WHAT IS A BLOOD CLOT AND WHY IS IT DANGEROUS?
When you cut or injure yourself, your body stops the bleeding by forming a blood clot. Proteins and particles in your blood, called platelets, stick together to form the blood clot. The process of forming a clot is called coagulation. Normal coagulation is important during injury, as it helps stop a cut from bleeding and starts the healing process.
However, the blood shouldn’t clot when it’s just moving through the body. If blood tends to clot too much, it is referred to as a hypercoagulable state or Thrombophilia. People with Thrombophilia have an increased risk for blood clots developing in arteries and veins. Blood clots in the veins can travel through the bloodstream to major organs and cause deep vein thrombosis or a pulmonary embolus, (a blood clot in the lungs).
WHAT IS THROMBOPHILIA?
Thrombophilia is most easily understood as the opposite of hemophilia.
Individuals with Thrombophilia tend to form blood clots too easily because their bodies make too much of certain proteins or too little of anti-clotting proteins.
Thrombophilia can be inherited or acquired later in life. About 15% of people in the US have an inherited Thrombophilia but acquired thrombophilias may pose a higher risk during pregnancy.
MOST COMMON CLOTTING DISORDERS
The most common inherited Thrombophilias are Factor V Leiden, prothrombin mutations and Antithrombin protein C and S deficiencies.
We have not, as yet, developed blood tests to detect all genetic clotting disorders.
The most common acquired Thrombophilia is Antiphospholipid Syndrome or APS which occurs in up to 5% of pregnant women. APS is an autoimmune disorder. Women with lupus are especially at risk.
Other acquired hypercoagulable conditions include: cancer, recent trauma, surgery, obesity, pregnancy, contraceptive drugs, immobility (including lengthy airplane travel), inflammatory bowel syndrome and HIV.
PREGNANCY AND CLOTTING DISORDERS
Pregnancy is a naturally occurring hypercoagulable state which poses no risk to most women. However, even pregnant women without a clotting problem may be more likely than non-pregnant women to develop deep vein thrombosis and embolus. The risk of developing a blood clot is 4 to 6 times more likely in a pregnant woman. This is due to normal pregnancy-related changes in blood clotting that limit blood loss during labor and delivery. Pulmonary embolus is the leading cause of maternal death in the US.
Clotting disorders during pregnancy may contribute to serious fetal complications including: repeated miscarriage, (usually after the 10th week), stillbirth, (in the second or third trimester) placental clotting and abruption, (which can cause heavy bleeding), pre-eclampsia, (pregnancy associated high blood pressure), IUGR, (poor fetal growth), premature delivery, (before 37 weeks).
The most dangerous time for developing pulmonary embolism is during delivery and post-partum. C-sections creates the most danger of all.
CONTRACEPTIVE DRUGS AND BLOOD CLOTS
Most contraceptive drugs increase the risk of blood clots because they produce some of the same hormonal effects as pregnancy. Contraceptive drugs carry warnings, however, most women and their doctors pay little attention to these warnings. In recent years, the FDA has increased the warnings on several of the most dangerous contraceptives, but they still remain on the market.
The newer contraceptive drugs containing synthetic progesterone, such as YAZ, Yazmin and Ocella, now carry an increased warning because of severe side effects including deep vein thrombosis, pulmonary embolism, stroke and heart attack.
Any woman with a personal or family history of blood clots should not take contraceptive drugs without consulting a specialist.
DIAGNOSIS AND BLOOD TESTING
Testing for coagulation disorders must be performed at a specialized coagulation lab and interpreted by a pathologist, or clinician with expertise in coagulation, vascular medicine or hematology.
If you have a personal or family history of blood clots, you should ask your doctor to run blood test for the known genetic and acquired markers for clotting disorders. You should do this prior to taking contraceptive drugs prior to becoming pregnant and prior to having a C-section.
This testing should also be done if, during pregnancy, you have experienced any of the fetal complications listed in the prior section.
Most clotting events for young women are a “surprise”. Risk factors include long flights, contraceptive drugs, smoking, and obesity.
