CASE HISTORY – October 2003

Thrombophilia and pregnancy


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Thrombophilia is a hypercoagulative state which can be congenital or acquired. Congenital thrombophilia is caused by deficiencies of certain coagulation factors (protein S, protein C, antithrombin III deficiency or activated protein C resistence). The main clinical syndromes of thrombophilia are deep venous thrombosis in legs, pulmonary embolism, or both, more rarely in the superficial, cerebral or visceral veins. In more than half of all cases, thrombosis is triggered by operation, older age, pregnancy or oral contraceptives. Women who have thrombophilia, carry an eightfold higher risk of developing thrombosis during pregnancy or in puerperium compared with healthy women. The preconditions of thrombosis are venous stasis, increased coagulation and vascular wall damage. Physiological changes during pregnancy favour thrombosis: progesteron causes venodilation and stasis; also hypercoagulation and decreased fibrinolysis occur as well. Thrombosis of the cerebral veins or the dural sinuses can occur in any age, but peak incidence occur among young women due to pregnancy, childbirth and use of oral contraceptives. Stroke in pregnancy or in puerperium, is relatively rare and is usually related to eclampsia. Low molecular weight heparin is currently recommended for the treatment of thrombosis in pregnancy. Treatment is continued throughout pregnancy and for at least 6 months after delivery.
We present a case report of a 25-year-old women who suffered from several thrombotic events during pregnancy.