other vessels.

  The resulting blood clot is firmly attached to the site of damage to the endothelium, however, in some cases, the entire blood clot or its fragments can break away and enter other tissues and organs, leading to circulatory disorders

Blood clots often clog veins. In addition to the vessels of the lower extremities and the pulmonary artery, mesenteric veins, the portal, hepatic, renal, rarely the veins of the upper extremities and the brain are subject to thrombosis.

This pathology of extensive damage, up to 40% of the adult population suffer from its consequences, depending on the place of education:

• blood clots of the legs:
  
• thrombosis of veins and arteries of the intestine - intestinal necrosis and its acute inflammation - peritonitis;
    Acute occlusion of the mesenteric vessels is manifested by a sharp violation of blood circulation in the vascular areas proximal and distal to the site of obstruction, accompanied by severe angiospasm and additional thrombosis, resulting in acute malnutrition and ischemic damage to the intestinal wall
• cerebral vascular thrombosis - ischemic stroke - an acute violation of the blood circulation of the cerebral vessels, which can lead to death in a day or instantly;
• thrombosis of cardiac coronary vessels - myocardial infarction - a form of coronary heart disease, characterized by the death of a myocardial site due to insufficient blood supply;
  Acute ischemia causes the death of part of the functional muscle cells (necrosis) and their subsequent replacement with connective tissue fibers, i.e., the formation of a post-infarction scar
• placental vascular thrombosis - spontaneous miscarriage;
• hepatic vein thrombosis - ascites or abdominal dropsy, which differs from other diseases by the accumulation of excess fluid in the abdominal cavity.
    The accumulation of peritoneal fluid in ascites is accompanied by an increase in intra-abdominal pressure, pushing the dome of the diaphragm into the chest cavity

Causes of increased thrombosis:

• thrombophilia in first-line relatives;
• blood diseases:
  
• cancers;
• atrial fibrillation - increased heart rate up to 350-600 beats per minute;
• varicose veins or varicose veins;
    Varicose veins, or varicose veins, are pathological changes in the veins, accompanied by their saccular expansion, increase in length, the formation of convolutions and nodular tangles, which leads to valve failure and impaired blood flow
• arterial hypertension - a constant increase in blood pressure from 140/90 mm RT. Art. and higher;
• heart attacks and strokes;
• surgical procedures;
• obesity;
• long-term use of hormones.

How Pregnancy Affects Thrombophilia

Genetically determined thrombophilia affects generation after generation, but for a long time does not reveal itself. But with the onset of pregnancy and a change in blood viscosity, this tendency to thrombosis begins its excessive activity.

Pregnancy increases the formation of blood clots by 4–5 times, because blood changes its viscosity under the influence of hormones.

Video: researcher, obstetrician-gynecologist, author of books on women's health E. Berezovskaya about thrombophilia and pregnancy

What is the most dangerous period of pregnancy

The most dangerous period is up to 10 weeks, when the risk of miscarriage is particularly high due to the formation of a blood clot in the vessels of the placenta with its enhanced nutrition to ensure the vital activity of the fetus. If this boundary was successfully overcome, it should be remembered that in the 3rd trimester of pregnancy the risk of thrombosis will increase again. The body of a pregnant woman after 30 weeks is intensively prepared for childbirth and blood coagulation is markedly increased. In preparation for childbirth, the levels of such estimated indicators of coagulation are additionally checked:

• prothrombin or coagulation protein, normal - 8–142%;
• thrombin time or APTT, during which blood coagulation occurs. Normal - 11-17.8 seconds;
• - a plasma protein responsible for the formation of a blood clot. Its normal content is 2.00 - 4.00 g / l;
• atitrombin is a specific protein that provides resorption of a blood clot, normal - 75–125%.

