Coagulation Disorders In Pregnancy
Dr Sahana K P
Basaveshwaranagar, Bengaluru Feb 8, 2017
The coagulation system undergoes significant change during pregnancy. The caregiver for the pregnant woman must understand these changes, particularly when the woman has a pre-existing hematological condition. Because many hematological conditions are rare, there often is limited information to guide the obstetric and anesthetic management of these parturients. Complications of pregnancy are health problems that are related to pregnancy.
Early pregnancy complications
You're expecting! It's an emotional and exciting time, especially if it's your first baby. Most women have healthy pregnancies. But there are some pregnancy complications third trimester you'll need to pay more attention to. For example, nausea, a little bleeding, and vaginal discharge aren't unusual, but they could also mean there's a problem. Pregnancy complications that cause death are due to hemorrhage, infection, unsafe abortion, and eclampsia (very high blood pressure leading to seizures), or from health complications worsened in pregnancy. Here are some of the risk factor that should be healed if you are pregnant and have some health problems during pregnancy.
Vaginal Bleeding: Some spotting is normal, but heavy bleeding could be a sign of miscarriage or ectopic pregnancy. If you have bleeding and bad cramping similar to period cramps, this can be a sign of threatened miscarriage. If this is coupled with sharp, lower abdominal pain, it may be a sign of ectopic pregnancy," a serious complication that occurs when the fertilized egg implants outside the uterus, usually in the fallopian tubes.
High Fever: A fever greater than 101 degrees Fahrenheit or 38 degrees Celsius during pregnancy may be serious. Fevers during pregnancy that are accompanied by a rash and joint pain may be a sign of infection such as cytomegalovirus (CMV), toxoplasma, and parvovirus. "CMV is the most common cause of congenital deafness.
Vaginal Discharge and Itching: Some vaginal discharge is normal. But in some cases, "These may be signs of treatable infections or sexually transmitted diseases that can have important consequences in pregnancy.
Leg or Calf Pain, or Swelling on One Side/ Severe Headache: This won't happen in most pregnancies. It is a rare pregnancy complication. But pregnancy does mean a greater chance of developing a blood clot. A blood clot in the calf may lead to pain or swelling and can result in a blood clot that travels to the lung, which could be fatal. A blood clot in the brain may be heralded by a severe headache. There are other possible causes of bad headaches during pregnancy.
Pain or Burning During Urination: These can be signs of bladder or urinary tract infections, and if left untreated, they can lead to more serious illness, infection, pre-term labor, and pre-term birth.
Physiological changes to coagulation during pregnancy
Pregnancy is associated with changes in hemostasis, including an increase in the majority of clotting factors, a decrease in the number of natural anticoagulants and a reduction in fibrinolytic. Physiological changes in pregnancy affect the coagulation and fibrinolytic systems. Many of the clotting factors increase and anticoagulation factors decrease causing augmented coagulation and decreased fibrinolysis. Pre-existing coagulopathies may affect the course of pregnancy and the nature of coagulopathy may also be modified by pregnancy. Changes in coagulation affect the mode of delivery and the approach to analgesia and anesthesia in patients with hypercoagulable disorders.
Disorders of coagulation in pregnancy can be classified as:
A. Clotting factor abnormalities
1. Congenital coagulopathies:
a) Von Willebrands disease
b) Haemophilia A and B
c) Antithrombin deficiency
2. Acquired coagulopathies:
a) Pregnancy-induced hypertension
b) Placental Abruption
c) Retained dead fetus
d) Amniotic fluid embolus
e) Liver disease
f) Anticoagulants: Aspirin and Heparin
B. Platelet abnormalities:
1. Quantitative abnormalities (Not enough platelets)
a) Gestational thrombocytopenia
b) Idiopathic/immunological thrombocytopenic purpura
c) HELLP Syndrome
d) Disseminated intravascular coagulation (DIC)
2. Qualitative disorders (Poor platelet function)- Pregnancy is a hypercoagulable state due to the physiological changes of pregnancy. The platelet count is decreased at term compared to pre-pregnant states in normal pregnancy. Most coagulation factors increase during pregnancy but some do not. Parturients with inherited factor deficiencies may require treatment during pregnancy. Thromboembolism is the leading cause of maternal mortality and is increased in women with inherited thrombophilia. Provision of neuraxial anesthesia in parturients with coagulation abnormalities is dependent on the condition and the current status of coagulation.
In summary, A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. It often requires specialized care from specially trained providers. High risk of pregnancy complications can cause death. Getting early and regular prenatal care can help decrease the risk for problems by enabling health care providers to diagnose, treat, or manage conditions before they become serious. Pregnancy is associated with major changes in hemostasis including increases in the majority of clotting factors, decreases in the quality of natural anticoagulants and a reduction in fibrinolytic activity. These changes are greatest at the time of delivery. Platelet counts may be lower in pregnancy most commonly due to gestational thrombocytopaenia or ITP. Hemostasis is normal in gestational thrombocytopaenia and often in ITP despite low platelet numbers. In 2015, Pregnancy complication statistics showed that 303 000 women will die from complications related to pregnancy or childbirth. Also, for every woman who dies in childbirth, dozens more suffer injury, infection, disease or some kind of unhealthy condition.
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