Blood clotting early pregnancy: Vaginal Bleeding and Blood Clots During Pregnancy
Blood Clots During Pregnancy | American Pregnancy Association
Symptoms, Treatment, and Prevention
Blood clots are serious concerns and even more so while you are pregnant. Developing a blood clot while pregnant has additional risks or concerns because of your developing baby, thankfully they are rare and there is little need for concern.
However, there are steps you can take to further minimize your risk of experiencing them while you are pregnant.
What is a Blood Clot?
A blood clot occurs when your body sends cells, called platelets, to block the flow of blood. Normally, this occurs when you have a cut, to keep the injury from bleeding continuously. During pregnancy, your blood is more likely to clot as a safeguard against losing too much blood during labor.
However, a condition known as deep-vein thrombosis (DVT), which happens when blood clots form in the legs and pelvic region, can occur and is linked with a number of serious health concerns. The good news is there are ways to both prevent DVT and to treat it after it occurs.
Also, blood clots affect only 1 or 2 pregnant women out of every 1,000, so there is no need for alarm unless you feel you may be at risk.
What are the Causes of Blood Clots during Pregnancy?
Research has shown a number of possible causes of DVT, and it is important to note whether you fall into any of these categories. Women are most likely to experience a blood clot in their first three months of pregnancy or in the first six weeks after giving birth. If you believe you may be at risk for DVT, be sure to talk to your healthcare provider.
You could be at risk if:
- You or a close relative have experienced DVT before
- You smoke or are exposed to secondhand smoke frequently
- You are over 35 years old
- You are overweight
- You travel long distances while pregnant
- You are expecting multiples
- You are sedentary for long periods of time
- You have a Cesarean section
Women tend to be more sensitive and aware of potential complications while they are pregnant. Although blood clots are unlikely, there are a few signs that can indicate the possibility of a blood clot.
- Swelling or pain in one leg
- Pain that worsens when you walk
- Veins that look larger than normal
What are the Risks during Pregnancy?
DVT can seriously affect your pregnancy in a number of ways:
- Blood clots in the placenta
- Heart attack
- Pulmonary embolism, which is when blood clots break off and are lodged in the lungs
How can you Prevent and Treat Blood Clots?
Prevention of DVT is important and can be achieved by a healthy lifestyle. Staying active is a crucial component in combating DVT, so check with your healthcare provider to see which activities and types of exercises you can do. Regular exercise improves circulation and can keep clots from forming. It is also important to eat healthily, and if you are currently smoking, you should stop immediately. It is important to notify your healthcare provider if you feel you may be at risk of DVT.
If you have been diagnosed with DVT, you will most likely be treated with an anticoagulant, which hinders the blood from clotting as easily.
Want to Know More?
Compiled from the following Resources:
Blood Clotting and Pregnancy. (n.d.). Retrieved August 8, 2014, from https://www.hematology.org/Patients/Clots/Pregnancy.aspx
Preidt, R. (2014, April 2). Some Women at Risk for Blood Clots From Pregnancy. Retrieved August 8, 2014, from https://www.webmd.com/baby/news/20130402/study-pinpoints-women-at-risk-for-blood-clots-from-pregnancy
Blood Clots and Pregnancy. (2014, January 1). Retrieved August 8, 2014, from https://www.marchofdimes.org
What Does It Mean for You and Baby?
Isn’t it ironic how some of the most joyful moments of modern pregnancy — like catching a glimpse of your baby in an early pregnancy ultrasound — can inspire so much angst?
Before the days of sophisticated medical imaging, countless women sailed through seemingly perfect pregnancies, producing perfect little people, without ever knowing they had complications like a uterine blood clot. But now you can find out, and so you worry — very often without cause.
Most of the blood clots that turn up on sonograms during the first trimester are what doctors call subchorionic hematomas. In plain English, that means a blood clot that’s situated between the wall of your uterus and your baby’s gestational sac (or chorionic membrane).
Uterine blood clots are no different from those that occur anywhere else in the body: They form from coagulated blood cells and proteins. To have one, you must have been bleeding in your uterus at some point, which is much less ominous than it sounds. Sometimes, they cause noticeable vaginal spotting or bleeding, which is quite common during early pregnancy.
Over time, the clot may be reabsorbed into the uterus, or it may just loiter around harmlessly until your baby is born. On your follow-up visit, your doctor will likely perform another ultrasound to find out; as long as the pregnancy is progressing nicely, you’re at no higher risk of complications.
