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    Coagulation Changes in Pregnancy

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    Ramachandran Sundararaman

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    Coagulation Changes in Pregnancy

    Uploaded by

    Ramachandran Sundararaman
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    Coagulation changes in pregnancy

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    Coagulation Changes in Pregnancy

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    Ramachandran Sundararaman

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    © All Rights Reserved
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    Home / ABA Keyword Categories / Coagulation changes in pregnancy

    Coagulation changes in pregnancy


    De nition
    Pregnancy is a state of hypercoagulation, which is likely an adaptive mechanism to reduce the risk of hemorrhage during and after the
    delivery process.  Unfortunately as a result of the hypercoagulable state, thromboembolism is one of the leading causes of death associated
    with pregnancy, particularly in developed nations, with clinically signi cant venous thromboembolism occurring in 1 of every 1000 to 2000
    pregnancies.   The hypercoagulability of blood during pregnancy has been con rmed with Thromboelastography (TEG) and is thought mainly
    due to the increased production of factor VII and brinogen.  Although many of the coagulation factors are increased during pregnancy, none
    are quite to the extent of factor VII and brinogen.

    The risk of developing a venous thromboembolism increases about 100-fold when a parturient is admitted to a hospital and also seems to be
    worse during the third trimester. This is thought to be due to changing hormonal levels, in particular increased estrogen as pregnancy
    progresses.  It is important to note that the classic Virchow’s Triad favors thrombus formation in pregnancy with increased venous stasis,
    increased coagulability factors, and increased endothelial damage.  Risk of venous thromboembolism in pregnancy increases with the
    following additional risk factors:  obesity, smoking, multiple gestations, advanced maternal age, increased parity, cesarean section, as well as
    the presence of a concomitant thrombophila.  Unfractionated heparin and low molecular weight heparin are the modalities of choice for
    anticoagulation during pregnancy.

    There is some evidence to suggest that the body creates a level of homeostasis by also increasing brinolysis to a certain extent.  During
    pregnancy, we see increases in plasma activity of plasminogen alpha2-antiplasmin and elevated concentrations of D-dimer, which suggests
    increased brinolytic activity and the restriction of brin formation.   This would explain that despite all the factors favoring a
    hypercoagulable state in pregnancy, venous thromboembolism remains a relatively rare event.

    Chemical Changes During Pregnancy

    Subspecialty
    Obstetric Anesthesia
    Related Media
    Keyword history
    73%/2015
    45%/2014

    See Also:
    Pregnancy: Hematologic changes
    Pregnancy: DIC
    Pregnancy: Hemostasis

    Similar Keyword:
    Pregnancy: Changes in coag factors

    Sources
    1. Miller’s Anesthesia, 7th Edition. p 2205.
    2. Birnbach DJ, Gatt SP, Datta S (eds). Textbook of Obstetric Anesthesia. New York, NY: Churchill Livington; 2000: p 41.

    PubMed
    1. Alyshah Abdul Sultan, Joe West, Laila J Tata, Kate M Fleming, Catherine Nelson-Piercy, Matthew J Grainge Risk of rst venous
    thromboembolism in pregnant women in hospital: population based cohort study from England. BMJ: 2013, 347;f6099
    2. Emily M Armstrong, Jessica M Bellone, Lori B Hornsby, Sarah Treadway, Haley M Phillippe Pregnancy-Related Venous
    Thromboembolism. J Pharm Pract: 2014, 27(3);243-252
    3. Ekaterina H Uchikova, Ilija I Ledjev Changes in haemostasis during normal pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol.:
    2005, 119(2);185-8

    Filed Under: ABA Keyword Categories, Advanced, C, Obstetric Anesthesia, Obstetric


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