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Thrombophilia:
Another Factor to Consider in Cases of Recurrent Pregnancy Loss
Recurrent pregnancy loss takes a
devastating emotional toll on our patients. Each miscarriage brings
with it a profound sense of loss and frustration. While hormonal,
uterine, immune system, and chromosomal abnormalities are widely
accepted as possible causes of repeat miscarriages, the latest
studies point to a new area of investigation - inherited blood
clotting factors.
When a patient has a tendency to form blood clots, the
condition is called thrombophilia. Thrombophilia can be a
life-threatening event if the clots restrict blood flow.
Thrombophilia can be an inherited disorder, but can also be caused
by external events such as surgery, obesity, pregnancy, use of oral
contraceptives, antiphospholipid syndrome, or long periods of
immobility.
Even though men and women can have
clotting disorders, these conditions pose added difficulties for
women because of their relationship to reproductive issues. Women
with these disorders can develop serious complications during
pregnancy leading to miscarriage. Pregnancy, oral contraceptives and
post-menopausal hormone replacement therapy are all triggering
events for DVT in women with thrombophilia (DVT or Deep Vein
Thrombosis is a blood clot that develops in a deep vein, usually in
the lower leg. Deep vein thrombosis can cause pain in the leg and
can potentially lead to complications).
In some individuals, excessive clotting in the
blood vessels never occurs until they have problems with placental
blood flow in a pregnancy. Under these circumstances, the blood
supply in the placenta (that is, the primary site of nutrition and
gas exchange between the mother and fetus) will be interrupted due
to clotting and this leads to a decrease in blood flow to the
developing fetus. As a result the fetus grows more slowly and is
smaller than expected (this is called intrauterine growth
restriction) and in severe cases, this may lead to late pregnancy
loss
Recent research indicates that patients who experience recurrent
miscarriage may have one or more of these markers for thrombophilia.
Recommended Tests for Patients with Recurrent Miscarriage
Ongoing research has uncovered new clues about possible reasons for
recurrent pregnancy loss. Because many of these conditions are
easily treated, physicians owe it to their patients to conduct
thorough evaluations. This is especially true considering these new
findings. We recommend that in addition to the usual infertility
panel (which would include testing for antiphospholipid antibodies,
lupus anticoagulant, and anticardiolipin antibodies), patients with
recurrent miscarriages should be tested for genetic markers of
thrombophilia, including:
Abnormal results on any of these tests may indicate an increased
risk of forming placental blood clots, deep vein thrombosis, and
potentially fatal pulmonary embolism during pregnancy. Because of
this, therapy should be strongly considered.
Because inherited thrombophilia has been shown to be a major
cause of recurrent miscarriage, patients with recurrent fetal loss
should be evaluated for clotting disorders, even in the absence of
clinical signs. This is especially true if the loss occurred after a
heartbeat was detected. When lab results show a clotting disorder,
consult your physician for appropriate treatments and follow-ups.
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