What caused the uterus blood clot? It’s hard to be certain. It may have been a ruptured blood vessel. Or the hematoma may have slightly separated the placenta from the uterine wall — a condition called a placental abruption, which, with early diagnosis, your doctor should be able to reduce risks for you and your baby.
Hearing that you have a blood clot during pregnancy can feel frightening. The good news is that first trimester blood clots (or subchorionic hematoma) are rarely associated with either miscarriages or problems later in the pregnancy. In the meantime, to be on the safe side, heed your doctor’s advice and take it easy.
Your doctor may also put your pelvis off-limits to vaginal exams (and, sadly, pregnancy sex). So get as much bed rest as possible — and consider it a well-deserved breather. Brewing a baby is exhausting business! Most importantly, put the worrying on the back burner.
Here’s to enjoying some well-deserved R&R,
Does Early Pregnancy Bleeding Mean a Miscarriage?
If you’re newly pregnant and start to notice vaginal bleeding, give yourself a moment to take a deep breath. Although bleeding may be a cause for alarm, it isn’t necessarily a sign of miscarriage—especially if it’s light.
Here’s a look at why bleeding or spotting may happen during different points in pregnancy. Always be sure to call your doctor to discuss your individual concerns.
Verywell / Jessica Olah
Bleeding During the First Trimester
First-trimester bleeding is more common than many people assume. Research varies, with some experts citing early-pregnancy bleeding in 15% to 25% of patients, and others reporting this figure to be as high as 40%.
Though an impending miscarriage is possible, it’s best not to jump to conclusions before discussing your symptoms with your doctor.
About 50% of women with first-trimester vaginal bleeding will miscarry, and 50% will not.
Possible Causes of Bleeding
Beyond miscarriage, possible causes of first-trimester bleeding or spotting include:
- Cervical sensitivity: A pelvic exam or sexual intercourse may cause your cervix to become tender and inflamed, leading to light, brown-tinged spotting that should resolve within a day or so.
- Implantation bleeding: Some women experience implantation bleeding as the lining of the uterus adjusts to the newly implanted egg.
- Infection: A urinary tract, cervical, or pelvic infection can cause vaginal bleeding.
- Molar pregnancy: Molar pregnancy is a rare form of gestational trophoblastic disease. In a molar pregnancy, a cluster of abnormal tissue develops in the uterus rather than an embryo, usually due to chromosomal problems during conception. Because molar pregnancies raise hCG levels, pregnancy tests still come back positive.
- Subchorionic hemorrhage: When blood accumulates between your uterine wall and the amniotic sac, a subchorionic hemorrhage or hematoma can cause early pregnancy bleeding. Subchorionic hemorrhage occurs in about 1% of pregnancies.
Cervical polyps and heavy exercise may also be responsible for spotting during early pregnancy.
Signs of Miscarriage
The highest risk of miscarriage is during the first 12 weeks of pregnancy. Vaginal bleeding that is bright red and gets heavier over time (rather than lighter) is more likely to indicate a miscarriage. Other signs of a miscarriage may include:
- Cramping: Lower abdominal cramping that’s worse than your typical menstrual cycle
- Discharge: Tissue, clots, or clumps in the blood
- Dizziness: Feeling lightheaded or faint
Less common than miscarriages, ectopic pregnancies can also produce vaginal bleeding. In an ectopic pregnancy, the fertilized egg implants itself somewhere other than the uterus, often in one of the fallopian tubes. Symptoms of ectopic pregnancy can be similar to miscarriage (including bleeding and cramping), you may notice a sharp or stabbing pain in your abdomen.
Second and Third Trimester Bleeding
In some cases, vaginal bleeding in the second or third trimester is not serious. Nonetheless, a dangerous condition must always be ruled out through an evaluation by your doctor.
See your doctor right away if you experience bleeding in your second or third trimester. Heavy or bright red blood that is accompanied by other symptoms like abdominal pain or contractions must be addressed immediately.
Light bleeding or spotting can happen later in pregnancy due to many of the same reasons as first trimester bleeding, such as slight irritation of the cervix after sexual intercourse, a medical exam, or growths on the cervix. Make an appointment with your doctor right away to pinpoint the cause and rule out a serious condition, such as:
A placental abruption occurs if all or some of the placenta suddenly separates from the uterus after week 20 of gestation. It’s an uncommon condition, occurring in about one out of every 100 pregnancies. It usually happens in the third trimester, and can trigger preterm delivery or stillbirth. You may feel contractions and abdominal pain along with the bleeding during a placental abruption.