Possible consequences and complications of a relapse of thrombophilia

Hereditary or acquired thrombophilia is considered as the most likely cause of obstetric complications such as:

• miscarriage;
• ZVRP or fetal growth retardation when its growth and development parameters do not correspond to the obstetric period of pregnancy;
• fetal death in the womb or stillbirth;
• placental insufficiency with a delay in the development of the fetus and its oxygen starvation (hypoxia);
• premature detachment of a normally located placenta - early separation of the placenta from the walls of the uterus, which occurred before the birth of the fetus;
• preeclampsia - a deviation from the normal course of pregnancy, characterized by a combination of the main symptoms: edema, protein in urine tests, increased pressure;
• eclampsia is the most severe, critical form of gestosis, occurring with convulsive syndrome, loss of consciousness, the development of post-eclampsic coma;
• fetoplacental insufficiency.

Clinical manifestations of thrombophilia

Depending on where the clot formed, the symptoms are different:

With a relapse of thromboembolism, both genetic and acquired, pregnant women often turn not to a hematologist, but to their gynecologist with the confidence that they suffer from late obstetric complications of pregnancy, namely, expected in the later stages of gestosis or VVD - vegetovascular dystonia:

• headache;
• hypertension
• general weakness;
• loss of consciousness;
• fatigue;
• dyspnea;
• edema of the upper and lower extremities;
• leg cramps;
• cyanosis or redness of the skin;
• pain in the lower abdomen;
• uterine bleeding;
• toxicosis with vomiting.

Diagnostic methods for thrombophilia

First of all, it is necessary to donate blood for the study of hemostasis - this is a biological system in the body whose function is to maintain the liquid state of the blood, stop bleeding with damage to the walls of blood vessels and dissolve blood clots that have fulfilled their function. The main factors are blood coagulation:

• F5 - Acelerin gene, Leiden mutation;
• F2 - prothrombin.

These genes are the most studied and it is known that their violation can lead to the most serious complications of pregnancy, for example, placental abruption at 25–26 weeks of pregnancy. On their basis, hetero- or homozygosity of a woman is revealed, i.e. how much her genes are damaged. Analyzes for these two markers are carried out first of all, you can donate blood for this even after a light breakfast. The analysis takes only two days. Such tests for gene polymorphism are given only once in a lifetime; there is no need to retake after treatment.

If necessary, it is additionally assigned:

• study of the plasminogen activator gene, fibrin, in the diagnosis of the PAI-1 genome and coagulation factor XIII. It is known that inhibition of fibrinolysis often leads to disruption of the implantation process of the fetus. In this regard, a decrease in the fibrinolytic activity of this system is one of the reasons for early termination of pregnancy;
• platelet receptor genes, the presence of mutations in these genes leads to increased platelet aggregation and adhesion. Platelets first appear at the site of the defect. They adhere (adhere) to damaged endothelial cells, swell and form processes. In parallel with the adhesion, the process of platelet aggregation, swelling and gluing them together with the formation of processes and the imposition of aggregates on the site of damage to the vessel, as a result of which the hemostatic plug or thrombus rapidly grows. Diagnosis of the following factors is required:
  • FBG - fibrinogen gene;
  • ITG A2 - platelet integrin gene;
  • ITG B3. Such patients are insensitive to aspirin, they need chimes;
  • F7 - proconvertin gene;
  • F13 - gene fibrin-stabilizing factor.
• folate cycle genes or homocysteine \u200b\u200baccumulation regulating genes that indicate a predisposition to thrombophilia. After all, homocysteinemia is a condition with elevated blood homocysteine \u200b\u200bfrom a physiologically acceptable norm and leads to the birth of children with congenital pathology. Their violation suggests that you need to check the level of homocysteine:
  • MTR gene encoding the methionine synthase enzyme;
  • MTRR is a gene encoding the methionine synthase reductase enzyme;
  • MTHFR is a gene encoding the methionine synthase enzyme.

Based on the results of the analysis, the severity of the possible manifestation of thrombophilia is established and treatment recommendations are given, and sometimes the condition of a pregnant woman is simply monitored.

