Thrombophilia in Pathological Pregnancies

Abstract Introduction. Many situations in pregnancy create a thrombophilia, which is believed to have a protective function, which is the result of the hormone influence, primarily by gestagenic hormones. This is a physiological condition and it helps in successful implantation of the embryo and prevention of bleeding. The presence of additional, hereditary or acquired cause of thrombophilia disrupts the natural balance and creates conditions for venous thromboembolism and consequences for pregnancy, such as miscarriage, intrauterine fetal death, delayed intrauterine growth, eclampsia and abruption of the placenta. Methods. The study was designed as a retrospective epidemiological cross-sectional study and was conducted at the Institute of Transfusion Medicine in Skopje in the period from June to October 2016. The study included patients with current pathological pregnancies. The following laboratory analyses were conducted in all patients: hemostasis, D-dimer, antithrombin III, protein C, protein S, antiphospholipid antibodies, lupus anticoagulant, MTHFR, factor V Leiden and prothrombin mutation. Results. The study included 41 patients, of whom 3 were excluded due to an insufficient medical history, 3 who were receiving corticosteroid therapy, 2 due to incomplete laboratory analyses and one patient with proven systemic lupus. Data analysis showed that family history of thrombophilia was present in 25%. The most common MTHFR mutation was recorded in 26 (82%) patients, followed by the factor V mutation present in 18 (55%) of the examined patients. AT III deficiency was detected in only one patient (2%). In 12 patients (35%) a disturbed ratio of DD vs. markedly shortened APTT or inappropriately low levels of DD was registered, which is an indirect indicatorof hypofibrinolysis. Conclusion. Pathologic pregnancy is a condition that is often associated with thrombophilia. Advanced age of a patient, family and personal history of thrombotic conditions indicate a high risk of complications in pregnancy. Due to the current increased frequency of high risk pregnancies associated with circulation problems with the placenta, there is a need for more frequent hemostatic examinations in pregnancy.