This phenomenon happens in around one out of 100 pregnancies. An incompetent cervix is when the cervix starts to dilate too soon, which can result in miscarriage or pre-term birth. This complication is responsible for nearly 25% of miscarriages that occur in the second trimester.
This condition occurs when the placenta is low-lying and either somewhat or totally covers your cervix. Placenta previa can cause growth restrictions in the baby and fatal hemorrhaging (blood loss) in the mother, among other complications.
If you’re diagnosed with placenta previa, you will likely have to go on bed rest, often in a hospital. While serious, placenta previa is also rare, occurring in approximately one out of every 200 pregnancies.
When the placenta grows too deeply into the uterine wall it cannot be released after the baby is born. This condition is called placenta accreta. It can become life-threatening if not found before delivery due to the risk of hemorrhage and late-pregnancy bleeding.
Placenta accreta is usually found during routine prenatal ultrasound. If you have placenta accreta, your doctor will plan for extra precautions during the delivery and possibly a hysterectomy (surgical removal of the uterus) once the baby is born.
Labor prior to the 37th week of pregnancy is considered preterm labor, the signs of which can be mistaken for bleeding. Often, before labor starts, you’ll pass the mucus plug, which can look bloody and watery (thus the common moniker, “bloody show”). The mucus plug may be passed several weeks before going into labor, or it could signal that preterm labor is about to occur.
Other symptoms of preterm labor may include cramping, abdominal pain or pressure, lower back pain or pressure, diarrhea, and contractions.
What to Do If You Notice Bleeding
If you experience bleeding or spotting any time during pregnancy, call your doctor and use a panty liner or pad to monitor it. Pay attention to the color: Is it pink, bright red, or brown? Note any activities you might have done in the past day or two that may be causing the bleeding, such as a pelvic exam, Pap smear, or sexual intercourse.
Never use a tampon during pregnancy or put anything in your vagina while you’re bleeding. Avoid sexual intercourse until your doctor gives you the all-clear.
A Word From Verywell
Vaginal bleeding during pregnancy can have lots of different causes—some serious and some not. It’s tough to know the difference on your own, so always call your doctor immediately if you experience bleeding during your pregnancy. Be sure to explain any other symptoms along with recent lifestyle cues to help decipher the cause.
Blood Clotting & Pregnancy – Hematology.org
If you are pregnant, or you have just had a baby, you are at greater risk of developing a blood clot.
Blood clots in pregnant women tend to form in the deep veins of the legs or in the pelvic area. This condition is known as deep vein thrombosis (DVT). Pulmonary embolism (PE) is a life-threatening event that occurs when a DVT breaks off and travels to the blood vessels of the lungs.
DVT and PE, collectively known as venous thromboembolism, are highly preventable (see prevention tips below). The U.S. Surgeon General has issued a Call to Action on DVT and PE to raise public awareness of these blood conditions and increase research on the causes, prevention, and treatment.
Blood clots are also potentially dangerous to your baby. Blood clots can form inside the placenta, cutting off blood flow and harming your baby.
Am I at Risk?
The risk of developing a blood clot during pregnancy is increased by the following:
- Previous blood clots
- A genetic predisposition to blood clots
- Prolonged immobility (e.g., bedrest, long distance travel)
- Multiple births
- Increased maternal age
- Other medical illness (e. g., cancer, infection)
How are Blood Clots in Pregnant Women Treated?
Typically, blood clots are treated with an anticoagulant, a medicine that prevents the blood from clotting. Certain anticoagulants are safe to use during pregnancy.
Are Blood Clots Preventable?
There are a few things that you can do to prevent blood clots during pregnancy:
- Be aware of risk factors.
- Know your family history.
- Make sure your doctor knows about any history of blood clots or blood clotting disorders in your family.
- Remain active, with your doctor’s approval.
- Be aware of the signs and symptoms of a blood clot. Visit your doctor immediately if you think you have one.
If you are pregnant and have concerns about blood clots, talk with your doctor about your risks and prevention. Depending on your condition, your OB-GYN may refer you to a hematologist, a doctor who specializes in treating blood conditions.
Antiphospholipid Antibody Syndrome: A Patient’s Journey
Where Can I Find More Information?
