Obstetrics and gynecology clinics of North America
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Obstet. Gynecol. Clin. North Am. · Sep 2006
ReviewThrombophilia and the risk for venous thromboembolism during pregnancy, delivery, and puerperium.
The main inherited thrombophilias (antithrombin deficiency, protein C and S deficiency, FVL, the prothrombin gene variant, and MTHFR C677T homozygotes) have a combined prevalence in Western European populations of 15% to 20%. One or more of these inherited thrombophilias is usually found in approximately 50% of women who have a personal history of VTE. Obstetricians must therefore be aware of the interaction between thrombophilias and the procoagulant state of pregnancy and should have an understanding of additional risk factors that may act synergistically with thrombophilias to induce VTE. Such knowledge combined with the appropriate use of thromboprophylaxis and treatment in women who have objectively confirmed VTE continue to improve maternal and perinatal outcomes.
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Obstet. Gynecol. Clin. North Am. · Sep 2006
ReviewPeripartum and perioperative management of the anticoagulated patient.
Management of the pregnant patient requiring anticoagulation in the peripartum period represents a significant clinical challenge. The peripartum period includes the most thrombogenic pregnancy-associated state and the intrapartum and immediate postpartum periods, when hemorrhage is and important concern. Clinical decisions depend on the type of antepartum anticoagulation, obstetric factors, risk of hemorrhage, and the risk and implications of thrombosis.