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Federación Mexicana de Ginecología y Obstetricia, A.C.

2017, Number 10

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Ginecol Obstet Mex 2017; 85 (10)

Thrombophilia and pregnancy: Incidence, risk factors and perinatal results

Gutiérrez-Castañeda MR, Font-López KC

Language: Spanish
References: 25
Page: 676-684
PDF size: 584.18 Kb.


ABSTRACT

Objetive: To analyze the incidence, risk factors and perinatal outcomes of patients with thrombophilia and pregnancy
Materials and Methods: Observational study of a series of cases at the General Hospital Fernando Quiroz Gutiérrez ISSSTE. From 2010 to 2016. We included all pregnant women with a diagnosis of thrombophilia, performed with a thrombophilia profile. Treatment with acetylsalicylic acid and low molecular weight heparin was started since diagnosis. Pregnancy and puerperium surveillance was performed with observation of results, which were captured and analyzed with the Excel program.
Results: There were 81 cases, with an incidence of 1.06%. The most frequent thrombophilia was the antiphospholipid antibody syndrome 39.5%, followed by the protein S deficiency 35.8%. The most frequent risk factors were: recurrent gestational loss 63%, preeclampsia 23% and fetal death 17%. Perinatal outcomes after treatment: 97.6% of healthy neonates, 2.4% of abortions and 4.9% of preeclampsia.
Conclusions: A history of repeated gestational loss, fetal growth restriction, hypertensive pregnancy and fetal death should lead to suspected thrombophilia; With the obligation to carry out study protocol for confirmation. Reproductive success is feasible, if the binomial is subjected to strict monitoring and timely treatment.


REFERENCES

  1. Lockwood CJ, Bauer KA. Inherited thrombophilias in pregnancy. May 2017. UpToDate. https://www. uptodate.com/contents/inherited-thrombophilias-inpregnancy? source=search_result&search=trombofilia+e n+el+embarazo&selectedTitle=1~150

  2. Erkan Doruk. Ortel TL. Diagnosis of antiphospholipid síndrome. Jul 2017. UpToDate. https://www. uptodate.com/contents/diagnosis-of-antiphospholipidsyndrome? source=search_result&search=antifosfol%C3% ADpido%20del%20embarazo&selectedTitle=2~150

  3. Ceressetto AD, Fassi J, Fondevila H. et. al. Trombofilias. Sociedad Argentina de Hematología. En Guías de diagnóstico y tratamiento. 2015

  4. Hasbún HJ, Conte LG. Manejo de la embarazada con trombofilia hereditaria. Rev. Chil Obstet Ginecol. 2003;68:458- 470.

  5. Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med. 2000;342:424-425

  6. INEGI. 2015 http://www.beta.inegi.org.mx/proyectos/ registros/vitales/mortalidad/

  7. Riva E. Trombofilia hereditaria: asociación con ETEV y complicaciones obstétricas. Arch Med Interna 2011; Supl 2: S3

  8. Ziakas PD, Poulou LS, Pavlou M. et.al. Thrombophilia and venous thromboembolism in pregnancy: a metaanalysis of genetic risk. Europ J Obstet Gynecol Reprod Biol. 2015;191:106-111

  9. Wu O, Robertson L, Twaddle S, et. al. Screening for thrombophilia in high-risk situations: systematic review and costeffectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study. Health Technol Assess 2006;10:1-110.

  10. Lockwood CJ. Heritable coagulopathies in pregnancy. Obstet Gynecol Surv 1999;54:754

  11. Otero AM. Pou FR. Pons E. Trombofilia y pérdida recurrente de embarazo. Rev Med Uruguay 2004;20:106-113

  12. Simcox LE, Ormesher L, Tower C. Thrombophilia and Pregnancy Complications. Int. J. Mol. Sci. 2015;16:28418– 28428

  13. Friederich PW, Sanson BJ, Simioni P, et al. Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann Intern Med 1996; 125:955-960.

  14. Jacobsen AF, Dahm A, Bergrem A, et al. Risk of venous thrombosis in pregnancy among carriers of the factor V Leiden and the prothrombin gene G20210A polymorphisms. J Thromb Haemost 2010; 8:2443-9.

  15. Davenport WB, Kutteh WH. Inherited Thrombophilias and Adverse Pregnancy Outcomes. Obstet Gynecol Clin N Am. 2014;41:133-144

  16. Policlínicas de Alto Riesgo Obstétrico de Hospital de Clínicas y Centro Hospitalario Pereira Rossell. Trombofilia y embarazo. Pautas de diagnóstico y tratamiento Thrombophilia and pregnancy - Guidelines for diagnostic and treatment. Arch Med Interna 2011; Supl 2. S1-S7

  17. Korin J. Trombofilia y complicaciones del embarazo. Hematología. 2012;16:86-92

  18. American College of Obstetricians and Gynecologists Women's Health Care Physicians. ACOG Practice Bulletin No. 138: Inherited thrombophilias in pregnancy. Obstet Gynecol 2013;122:706-717.

  19. Khalafallah AA, Ibraheem AR, Teo, QY, et.al. Review of Management and Outcomes in Women with Thrombophilia Risk during Pregnancy at a Single Institution. ISRN Obstet Gynecol. 2014;1-6.

  20. Aguilar HR. Estudio descriptivo de pacientes con complicaciones obstétricas y trombofilias y evaluación de su tratamiento, 2014-2012. RMP. 2014;34:22-30

  21. Gao H. Tao F. Prothrombin G20210A mutation is associated with recurrent pregnancy loss: A systematic review and meta-analysis uptodate. Thrombosis Research. 2015;135:339-346

  22. Lin J, August P. Genetic thrombophilias and preeclampsia: a meta-analysis. Obstet Gynecol 2005;105:182-92.

  23. Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol 2002;101:6-14.

  24. Bouvier S, Cochery NE, Lavigne LG, et.al. Comparative incidence of pregnancy outcomes in thrombophilia-positive women from the NOH-APS observational study. Blood. 2014;123:414-421

  25. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006; 4:295. http://onlinelibrary. wiley.com/doi/10.1111/j.1538-7836.2006.01753.x/ abstract.




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