If you find that you are interested in learning more about blood diseases and disorders, here are a few other resources that may be of some help:
Results of Clinical Studies Published in
Search Blood, the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, patients interested in viewing an access-controlled article in Blood may obtain a copy by e-mailing a request to the Blood Publishing Office.
A list of Web links to patient groups and other organizations that provide information.
How to Prevent Blood Clots in Pregnancy
Pregnancy brings more than morning sickness and fatigue — it also brings a risk of deep vein thrombosis (DVT), a preventable condition in which blood clots form in the veins. In fact, pregnancy and DVT risk go hand-in-hand. Pregnant women have a five times higher risk of deep vein thrombosis than women who aren’t pregnant, according to the Centers for Disease Control and Prevention (CDC). The risk remains up to three months after the baby is born.
The reason expectant women should be mindful of the link between pregnancy and DVT is that an untreated clot has the potential to break free and travel through the bloodstream.
“The fear is it will move to the heart or lungs and cause a pulmonary embolism, which can lead to death,” says Daniel Roshan, MD, a maternal fetal medicine specialist and an assistant professor of obstetrics and gynecology at the NYU Grossman School of Medicine in New York City.
Causes of Deep Vein Thrombosis in Pregnancy
Why is there an increased risk of deep vein thrombosis when a woman is expecting? “A lot of physiological changes take place during pregnancy,” says Pamela Berens, MD, a professor of obstetrics and gynecology with McGovern Medical School at UTHealth in Houston. One is the compression in the pelvis from the baby. “There are also changes in clotting factors in the blood that begin early in pregnancy and last until a woman is six weeks postpartum,” she added.
Pregnancy hormones play a role. “There’s a lot of estrogen circulating during pregnancy, and estrogen increases the risk of blood clots,” Dr. Roshan says. Women on birth control pills that contain estrogen are at a similar increased risk of DVT. Roshan says that women with genetic clotting disorders, called thrombophilias, are at an even higher risk for deep vein thrombosis in pregnancy.
Risk Factors for Deep Vein Thrombosis in Pregnancy
Certain factors that can further raise your chances of developing deep vein thrombosis in pregnancy include:
- Being 35 or older
- Previous blood clot during pregnancy or clot outside of pregnancy
- A genetic predisposition to blood clots
- Multiple births
- Being overweight
- Fertility treatments involving use of hormones
- Prolonged immobility, such as bed rest, travel, or recovery after delivery
- Certain pregnancy-related complications like preeclampsia or conditions like diabetes.
Having a cesarean delivery (C-section) nearly doubles a pregnant woman’s risk of a dangerous blood clot, the CDC reports.
Race can also be a risk factor. Research has shown that the overall incidence of DVT and pulmonary embolism is 30 to 60 percent higher in Black people than in white people. This accounts for both men and women.
Significant racial disparities exist in heart-related complications, including blood clots, among pregnant and postpartum women in the United States. According to a study published in the Journal of the American Heart Association in December 2020, pregnant Black women were found to have a 42 percent higher likelihood of developing a blood clot in the lungs compared with white women. Black women also had a higher incidence of heart attack, stroke, and heart muscle weakness and were also more likely to die in the hospital.
How to Recognize DVT Symptoms in Pregnancy
You have enough on your mind without stressing over deep vein thrombosis. So instead of worrying, be aware of the symptoms. Most blood clots during pregnancy occur in the legs. “So watch for tenderness in the calf and thighs, pain in the back of your calf, and swelling, particularly if it is on one side more than the other,” Roshan said.
Blood clots during pregnancy that have moved to the heart or lungs can cause chest pain, shortness of breath, or both. This signals an even more serious situation.
“If you have any signs of DVT, seek medical attention right away,” Roshan said. A healthcare professional will be able to easily see if your discomfort is due to a pregnancy blood clot by performing an ultrasound of the affected area.
If you indeed have DVT, the treatment will be a blood thinner, usually Lovenox (enoxaparin), which is safe during pregnancy. “We treat the clot with a therapeutic dose for a few months and then lower it to a prophylactic (preventive) dose,” he said.
For pregnant women with a prior history of DVT or blood clots during pregnancy or with a genetic thrombophilia, doctors usually prescribe blood thinners in the lower preventive dose. “We usually monitor women taking blood thinners throughout their pregnancies because as the pregnancy progresses, they sometimes need higher doses,” Roshan said. “And for women with a family history of DVT but no personal past history, we sometimes prescribe baby aspirin and tell them to be particularly cautious about symptoms.”
