RT Book, Section
A1 Silver, Robert M.
A2 Pacheco, Luis D.
A2 Saade, George R.
A2 Hankins, Gary D.V.
SR Print(0)
ID 1115520675
T1 Thrombophilias
T2 Maternal Medicine
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071824163
LK obgyn.mhmedical.com/content.aspx?aid=1115520675
RD 2024/04/20
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.