Be aware of symptoms including shortness of breath, chest pain, persistent leg pain, and swelling or redness in your leg.
FETAL ULTRASOUND DIAGNOSIS
There are now special ultrasound techniques available to detect several of the serious fetal complications created by Thrombophilias in pregnant women. Placental clotting and umbilical blood flow can be monitored using these techniques. This is critical because reduced blood flow to the fetus may be responsible for low birth weight and developmental difficulties.
Only a high-risk, maternal/fetal specialist who has expertise in this type of ultrasound technology is qualified to perform placental diagnostics.
TREATMENTS
Women who have been diagnosed with a Thrombophilia, or women who have a history of blood clots are usually treated with anticoagulants during pregnancy and during the postpartum period. These drugs can be self-administered and are safe because they do not cross the placenta or enter into breast milk. A low-dose aspirin may also be prescribed.
These treatments are constantly evolving and improving. The lives of many women and babies can be saved but much more research is needed. Unfortunately, not all obstetricians are familiar with these treatments. Women must seek out qualified specialists.
WHERE TO GET HELP
Most major university medical centers are both research and treatment centers that have departments of Maternal Fetal Medicine within their department of Obstetrics and Gynecology.
Maternal Fetal medical doctors are sometimes called Perinatologists. These are doctors who are first trained in obstetrics and gynecology and then further specialize in fetal care. There are different areas of specialization within this field as well. Many of these doctors deal with very specific, high-risk situations. Blood disorders is one of these.
Women with Thrombophilia would see a Maternal/Fetal Blood Specialist, (a, M/F doctor who is also a hematologist) and/or a maternal/fetal specialist with expertise in specific fetal diagnostic techniques.
It is important to remember that ordinary obstetricians are not trained in these areas and many maternal/fetal doctors are not trained to deal with very specific high-risk situations.
ADDITIONAL LINKS
www.npr.org/2018/05/10/607782992/for-every-woman-who-dies-in-childbirth-in-the-u-s-70-more-come-close
https://www.npr.org/2018/03/11/592272083/many-women-come-close-to-death-in-childbirth
When you cut or injure yourself, your body stops the bleeding by forming a blood clot. Proteins and particles in your blood, called platelets, stick together to form the blood clot. The process of forming a clot is called coagulation. Normal coagulation is important during injury, as it helps stop a cut from bleeding and starts the healing process.
However, the blood shouldn’t clot when it’s just moving through the body. If blood tends to clot too much, it is referred to as a hypercoagulable state or Thrombophilia. People with Thrombophilia have an increased risk for blood clots developing in arteries and veins. Blood clots in the veins can travel through the bloodstream to major organs and cause deep vein thrombosis or a pulmonary embolus, (a blood clot in the lungs).
WHAT IS THROMBOPHILIA?
Thrombophilia is most easily understood as the opposite of hemophilia.
Individuals with Thrombophilia tend to form blood clots too easily because their bodies make too much of certain proteins or too little of anti-clotting proteins.
Thrombophilia can be inherited or acquired later in life. About 15% of people in the US have an inherited Thrombophilia but acquired thrombophilias may pose a higher risk during pregnancy.
MOST COMMON CLOTTING DISORDERS
The most common inherited Thrombophilias are Factor V Leiden, prothrombin mutations and Antithrombin protein C and S deficiencies.
We have not, as yet, developed blood tests to detect all genetic clotting disorders.
The most common acquired Thrombophilia is Antiphospholipid Syndrome or APS which occurs in up to 5% of pregnant women. APS is an autoimmune disorder. Women with lupus are especially at risk.
Other acquired hypercoagulable conditions include: cancer, recent trauma, surgery, obesity, pregnancy, contraceptive drugs, immobility (including lengthy airplane travel), inflammatory bowel syndrome and HIV.
PREGNANCY AND CLOTTING DISORDERS
Pregnancy is a naturally occurring hypercoagulable state which poses no risk to most women. However, even pregnant women without a clotting problem may be more likely than non-pregnant women to develop deep vein thrombosis and embolus. The risk of developing a blood clot is 4 to 6 times more likely in a pregnant woman. This is due to normal pregnancy-related changes in blood clotting that limit blood loss during labor and delivery. Pulmonary embolus is the leading cause of maternal death in the US.