Prevent Pregnancy Blood Clots
By virtue of being pregnant or in the postpartum period, expectant women and new moms are at an increased risk of DVT, so you can’t eliminate the risk completely. But there are some steps you can take to reduce your risk of blood clots.
Keep moving. “If you are overweight and sedentary, that will affect your blood flow and increase your risk for deep vein thrombosis in pregnancy,” Dr. Berens says. “So stay active and maintain a healthy weight.” If you have to be on bed rest because of an injury or complication in your pregnancy, your doctor may prescribe blood thinners as a precautionary measure.
Get up during travel. “Flying in itself is a risk factor for DVT, so pregnant women who fly are definitely at an increased risk,” Berens said. If you have to fly, get up and move around every hour or two and do ankle roll exercises while you sit. “And do the same thing if you go on a long car or bus ride,” she added.
Wear compression stockings. Because they help improve circulation and reduce swelling in the legs, compression stockings can help lower your risk of deep vein thrombosis in pregnancy, Roshan said.
Drink lots of water. Staying hydrated during pregnancy helps prevent clots by keeping the blood from getting too thick, Roshan said. The CDC recommends that women drink 10 glasses of liquid every day during pregnancy and 12 to 13 glasses every day while breastfeeding.
Overall, err on the side of caution when it comes to blood clots during pregnancy, for your sake and the sake of your baby. “Deep vein thrombosis in pregnancy can be life-threatening, so if you see any signs, don’t hesitate to go to your doctor to get checked,” Roshan said.
Blood Tests for Miscarriage Risk
When they can help—and when they don’t
Blood tests to show your risk of miscarriage have become more common. The tests show if you have a condition called “thrombophilia.” This condition can increase blood clots. It may increase the risk of a miscarriage or other problems during pregnancy.
There are many different tests for thrombophilia. Doctors often order the tests for pregnant women who have had problems—such as miscarriage, a sharp rise in blood pressure (pre-eclampsia), or a baby that did not develop normally.
But often, tests are not needed. Even if you have had a pregnancy problem, you may not need any of these tests. Here’s why:
The test results are not always useful.
Usually, the test results do not help you and your doctor make decisions about your care.
For example, some blood tests look for certain genes. The genes can increase the risk of blood clots. But the genes do not increase your risk of miscarriage or other problems in pregnancy. Often, thrombophilia is mild and does not cause any problems. Many women who have it go on to give birth to healthy babies.
The tests can lead to unnecessary treatments and risks.
If the test shows that you have thrombophilia, your doctor may want you to take a drug called heparin during your pregnancy. This drug is injected and helps prevent blood clots.
But it is not clear that this drug lowers the risk of miscarriage or other problems. Also, the injections can cause side effects, such as heavy bleeding and allergic reactions.
The tests can be a waste of money.
The blood tests can cost $1,000 or more. Some health plans don’t pay for them. And you may also waste a lot of money on unneeded treatments. Heparin, for example, can cost hundreds of dollars, too.
Most people don’t need the tests.
You do not need to get tested just because you’ve had a miscarriage or pregnancy complication in the past. There are more effective ways to reduce your risks.
Consider a thrombophilia test if:
- You have had a blood clot in a vein deep in the body (a deep vein thrombosis).
- You have had a clot that traveled to a lung for no known reason (a pulmonary embolism).
- You have had three or more miscarriages. In this case, you should consider being tested for a form of thrombophilia called “antiphospholipid syndrome.” This syndrome increases the risks of miscarriage, poor growth of the fetus, and pre-eclampsia. This syndrome can be treated with aspirin and heparin. In this case, the test and treatment have more benefits than risks.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2018 Consumer Reports. Developed in cooperation with the Society for Maternal-Fetal Medicine.
Bleeding during pregnancy When to see a doctor
It’s important to report any vaginal bleeding during pregnancy to your health care provider. Be prepared to describe how much blood you passed, what it looked like, and whether it included any clots or tissue.