Table: diagnosis of thrombophilia according to the results of laboratory diagnostics

Analysis Name	What determines
General blood analysis	increased number of red blood cells, white blood cells and platelets, their sizes and parameters; increased ratio of the volume of formed elements to the volume of blood plasma (increased hematocrit); erythrocyte sedimentation rate decrease.
Coagulogram	INR (International Normalized Ratio) is an index that shows the ratio of the patient's prothrombin time to the prothrombin time of a healthy person. The INR rate is from 0.7 to 1.3 (that is, about 1 unit on average); APTT (activated partial thromboplastin time) is a specific blood test that shows the activity of the internal blood coagulation pathway. Calcium is removed from the blood, and then platelets and reagents are added, the clot formation time is noted. APTT norm 25 - 37 seconds; IPT (prothrombin index) is the ratio of the PTV of the control plasma to the PTV of the patient. It is expressed as a percentage. Norm PTI 85 - 110%; PTV (prothrombin time) is the time of clot formation after adding a reagent to the test tube with the patient’s blood (tissue factor obtained from animal blood). Standards PTV: 9 - 15 seconds; Fibrinogen is one of the factors in blood coagulation. In his blood should be 2 - 4 grams in 1 liter. Normally, soluble fibrinogen is converted to insoluble fibrin in case of damage to the vessel and bleeding, blood cells settle on the fibrin threads, and a blood clot forms (as it is artistically shown in the picture). Then, when the thrombus, having fulfilled its function, dissolves, the fibrin disintegrates (degrades); D-dimer is a product of fibrin degradation. Normally, its content is not higher than 500 ng / ml. With increased coagulability, its content increases; RFMC (soluble complexes of fibrin monomers) is a marker of intravascular coagulation and the formation of microthrombi. normally, this indicator is less than 4 in non-pregnant women and can be up to 9 in pregnant women; Antithrombin III is a regulatory blood protein that controls the clotting process and prevents excessive blood clots. Normally, its content in pregnant women is 70 - 116%. As a rule, the whole range of coagulogram results is determined first, and then control is carried out according to the level of the D - dimer.
Genetic markers of congenital thrombophilia:	antithrombin III deficiency; resistance to activated protein C (resistance to activated protein C - V factor mutation). Its deficiency is dangerous; protein S deficiency; prothrombin gene mutation; the presence of hyperhomocysteinemia; plasminogen activator inhibitor gene polymorphism (PAI-1). identification of mutations of various levels: fibrinogen, beta polypeptide (FGB); coagulation factor 13, subunit A1; clotting factor 7 (F7); coagulation factor 5 (F5); coagulation factor 2, prothrombin (F2); integrin beta-3; integrin alpha-2.
Homocysteine	in pregnant women, homocysteine \u200b\u200bshould be in the range of 3.4–20.4 µmol / L.

How to monitor the condition of the fetus with a revealed tendency to thrombosis

With a diagnosed thrombophilia in a pregnant woman, there will be more control over the condition of the fetus and studies will be prescribed more often.

To control the development of the fetus and the safety of the placenta, it is necessary:

1. In the first trimester:
   • at 8-10 obstetric weeks - three-dimensional ultrasound of the uteroplacental blood flow;
   • later ultrasound with dopplerometry, which reveals areas of reduced blood flow in the placenta.
2. In the II and III trimesters:
   • when checking ultrasound screening:
     • dopplerometry to measure the nature and speed of blood flow in the vessels;
     • fetometry or measurements of the baby in utero;
   • cardiotocography for registration of fetal heart rate and uterine tone.

Who needs to take genetic studies for an inherited form of thrombophilia

Genetic tests to diagnose hereditary thrombophilia reveal genetic mutations that are important for thrombophilia.

First of all, similar to the study are assigned:

1. Women who are supposed to use hormonal drugs in treatment, and those who are preparing for elective caesarean section;
2. Women who have had a past history of personal history when chromosomal, hormonal, infectious and uterine causes of miscarriage are excluded:
   • with habitual miscarriage during various periods of pregnancy;
   • with repeated pregnancy complications:
     • preeclampsia;
     • detachments of a normally located placenta;
     • fetal growth retardation syndrome.
   • bad IVF experience;
   • a tendency to small bleeding (nasal, visceral).
3. Women with complicated family thrombotic history:
   • unclear causeless (idiopathic) thrombosis;
   • in a family of close relatives, cases of early stroke, myocardial infarction, pulmonary thromboembolism, sudden death before the age of 50;
   • repeated episodes, especially in women under 50;
   • thrombosis of rare localization (in mesenteric vessels of the intestine, in cerebral veins);
   • complications from the use of oral contraceptives or hormone therapy;
   • the birth of children with chromosomal onomalies.

