I. What is thrombophilia?
In short, if the body’s coagulation, anticoagulation and fibrinolytic system are abnormal during pregnancy, pathological blood hypercoagulation may occur, forming a pre-thrombotic state, which may then develop into a thrombus.
Second, what is the relationship between thrombophilia and habitual abortion?
Thrombophilia does not necessarily occur in thrombophilia, but it may lead to poor placental perfusion or even infarction due to imbalance in coagulation-anticoagulation mechanism or fibrinolytic activity, microthrombosis of uterine spiral arteries or chorionic vessels, resulting in a variety of adverse pregnancy outcomes: recurrent miscarriage, severe early-onset pre-eclampsia severe, neonatal coagulation abnormalities, stillbirth and stillbirth. It was found that 67% of patients with recurrent spontaneous abortion had defects in the fibrinolytic pathway, and 66% of those with pregnancy loss had a propensity for thrombosis.
Third, what are the causes of embolism?
The causes of hereditary thrombophilia include: anticoagulant protein defects (protein C deficiency, protein S deficiency, etc.), coagulation factor defects (antithrombin III, prothrombin G20210A mutation, abnormal fibrinogenemia, etc.), fibrin defects (tissue-type fibrinogen activator (t-PA) deficiency, increased fibrinogen activation inhibitor-1 (PAI-1), etc.), metabolic defects ( hyperhomocysteinemia, etc.)…
The causes of acquired embolism are: antiphospholipid syndrome, systemic lupus erythematosus, neoplastic diseases, myeloproliferative neoplasms, nephrotic syndrome, acute medical diseases (congestive heart failure, severe respiratory diseases, etc.), inflammatory bowel disease, etc.
Risk factors for embolism include surgery or trauma, prolonged braking, advanced age, pregnancy and puerperium, tumor treatment, acquired anticoagulant deficiency, etc.
IV. What are the screening methods for embolism?
For patients with habitual abortion, we first recommend routine tests including: blood coagulation routine, platelet aggregation rate, D-dimer, relevant autoantibodies (anti-cardiolipin antibodies, anti-2 glycoprotein antibodies, etc.), and homocysteine (Hcy).
If further screening is needed, the tests that one can complete are: prothrombin III antigen, prothrombin III activity, protein C, protein S, a2 fibrinolytic inhibitor, lupus anticoagulant assay, coagulation factor activity, MTHFR gene test, etc.
For maternal-uterine and utero-placental blood supply, “uterine artery blood flow and umbilical blood flow monitoring” are performed to understand the endometrial and placental blood supply. It should be noted that “uterine artery monitoring” changes dynamically with the menstrual cycle and the progress of pregnancy, and there are no uniform norms and standards nationwide, and the results may vary depending on the testing instrument and the testing doctor.
VI. Precautions before the test?
Since the results of this type of test are easily affected by many factors, we recommend that you have not taken folic acid, vitamins, anticoagulation, hormones and Chinese medicine in the recent past; no menstrual period, no recent cold, no history of surgery or trauma; and the platelet aggregation test also requires an early morning fasting. And before and during pregnancy, the doctor will ask the patient to repeat the test.
However, it is worth noting that almost all coagulation factors increase in varying degrees starting after 12 weeks of gestation, reaching a peak at the time of delivery, with Fg, coagulation factor VIII, and factor VII increasing most significantly, with coagulation factor VII levels exceeding 10 times the normal reference value, Fg reaching 4 to 8 g/L at delivery, and factor VIII levels reaching 100% to 130% of normal. On the other hand, certain anticoagulant components such as PS and PC activity decrease during pregnancy, with PS decreasing by 50% to 70%. Therefore, post-pregnancy measurements of some of these indicators cannot be used to guide clinical treatment.
VII. Which embolism-prone conditions require treatment?
Pregnant women with a clear history of hereditary embolism; family history or past history of venous thrombosis, pulmonary embolism, etc.; history of adverse pregnancy such as 3 or more miscarriages, history of stillbirth, history of stillbirth, abnormal coagulation tests; combined systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS); obstetric complications of the current pregnancy such as gestational diabetes, pre-eclampsia, FGR, etc.; some pregnancies Patients with combined heart disease, such as heart valve replacement, wind heart mitral valve lesion with atrial fibrillation.
How to treat embolism?
The treatment of embolism mainly includes anticoagulation and treatment of the cause of embolism. Based on the safety of the fetus in patients with habitual abortion, the drugs we commonly use are mainly aspirin, low molecular heparin, B vitamins, folic acid, salvia, etc. However, the above drugs have certain side effects on the mother, so the drugs should be used under the guidance of the doctor.
Nine, treatment failure, where to go?
Patients with embolism-prone Xi flow will still have the possibility of fetal preservation failure after receiving anticoagulation treatment. While being frustrated, what can we do? In fact, embolism is only a small part of the many causes of spontaneous abortion, or even an accompanying part. For example, if there are also chromosomal abnormalities in the embryo, the failure of fetal preservation is actually a good thing. For example, in patients with antiphospholipid syndrome, easy embolism is one of its manifestations, and anticoagulation is needed along with immunotherapy for antiphospholipid syndrome, etc.
Ten, written in the end, with you to encourage
The wonders of life have created its unending legacy of continuity, but also destined to play the game with each disease, the process of peeling the cocoon of hard work. In the face of disease, doctors and patients are comrades in arms, supporting and growing with each other. Regardless of success or failure, the trust given to us, what we can return is not 100% success, but certainly is the commitment of 100% effort.