During the first trimester (weeks one through 12):
- Tell your health care provider at your next prenatal visit if you have spotting or light vaginal bleeding that goes away within a day
- Contact your health care provider within 24 hours if you have any amount of vaginal bleeding that lasts longer than a day
- Contact your health care provider immediately if you have moderate to heavy vaginal bleeding, pass tissue from your vagina, or experience any amount of vaginal bleeding accompanied by abdominal pain, cramping, fever or chills
- Inform your health care provider if your blood type is Rh negative and you experience bleeding because you might need a medication that prevents your body from making antibodies that may be harmful to your future pregnancies
During the second trimester (weeks 13 through 24):
- Contact your health care provider the same day if you have light vaginal bleeding that goes away within a few hours
- Contact your health care provider immediately if you have any amount of vaginal bleeding that lasts longer than a few hours or is accompanied by abdominal pain, cramping, fever, chills or contractions
During the third trimester (weeks 25 through 40):
- Contact your health care provider immediately if you have any amount of vaginal bleeding or vaginal bleeding accompanied by abdominal pain
In the final weeks of pregnancy, remember that vaginal discharge that is pink or bloody might be a sign of impending labor. Contact your health care provider and confirm that what you are experiencing is indeed bloody show. Occasionally, it might be a sign of a pregnancy complication.
Jan. 22, 2020
- Norwitz ER, et al. Overview of the etiology and evaluation of vaginal bleeding in pregnant women. https://www.uptodate.com/contents/search. Accessed Nov. 14, 2019.
- Frequently asked questions. Pregnancy FAQ038. Bleeding during pregnancy. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq038.pdf?dmc=1&ts=20131107T1529588773. Accessed Nov. 14, 2019.
- Gabbe SG, et al. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2017. http://www.clinicalkey.com. Accessed Nov. 14, 2019.
- Chestnut DH, et al. Antepartum and postpartum hemorrhage. In: Chestnut’s Obstetric Anesthesia: Principles and Practice. 6th ed. Elsevier; 2020. http://www.clinicalkey.com. Accessed Nov. 14, 2019.
- Ferri FF. Molar pregnancy. In: Ferri’s Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 14, 2019.
- AskMayoExpert. Vaginal bleeding in the first trimester of pregnancy. Mayo Clinic; 2017.
- Wick MJ, ed. Symptoms guide. In: Mayo Clinic Guide to a Healthy Pregnancy. 2nd ed. Mayo Clinic; 2018.
- Butler Tobah Y (expert opinion). Mayo Clinic. Nov. 19, 2019
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Hemostasis during pregnancy is the norm, causes of violations
Normal pregnancy is accompanied by many changes aimed at ensuring the growth of the fetus. Changes also occur in the hemostasis system, while any deviations from the norm can be fraught with serious complications for both the mother and the child.
Changes in hemostasis during pregnancy
Changes in the hemostasis system in pregnant women are primarily associated with the emergence of a new circle of blood circulation – the uteroplacental one, which is necessary for the full supply of the fetus with oxygen and nutrients.
Changes in platelet count
In most cases, the content of platelets in the blood remains unchanged, however, in about 10% of women 1 , the concentration of these cells decreases – thrombocytopenia develops. It is usually associated with three states 2 :
- Hypertensive disorders, e.g. preeclampsia
- Gestational thrombocytopenia due to an increase in total blood volume
- Idiopathic (that is, developed for unexplained reasons) thrombocytopenic purpura.
Changes in the blood coagulation system
During pregnancy, significant changes occur in the hemostasis system, aimed at increasing the total activity of blood coagulation factors 3 . This is due to the fact that in the walls of the vessels that provide placental blood flow and, consequently, the vital activity of the fetus, there is no layer that prevents blood clotting inside the vessels. Fibrin threads regularly accumulate on the tissues of the placenta. So that they do not disturb the blood flow, it is necessary to constantly dissolve them, and for this the fibrinolytic system of the blood must be much more active than before conception.That is why the indicators reflecting the level of coagulation and fibrinolysis in healthy women who are expecting a baby are increased.
An increase in the coagulation potential is associated with a significant increase in the level of almost all blood coagulation factors, except for factors XI and XIII. In addition, the concentration of fibrinogen in plasma also increases.
Changes in hemostasis indices in pregnant women, general picture 1 :
- Plasma fibrinogen levels at the end of pregnancy may be higher than normal
- Factor VII content can increase several times
- The level of von Willibrand factor and factor VIII increases in late periods, when the activity of the coagulation system is more than doubled compared to the non-pregnant state
- Factor IX level increases slightly
- Factor XI level decreases slightly
- Factor XIII after an initial increase gradually decreases, reaching half the normal value for non-pregnant women
- The level of factors II and V does not change significantly
- Antithrombin often stays the same
- Protein C activity, presumably unchanged
- Protein C antigens tend to increase in the second trimester, however they remain within the normal range
- Total and free protein S decrease with increasing gestational age.