Clotting disorders during pregnancy may contribute to serious fetal complications including: repeated miscarriage, (usually after the 10th week), stillbirth, (in the second or third trimester) placental clotting and abruption, (which can cause heavy bleeding), pre-eclampsia, (pregnancy associated high blood pressure), IUGR, (poor fetal growth), premature delivery, (before 37 weeks).
The most dangerous time for developing pulmonary embolism is during delivery and post-partum. C-sections creates the most danger of all.
CONTRACEPTIVE DRUGS AND BLOOD CLOTS
Most contraceptive drugs increase the risk of blood clots because they produce some of the same hormonal effects as pregnancy. Contraceptive drugs carry warnings, however, most women and their doctors pay little attention to these warnings. In recent years, the FDA has increased the warnings on several of the most dangerous contraceptives, but they still remain on the market.
The newer contraceptive drugs containing synthetic progesterone, such as YAZ, Yazmin and Ocella, now carry an increased warning because of severe side effects including deep vein thrombosis, pulmonary embolism, stroke and heart attack.
Any woman with a personal or family history of blood clots should not take contraceptive drugs without consulting a specialist.
DIAGNOSIS AND BLOOD TESTING
Testing for coagulation disorders must be performed at a specialized coagulation lab and interpreted by a pathologist, or clinician with expertise in coagulation, vascular medicine or hematology.
If you have a personal or family history of blood clots, you should ask your doctor to run blood test for the known genetic and acquired markers for clotting disorders. You should do this prior to taking contraceptive drugs prior to becoming pregnant and prior to having a C-section.
This testing should also be done if, during pregnancy, you have experienced any of the fetal complications listed in the prior section.
Most clotting events for young women are a “surprise”. Risk factors include long flights, contraceptive drugs, smoking, and obesity.
Be aware of symptoms including shortness of breath, chest pain, persistent leg pain, and swelling or redness in your leg.
FETAL ULTRASOUND DIAGNOSIS
There are now special ultrasound techniques available to detect several of the serious fetal complications created by Thrombophilias in pregnant women. Placental clotting and umbilical blood flow can be monitored using these techniques. This is critical because reduced blood flow to the fetus may be responsible for low birth weight and developmental difficulties.
Only a high-risk, maternal/fetal specialist who has expertise in this type of ultrasound technology is qualified to perform placental diagnostics.
TREATMENTS
Women who have been diagnosed with a Thrombophilia, or women who have a history of blood clots are usually treated with anticoagulants during pregnancy and during the postpartum period. These drugs can be self-administered and are safe because they do not cross the placenta or enter into breast milk. A low-dose aspirin may also be prescribed.
These treatments are constantly evolving and improving. The lives of many women and babies can be saved but much more research is needed. Unfortunately, not all obstetricians are familiar with these treatments. Women must seek out qualified specialists.
WHERE TO GET HELP
Most major university medical centers are both research and treatment centers that have departments of Maternal Fetal Medicine within their department of Obstetrics and Gynecology.
Maternal Fetal medical doctors are sometimes called Perinatologists. These are doctors who are first trained in obstetrics and gynecology and then further specialize in fetal care. There are different areas of specialization within this field as well. Many of these doctors deal with very specific, high-risk situations. Blood disorders is one of these.
Women with Thrombophilia would see a Maternal/Fetal Blood Specialist, (a, M/F doctor who is also a hematologist) and/or a maternal/fetal specialist with expertise in specific fetal diagnostic techniques.
It is important to remember that ordinary obstetricians are not trained in these areas and many maternal/fetal doctors are not trained to deal with very specific high-risk situations.
ADDITIONAL LINKS
www.npr.org/2018/05/10/607782992/for-every-woman-who-dies-in-childbirth-in-the-u-s-70-more-come-close
https://www.npr.org/2018/03/11/592272083/many-women-come-close-to-death-in-childbirth
