THROMBOPHILIA, RESPONSIBLE FOR 50 PERCENT OF RECURRENT ABORTIONS: WHY IT OCCURS AND HOW IT IS TREATED

Between 20 and 30% of pregnancies end in a spontaneous abortion, and in 15% of cases, the abortion will recur again. The causes that hide behind recurrent abortions can be multiple, and among them are maternal blood clotting disorders.

This problem is called thrombophilia, and according to a study carried out by the Clínica Universidad de Navarra and the Jiménez Díaz Foundation University Hospital, it could be the cause of up to 50% of repeat abortions.

We explain what are thrombophilia disorders, why they occur and how they are treated so that they do not affect the development of pregnancy.

What is thrombophilia?

Thrombophilia is a blood clotting imbalance which tends to hypercoagulability; that is, the exaggerated tendency to form clots inside the blood vessels, when they are not necessary. These clots can form inside the veins, arteries and also the placenta.

This disorder is associated with an increased risk of gestational complications, such as early natural abortion, recurrent abortions, intrauterine fetal death, premature delivery or delayed intrauterine growth.

Types of thrombophilia

Hereditary thrombophilias, present from the moment of birth. These thrombophilias are characterized by a genetic alteration in some of the blood factors, or by the decrease in some proteins that usually protect us from clot formation.

Hereditary thrombophilias are alterations in Factor V Leiden, mutation in the Factor II or Prothrombin 20210 gene, Antithrombin deficiency, Proteins C and S.

Acquired Thrombophilias. In this group we find the antiphospholipid syndrome, of autoimmune origin, or some cases of resistance to activated protein C.

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How are thrombophilia disorders diagnosed?

Tests to detect thrombophilia consist of a specific blood test that identifies thrombophilic markers. These tests are performed in the following cases:

If the woman has had thrombosis in a deep vein of the body, or when the clot progressed to the lung.
Yes the woman lost two or more pregnancies of less than 10 weeks.
Yes the woman lost one or more pregnancies of more than 10 weeks.
If the woman had any obstetric complication, such as preterm birth or a pregnancy with baby growth retardation.
If the woman presented preeclampsia, eclampsia or placental abruption.
If the woman presents family background of thrombosis or complications in pregnancy and program the search for pregnancy

In most occasions, the thrombophilia study is done after the presence of two or more recurrent natural abortions. And the experts say that when a woman has already suffered a miscarriage, the chances of going through the same again are around 15%, a percentage that increases to 25 or 30% if they have already had two or more previous abortions, or even up to 60% if the woman is over 40 years old.

How is thrombophilia treated?

If the suspicions of thrombophilia are confirmed, doctors will establish the treatment to be followed, with aspirin being the most used drugs at low doses and low molecular weight heparin (LMWH), which must be injected daily subcutaneously.

Both the type of medication, the dose and the duration of treatment will be determined individually according to each specific case.

Pregnancy with thrombophilia: how does it develop?

As usual, the pregnant woman with thrombophilia problems has a stricter pregnancy follow-up, with more frequent clinical and ultrasound evaluation, and continuous blood tests to observe the state of coagulation.

In addition, these types of pregnancies are usually treated jointly by the gynecologist and hematologist.

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Heparin does not pass the placental barrier, so it does not affect the baby. As for the mother, Frequent complications are bruising at the injection site., and as infrequent, there is an increased risk of osteoporosis, an increased risk of bleeding and a decrease in the number of platelets.

Although each case must be assessed independently, the ideal is that heparin treatment is discontinued 24 hours before the administration of epidural anesthesia, in order to avoid risk of subdural hematoma. Hence, if the woman decides to give birth with an epidural, the delivery should be scheduled.

Heparin treatment will resume after delivery or caesarean section and for six more weeks, since during the puerperium there is an increased risk for the mother suffering from deep vein thrombosis

Experts say that with proper treatment and started early, between 85-90% of pregnant women with thrombophilia manage to have a full-term pregnancy without complications.

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