- Fibrinolytic activity decreases during pregnancy, remaining low in labor and in the postpartum period.
Of the important changes occurring in the hemostasis system in healthy women, it is necessary to note an increase in the concentration of D-dimer with an increase in the duration of pregnancy.
Thus, during pregnancy, physiological changes in the hemostatic system towards hypercoagulation are observed.
What laboratory parameters allow assessing the hemostasis system during pregnancy?
Most experts agree that the assessment of hemostasis must be carried out at different stages of pregnancy, starting from the moment of the initial examination.
To assess hemostasis, the level of several indicators is examined, each of which plays an important role in the functioning of the blood coagulation system.
The minimum examination of hemostasis includes the determination of the following parameters:
APTT – activated partial thromboplastin time. In some laboratories, this indicator is called APTT (activated partial thromboplastin time). APTT is the time required for the clotting of blood plasma after adding calcium, phospholipids and kaolin to it.
Shortening APTT indicates an acceleration of clotting and an increase in the likelihood of developing disseminated intravascular coagulation, as well as the possible presence of antiphospholipid syndrome or deficiency of coagulation factors.
Elongation APTT is characteristic of insufficient blood coagulation capacity and the risk of bleeding during childbirth or in the postpartum period.
Prothrombin time is an indicator of hemostasis, showing how long it takes for blood plasma to coagulate when calcium and tissue factor are added to it.Reflects the outer folding path.
Shortening prothrombin time is characteristic of disseminated intravascular coagulation.
Elongation may indicate an increase in the likelihood of postpartum hemorrhage due to a deficiency of a number of coagulation factors, liver disease, vitamin K deficiency and some other conditions and diseases.
In different laboratories, prothrombin time can be represented in three ways:
- Prothrombin Index, which is the ratio of a given prothrombin time result to that of normal blood plasma.
- Prothrombin according to Quick, which reflects the level of various coagulation factors in percent.
- INR, or INR – International Normalized Ratio, an indicator reflecting the comparison of blood coagulation of the test sample with coagulation of standardized blood in the norm.
Fibrinogen is a protein from which fibrin is formed, which is involved in the formation of a red blood clot.
A decrease in the content of this protein is observed in DIC syndrome, liver pathology.
An increase in the level of fibrinogen during pregnancy is a variant of the norm. You should also determine the number of platelets in the blood to exclude thrombocytopathies.
D-dimer is a fibrin breakdown product, a small protein fragment present in the blood after the destruction of a blood clot. That is, its increase indicates an active process of thrombus formation. At the same time, this indicator increases physiologically during pregnancy.
However, measuring the D-dimer level is not enough to confirm that a patient has developed thrombosis.To confirm the diagnosis, additional instrumental research methods (ultrasound duplex angioscanning, CT angiography) should be performed and the presence of clinical signs of the disease should be assessed.
If antiphospholipid syndrome (APS) is suspected, doctors may determine the presence of lupus anticoagulant, anticardiolipin antibodies, and antibodies to β2-glycoprotein 1 .
Also, in some cases, doctors may assume the presence of hereditary thrombophilia (a genetically determined ability of the body to form blood clots).You can find more detailed information about hereditary thrombophilia in the corresponding section.
- Prisco D., Ciuti G., Falciani M. Hemostatic changes in normal pregnancy // Hematol. Meet.Reports (formerly Haematol. Reports). 2009; 1 (10): 1-5.
- Katz D., Beilin Y. Disorders of coagulation in pregnancy // Br. J. Anaesth. / ed. Hemmings H.C. Oxford University Press. 2015; 115 (suppl 2): ii75-ii88.
- Ivanov A.V. Violation of the hemostasis system during pregnancy: clinical and diagnostic aspects // Laboratory medicine – 2014. – T. 4. – No. 11. – P. 60–63.
Blood clotting during pregnancy
The blood coagulation system is one of the most difficult regulated systems in our body. The processes of thrombus formation are in a certain equilibrium with the processes of fibrinolysis. If this balance is disturbed, pathological phenomena can be observed – hypercoagulability or, on the contrary, a tendency to bleeding.Of course, this is always facilitated by certain factors, one of which is the period of pregnancy.
