Reproductive thrombophilia risk

You have an increased risk of reproductive thrombophilia. Here is what you need to know.

Thrombophilia is a condition that makes the patients who suffer from it have an increased tendency to clot within their own blood vessels.  Normally the blood flows throughout the vascular system without clotting.  When a vessel is broken down (injury) and bleeding commences, the clotting mechanism of a normal person is forming a plug, to stop the bleeding. This plug is the result of a very complex coagulation mechanism, which requires significant coordination of many different proteins, antibodies, and other chemicals produced within the human tissues.

In patients with Thrombophilia, damage to the placenta happens mostly because of blood clot formation into the maternal as well as the fetal vessels.  In addition, because the maternal blood comes out of the maternal vessels and flows very slowly between the branches of the fetal vessels (intervillous space), maternal blood is vulnerable to clot formation and fibrin deposition (the glue that forms the clot). If maternal blood coagulates inside the intervillous space, then the fetal vessels will be destroyed because there will not be enough nutrients and oxygen for them.  That leads to placental degeneration and fetal vessel damage. Impaired placental development has been associated with the following conditions:

  1. Failure of the embryo to attach to the uterine lining (implantation failure).
  2. Recurrent miscarriages
  3. Growth failure of the fetus because of insufficient placenta growth.
  4. Hypertensive disorders of the pregnancy (Preeclampsia/Toxemia).
  5. Decreased amniotic fluid volume (Oligohydramnios).
  6. Partial or complete separation of the placenta (Abruptio placentae).
  7. Silent premature cervical changes may lead to premature birth.
  8. Pre-term labor and delivery.
  9. “Unexplained” intrauterine fetal demise (death).
  10. Severe fetal deprivation of oxygen may lead to variable degrees of mental problems including cerebral palsy.
  11. Finally, clots may form within the maternal veins and that can lead to thrombophlebitis or deep vein thrombosis, which can be dangerous for the mother.  However, this last one is less frequent, and it is more likely to happen in patients with specific coagulation problems. However, nine out of ten times, we are concerned with the effects that thrombophilia has on the development of the placenta and the baby, and the treatments we employ concern the protection of the placenta.

Although the precise risk of abnormal pregnancy outcomes (obstetrical complications) in patients with thrombophilia is not known, it is significantly high to warrant close pregnancy monitoring and treatment.  We know from several studies that examination of patients with abnormal pregnancy outcomes and complications involving both the mother and the baby reveals a very high incidence of various types of thrombophilias.

The male partner is also tested for genetic thrombophilia. We then combine the maternal and paternal results and estimate the risk and type of fetal genetic thrombophilia. Fetal thrombophilia causes severe placenta damage and all associated great obstetrical complications. We treat patients with fetal thrombophilia with a combination of protective supplements and antithrombotic medications (blood thinners). This knowledge of fetal thrombophilia is very important in customizing the treatment to be just right for the mother-fetus pair. Every patient is unique, and every pregnancy of the same patient is also unique because of the randomness of inherited thrombophilia. This understanding has helped Dr. Kofinas develop highly focused and customized protocols that lead to successful and healthy pregnancies.

What you need to do:

Speak to your PCP or OB doctor and ask them to test you for genetic, immune, and familial thrombophilia, and your partner for genetic thrombophilia. This knowledge will help your doctor to figure out the risk of the fetus having thrombophilia and thus design a customized treatment protocol. If your primary doctor is not familiar with this knowledge, you are welcome to visit Dr. Kofinas to complete your workup, and get a customized protocol for your next pregnancy.