Video: geneticist Z. Bayanovna about thrombophilia genes

Thrombophilia Therapy During Pregnancy

Identifying thrombophilia is not a sign that a woman will not be able to give birth. If you go through all the examinations in time and plan your pregnancy, there is every chance that the future mother will have healthy children.

Treatment initiated on time will contribute to successful placentation and reliable attachment of the embryo to the uterine wall. Compliance with anticoagulant treatment is indicated throughout pregnancy and for 6 weeks after childbirth.

If therapy is started late in pregnancy, the woman has few chances to bear the fetus without significant complications.

After carrying out all the necessary studies, the doctor will prescribe the woman without fail:

1. If the homocysteine \u200b\u200blevel is normal, then folic acid (vitamin B9) is prescribed in an increased dose throughout pregnancy and is not canceled when the term reaches 12 obstetric weeks:
   • Folacin;
   • Folio;
   • Folic acid 9 months;
   • metapholin is an accessible form of folic acid that is absorbed by almost everyone, since it does not require a long chemical process involving enzymes (as in the metabolism of ordinary folic acid). The ratio of those who absorb this vitamin and those whose body is insensitive to it is about the same. To verify this, expensive and inaccessible tests are needed.
2. Vitamin complexes are prescribed:
   • which contain polyunsaturated fatty acids:
     • Femibion \u200b\u200bNatalkea I;
     • Angiitis;
     • Vitrum cardio omega - 3;
     • Omegamam 9 months;
     • Wessel duet f.
   • magnesium and B6 hepatitis 1 tablet 2 times a day for 1 month:
     • Magne B6 - forte;
     • Magnelis B6.
3. In some cases, the administration of low molecular weight heparin (NMH) has been shown - and its derivatives Dalteparin, Enoxaparin, Fraxiparin as antithrombotic therapy:
   
4. Progesterone preparations:
   
5. Additionally, anticoagulants are prescribed to slow down blood coagulation processes:
   • Warfarin, which blocks the synthesis of vitamin K-dependent blood coagulation factors (II, VII, IX, X) in the liver, it reduces their concentration in plasma;
   • Pradax or a thrombin inhibitor, which in turn is responsible for the process of converting fibrinogen to fibrin and the occurrence of a thrombus.

Video: Obstetrician-gynecologist I.I. Tyan on congenital thrombophilia and pregnancy management tactics

Diet

All patients with an increased risk of thrombosis are given an antithrombotic diet according to (J. Casper, 1973), the food should be rich in folates and B vitamins.

Thrombophilia is a disease that has been identified recently, so experts are still working on its study. This pathology is especially dangerous for patients in position. During the bearing of a child, the woman’s body weakens and loses the ability to combat pathologies. Qualified specialists advise that before planning a pregnancy be sure to be examined in order to prevent unwanted reactions of the body that harm both mom and baby.

How dangerous is a predisposition to blood clots during pregnancy? What are the most effective diagnostic methods for thrombophilia?

The concept of thrombophilia and its consequences during pregnancy

Thrombophilia is a pathological condition of the body, accompanied by an increased tendency to blood clots. Normally, the activity of coagulation and anticoagulation systems in the circulatory mechanism should be in the right balance. The diagnosis is made when the factors of one of the systems are significantly weakened. Often at an early stage of development, the disease is asymptomatic and diagnosed by pure chance, for example, during injuries, surgeries, during pregnancy.

One of the features of the “interesting situation” is the increase in blood coagulability for potential compensation for blood loss during childbirth, prevention of placental abruption and loss of the baby. An increase in coagulability is the first cause of blood clots.

