TY - CHAP M1 - Book, Section TI - Thrombophilias A1 - Silver, Robert M. A2 - Pacheco, Luis D. A2 - Saade, George R. A2 - Hankins, Gary D.V. Y1 - 2015 N1 - T2 - Maternal Medicine AB - Thrombophilias refers to a group of conditions that is associated with (mostly venous) thromboembolism. Venous thromboembolism (VTE) is a leading cause of death in women and is among the top three causes of maternal death in wealthy nations. Moreover, pregnancy and the puerperium are associated with about a 10-fold increase in the risk for VTE with an incidence of approximately one in 1500.1 This increases another threefold to fivefold with cesarean delivery. The hormonal milieu (thought to be primarily due to increased estrogen) of pregnancy leads to a relative increase in procoagulant proteins and a decrease in anticoagulant proteins. It is this delicate balance between procoagulant and anticoagulant proteins that allows for clot formation if there is a cut or injury to a blood vessel, but prevents excessive clot formation so that flow is not impeded. Imbalances in this system may lead to thromboembolism (or bleeding). A list of clotting factors that are altered during normal pregnancy is shown in Table 25-1. In addition, pregnancy is associated with an increased risk for venous stasis and tissue damage (perineal trauma and cesarean delivery). Thus, pregnancy is associated with all of Virchow triad of risk factors for thromboembolism. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/04/19 UR - obgyn.mhmedical.com/content.aspx?aid=1115520675 ER -