Pathogenesis and prevention of thromboembolic complications in obstetric practice

The study was designed to analyse risk factors of venous thromboembolism (VTE), elucidate the role of genetic forms of thrombophilia and antiphospholipid syndrome (APS) in pathogenesis of VTE during pregnancy. 38 pregnant patients with VTE (group I) and 35 healthy pregnant women (group 2, controls) were screened for genetic thrombophilia and antiphospholipid antibodies (APA). Deep vein and ovarian vein thrombosis was diagnosed in 21 and 1 patients of group 1 respectively. VTE occurred in 15 on weeks 20-38 of pregnancy and in 12 in the postpartum period. 38 and 59% of the patients had VTE in their hereditary and obstetric histories respectively. Multigenic thrombophilia was recorded in all patients with VTE (4-6 mutations including homozygous ones), combined defects of fibrinolysis in 86%, and APA in 59%. Multigenic thrombophilia occurred in 20% of the healthy women while APA were not detected. It is concluded that thrombophilia may be an essential pathogenetic mechanism of thromboembolism during pregnancy. Women with pregnancy-associated thromboembolism, thromboembolism in personal or family history, and with the history of obstetric complications should be screened for thrombophilia.