Women prone to increased blood clots, or patients who have been diagnosed with thrombophilia before pregnancy, should carefully listen to any changes in their body. They can bear and give birth to a healthy baby, but, despite this, they are at risk of developing various complications in the 1st and 3rd trimesters, especially if blood clots form in vessels adjacent to the place where the fetus is located. Thrombophilia in the expectant mother proceeds very smoothly, in the early stages - generally asymptomatic. The consequences of thrombosis for girls in position include:

• regressive pregnancy;
• severe toxicosis;
• placental abruption or insufficiency;
• premature labor;
• the birth of a dead child;
• pathology of the development of the baby.

Causes of pathology

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Symptoms of thrombophilia and the degree of their manifestation depends on various factors - age, physical condition, etc. During pregnancy, the patient can be bothered by absolutely all signs of the disease. In girls in position, they manifest themselves to the highest degree. This is due to the appearance in the future mother of the third circle of blood circulation (placental), which causes congestion in the blood circulation. There are no capillaries in the mother’s placenta, so blood immediately penetrates from the arteries into the placenta, where it flows between the chorionic villi, flowing into the umbilical cord.

In recent years, the number of people suffering from congenital thrombophilia has increased. Hereditary factors:

• Protein C deficiency. Impaired synthesis of anticoagulants, which include protein C, can cause excessive thrombosis.
• Weakened factor in the coagulation system. The progress of the disease can occur against the background of the pathology of blood coagulation.
• Genetically determined shortage of antithrombin. This substance is one of the anticoagulants, but, unlike protein C, its deficiency can be either congenital or acquired.
• Mutation of genes. In this case, the child, even in the womb, due to the primary mutation, receives genes that provoke the development of the disease.

In addition to hereditary factors, thrombophilia can be caused by acquired causes. These include:

• autoimmune diseases;
• impaired functionality of the cardiovascular system;
• polycythemia-induced dehydration;
• oncological pathologies;
• prolonged use of catheters;
• living in an environmentally disadvantaged area.

Types of Thrombophilia and Related Symptoms

Doctors classify thrombophilia by etiology:

• Primary - genetically determined. The first symptoms appear in childhood.
• Secondary - acquired. The patient learns about her, as a rule, by chance at an unscheduled examination.

The following types of thrombophilia are also distinguished:

• Hematogenous. It develops due to pathologies developing in the coagulation system. With hematogenous thrombophilia, the risk of developing dangerous conditions such as heart attack and ischemia increases.
• Vascular. The development of the disease is associated with pathologies accompanied by vascular damage, for example, atherosclerosis.
• Hypodynamic. In this case, the pathology can be triggered by a violation of blood flow.

Signs of thrombophilia appear long after the onset of its development. The main symptoms are:

• pain and swelling at the site of the formation of a blood clot;
• shortness of breath and pain in the chest when inhaling;
• spotting cough;
• limb insensitivity;
• increased heart rate;
• unnatural fatigue;
• weakness;
• frequent headaches;
• slow response to events.

All of the above signs can bother the patient with other diseases. A pregnant woman should remember the need for an accurate diagnosis only after a series of diagnostic measures.

Diagnosis of the disease during pregnancy

The diagnosis of thrombophilia is confirmed after the patient undergoes an examination. Diagnosis of the disease includes a double blood test. For the first time, the study is conducted as part of a screening test. In this case, a specialist can detect the localization of pathology in the coagulation system even in a non-specific blood test. The second time, the patient must pass a series of specific tests to specify the diagnosis of thrombophilia.

A non-specific blood test allows you to identify a number of disorders that may indicate the development of thrombophilia:

• increase in blood density;
• increased platelet and red blood cell concentrations;
• imbalance in the volume of shaped elements in plasma;
• erythrocyte sedimentation rate decrease.

If these symptoms are detected, the pregnant woman is referred to a narrow specialist. A hematologist usually prescribes specific tests to diagnose parameters such as APTT, thrombin time and prothrombin index, as well as fibrinogen content.

Features of the treatment of thrombophilia in pregnant women

Treatment of thrombophilia in pregnant patients requires urgency. Ideally, therapy should begin long before pregnancy planning. If the disease was identified during the period of bearing the child, 3 narrow-profile specialists will immediately participate in the preparation of the course of treatment - a gynecologist, hematologist and geneticist. Therapy for thrombophilia requires an integrated approach. In order to achieve effectiveness, doctors recommend that patients in the position:

• take prescribed medications;
• eat according to the diet prescribed by the doctor;
• engage in physiotherapy exercises;
• constantly be in motion.

