[4] Thrombophilia In Pregnancy

Question 1

What percentage of VTE’s in pregnancy are caused by thrombophilias?

Answer 1

20-50%

Question 2

Why are women with thrombophila at an increased risk of VTE because of pregnancy?

Answer 2

Pregnancy is a pro-thrombotic state

Question 3

Why must an individual’s management of thrombophilia in pregnancy be individualised?

Answer 3

Different thrombophilas have different levels of clotting risk

Question 4

Is VTE the only risk of thrombophilia in pregnancy?

Answer 4

No

Question 5

What are the other associated risks of factor C Leiden in pregnancy?

Answer 5

• Fetal loss
• Pre-eclampsia
• Placental abruption
• In-utero growth restriction

Question 6

What are the other associated problems of anti-phospholipid syndrome?

Answer 6

• Recurrent miscarriage
• Fetal death
• Premature birth secondary to placental disease

Question 7

When should screening for thrombophilias be offered to pregnant women or those looking to conceive?

Answer 7

• Personal or family history of VTE
• Recurrent miscarriage
• Early onset pre-eclampsia
• Absorption

Question 8

Why can thrombophilia screening tests be unreliable in pregnancy?

Answer 8

There are changes to the haemopoietic system

Question 9

When is the ideal time for thrombophilia screening (in relation to pregnancy)?

Answer 9

• Pre-conception

- Postnatally after an adverse event in pregnancy

Question 10

Where should women with thrombophilia in pregnancy be managed?

Answer 10

In a combined obstetric-haematology clinic

Question 11

Is LMWH safe in pregnancy?

Answer 11

Yes

Question 12

What treatments are available to reduce the risk of VTE in thrombophilia in pregnancy?

Answer 12

• Antenatal and/or postnatal LMWH
• Compression stockings
• Avoid dehydration

Question 13

When should care be taken with LMWH in pregnancy?

Answer 13

Timing its use around birth to minimise the risk of bleeding and ensure full range of analgesic options