Combined Thrombophilia and Obstetric Complications

Gestational vascular complications are a major cause of maternal and fetal morbidity. A growing body of evidence suggests significant correlation of inherited and acquired thrombophilia with pregnancy loss, pre-eclampsia, eclampsia, placental abruption, intrauterine growth restriction (IUGR), and intra uterine fetal death (IUFD). Placental pathological findings in women with thrombophilia are characterized by thrombosis and fibrin deposition to a greater degree than in normal pregnancy [1]. The term Combined Thrombophilia is used when more than one prothrombotic conditions exist at the same time. As per definition any added prothrombotic diathesis promotes pregnancy to a combined thrombophilic state [1, 2]. Thrombophilic risk factors are common and can be found in 15% to 25% of Caucasian population. The combination of prothrombotic risk factors is not uncommon. Since pregnancy is an acquired hypercoagulable state, women harboring thrombophilia may present with clinical symptoms of vascular complications for the first time during gestation or at the postpartum period [3, 4]. Combined thrombophilia also exists when inherited and/or acquired prothrombotic factors are pooled. Every combination carries a different risk of thrombosis. A scoring system, which is composed of four major categories: obstetrical history, previous thromboembolic events, family history and type of thrombophilia, can help us to stratify universally the thrombotic risk during pregnancy and peripartum and administer the appropriate antithrombotic treatment.