From the Guidelines
Thrombophilia can significantly increase the risk of placental complications during pregnancy, and women with thrombophilia should receive prophylactic anticoagulation therapy to prevent these complications. The most common complications of placenta disorders in patients with thrombophilia include preeclampsia, placental abruption, intrauterine growth restriction, and recurrent pregnancy loss. According to the American Society of Hematology 2018 guidelines for management of venous thromboembolism, women with thrombophilia should receive prophylactic anticoagulation therapy, typically with low molecular weight heparin (LMWH) such as enoxaparin (40mg daily) or dalteparin (5,000 units daily), starting as early as possible in pregnancy and continuing for 6 weeks postpartum 1. For women with prior pregnancy complications or recurrent pregnancy loss, higher doses may be needed. Aspirin (81mg daily) is often added to the regimen, starting before conception or early in pregnancy 1. Regular monitoring with blood tests for platelet counts and anti-Xa levels may be necessary, especially for higher-risk patients. These medications work by preventing abnormal blood clotting that can impair placental blood flow, which can lead to complications like preeclampsia, placental abruption, intrauterine growth restriction, and recurrent pregnancy loss. The type of thrombophilia (inherited vs. acquired) affects the treatment approach, with antiphospholipid syndrome requiring more aggressive therapy 1. Early consultation with maternal-fetal medicine specialists and hematologists is essential for developing an individualized treatment plan based on the specific type of thrombophilia and pregnancy history. Viscoelastic testing (TEG/ROTEM) can be used to monitor hemostatic changes in patients with thrombophilia and to guide management of anticoagulant therapy during pregnancy 1. However, further studies are needed to determine the optimal prophylactic doses for anticoagulants in pregnancy and to evaluate the effectiveness of TEG/ROTEM in predicting obstetric complications. In summary, prophylactic anticoagulation therapy with LMWH and aspirin, as well as regular monitoring and individualized treatment planning, can help prevent placental complications in women with thrombophilia.
From the Research
Complications of Placenta Disorders in Patients with Thrombophilia
The complications of placenta disorders in patients with thrombophilia (hypercoagulability) include:
- Pre-eclampsia
- Placental abruption
- Birth of a small-for-gestational-age (SGA) neonate
- Late pregnancy loss These complications can lead to significant maternal, fetal, and neonatal morbidity and mortality 2.
Risk of Recurrence
Women with a history of placenta-mediated pregnancy complications are at high risk of recurrence in subsequent pregnancies 3, 4. The risk of recurrence can be reduced with the use of low-molecular-weight heparin (LMWH) in some cases 5, 6, 4.
Effectiveness of Low-Molecular-Weight Heparin
LMWH has been shown to reduce the risk of recurrent placenta-mediated pregnancy complications in some studies 5, 6, 4. However, the effectiveness of LMWH may depend on the specific population being studied and the presence of thrombophilia 3. A meta-analysis of individual patient data from randomized controlled trials found that LMWH did not significantly reduce the risk of recurrent placenta-mediated pregnancy complications in at-risk women, but may reduce the risk in women with previous placental abruption 3.
Thrombophilia and Placenta-Mediated Pregnancy Complications
Thrombophilia has been associated with an increased risk of placenta-mediated pregnancy complications 2. However, the relationship between thrombophilia and placenta-mediated pregnancy complications is complex, and further research is needed to fully understand the role of thrombophilia in these complications 2.