Thrombophilia is a disease that allows patients with this diagnosis to endure and safely give birth to a healthy baby, subject to all recommendations of narrow-profile specialists.

A woman in a position should be responsible for her well-being and the state of health of her child. A pregnant woman must be regularly shown to a gynecologist, hematologist and genetics. If suspicious symptoms appear, the patient must notify the doctor.

Drug therapy

Therapy depends on the severity, form of thrombophilia, and gestational age. If a woman has genetic thrombophilia, then treatment should be started during pregnancy planning or in its early stages. It is impossible to achieve full recovery for patients with genetic thrombophilia, however, drug treatment helps to stabilize the pregnant woman. Substitution therapy for them includes injections with drugs that make up for the missing elements of the coagulation system, or the introduction of plasma with a dropper.

Treatment of the acquired form with anticoagulants is carried out only with a combination of more than 3 threatening factors. The following drugs are usually prescribed to an expectant mother with an acquired form:

• acetylsalicylic acid;
• drugs with heparin - Dalteparin, Fraxiparin;
• folic acid;
• nicotinic acid;
• vitamins B and E.

Therapy is aimed at eliminating the maximum possible number of blood clots. The medical course of treatment is from 2 to 4 weeks. In some cases, drug therapy is necessary for patients for life. Treatment is canceled a few days before childbirth or cesarean section. It is much easier for doctors to cancel a drug for a pregnant woman if there is a planned cesarean section.

With natural delivery, a woman is hospitalized a few weeks before the expected date of delivery in order to monitor her condition after drug withdrawal.

Three days after the end of the drug course, the pregnant woman is sent for all the necessary tests. With an increase in the main indicators of blood and urine, gynecologists, taking into account all the risks, make a decision about the artificial birth.

Diet food

Combined therapy for thrombophilia also includes following a strict diet. Patients should diversify their diet with useful products that contribute to blood thinning. The diet for thrombophilia includes greens, ginger, seafood, fresh vegetables and fruits, and dried fruits. The basic nutritional rules for patients with a diagnosis of thrombophilia:

• maximum restriction of fried and spicy dishes;
• elimination of spices and spices from the diet;
• the exclusion of foods rich in cholesterol.

Plasma transfusion

Blood transfusion is another treatment for thrombophilia in pregnant women. If the patient’s illness is mild, intravenous injections with freeze-dried plasma or donated blood can help her. In severe form, fibrinolytic drugs are added to the plasma. Injections are done at the place where the blockage of the blood vessel occurred.

Folk remedies

The use of folk remedies should be agreed with the attending physician. All of them become effective only in combination with medications, the dosage of which must be determined only by a gynecologist. Effective folk remedies that help eliminate blood clots and stabilize the condition of a pregnant woman without the risk of developing unpleasant consequences:

• cranberry or meadowsweet tea drink
• grape juice;
• infusions of various herbs and their seeds - sweet clover, horse chestnut or Japanese sophora.

Tea, as a rule, must be consumed several times a day in half a glass. Infusions are prepared in a proportion of 100 g of seeds or herbs per 0.5 l of alcohol. The duration of their insistence is 14 days. At the end of the above period, the broth must be decanted. The dosage of the finished infusion is 20 ml 3 times a day.

Possible complications

A predisposition to blood clots is a dangerous condition that is fraught with the appearance of complications. Untimely initiated or ineffective treatment, non-compliance with the diet are the main prerequisites for the development of unpleasant consequences. These include:

• ischemia;
• gangrene
• regressive pregnancy if the affected vessel is close to the placenta;
• necrosis of intestinal tissues;
• inflammatory process affecting the entire abdominal cavity.

Women planning a pregnancy should take a very responsible approach to the issue of diagnosis in order to avoid unpleasant complications in the future. Proper nutrition, including products that dilute lymph, full sleep, walks in the fresh air, and avoiding psycho-emotional stress are the main measures to prevent such a dangerous condition as thrombophilia.