During pregnancy, under the influence of various influences, most of the normal processes in the body change. The most famous is the fact of a decrease in immunity, which is considered as a protective reaction of the body. After all, the fetus in the early stages can be perceived as a foreign protein, in this case, the insufficient work of the immune system is only for the good, since there is no struggle of the body against the baby.But not everyone knows about this feature and in some cases they try by any means to influence the state of immunity in order to avoid frequent viral diseases, exacerbation of existing chronic infections.
Similar changes occur with the blood coagulation system. During pregnancy, increased thrombus formation normally occurs. This can be explained by the preparation of the body for the subsequent possible blood loss during childbirth. Also, the properties of blood during pregnancy change due to an increasing load – blood flow and sufficient nutrition are required towards the placenta, which is abundantly supplied with blood.The developing systems and organs of the fetus also affect the characteristics of blood clotting. If such changes are insignificant and fit into the norms for pregnant women, then the pathology of hemostasis is excluded. But in cases where there are pronounced disorders, especially accompanied by a clinical picture, it is important to diagnose this condition in time and resolve the issue of the need for drug correction.
One of the indicators that pay special attention to during pregnancy is D-dimer .D-dimer is a breakdown product of a formed blood clot, a thrombus. The more pronounced thrombus formation, the more D-dimers are formed from thrombi. According to their level in the blood, hypercoagulability can be assumed, that is, increased coagulability, thrombus formation.
During pregnancy, the D-dimer is normally slightly elevated . Please note that laboratories always provide reference values for trimesters, but only the attending physician can accurately diagnose pathological coagulation, taking into account the complaints, the clinical picture.First of all, the obstetric and gynecological history is taken into account. So, in case of previously unsuccessful pregnancies that ended in interruption, loss of the fetus, if an increased D-dimer is found, a hematologist’s consultation is indicated to resolve the issue of prescribing anticoagulants. But if an increase in the D-dimer is noted once, while there are no signs of thrombosis, the patient’s history is unremarkable, doctors usually choose an observational tactic, although a few years ago even insignificant increases in the D-dimer forced specialists to include heparins in therapy.Now the clinical guidelines are drawn up in such a way that the approach to the study of blood properties is extremely complex and is not limited to the assessment of D-dimer. Be sure to take into account the general coagulogram, the presence of varicose vessels, a history of thrombosis, the presence of a syndrome of recurrent miscarriage.
In women with 2 or more pregnancy losses, an in-depth study of blood properties is shown already at the planning stage. It should be noted that against the background of the existing pathological conditions of the blood, conception is quite possible, but further progression of pregnancy without proper correction can be significantly difficult and even impossible.
Hematologist during pregnancy
A pregnant woman should be monitored not only by a gynecologist, but also by other narrow specialists, including a hematologist. This is due to the fact that during pregnancy, changes occur in the body aimed at ensuring the nutrition of the fetus and labor. First of all, the content of red blood cells – erythrocytes – is constantly increasing in the blood. The ovaries, immediately after conception, begin to produce large amounts of the hormone progesterone. It promotes increased production of another hormone by the kidneys – erythropoietin, which stimulates an increase in the volume of red blood cells.
This process is accompanied by an increase in the amount of oxygen that can bind the blood when it is fully saturated, and meets the ever-increasing needs of the mother and fetus. This can lead to a decrease in the level of hemoglobin and red blood cells, which is a pathology of pregnancy. Thus, the pregnant woman develops anemia or anemia.
During the study, an increased number of white blood cells – leukocytes – can be detected in the blood of a pregnant woman.Also, in the early stages of pregnancy, blood clotting increases. There may be an increase in the amount of fibrinogen protein dissolved in the blood, which becomes maximum during the last two months of pregnancy.
Starting from the sixth month of pregnancy, the female body reacts to pregnancy with the following changes:
the time it takes for a blood clot to form under the influence of calcium salts increases;
the rate of formation of a fibrin clot is significantly increased under the influence of heparin;
the rate of clot formation and serum release from the clot is significantly increased;
the body’s ability to dissolve clots decreases.
They are necessary so that in the event of blood loss during childbirth, the body can cope with it. A change in the composition of the blood may well have a negative effect on the baby. So, for example, with anemia of a pregnant woman, the fetus does not receive the required amount of oxygen. If the blood tests reveal any deviations from normal values, you should immediately consult a hematologist. Only he can prescribe, if necessary, medications that will contribute to the correct development of the fetus and the normal passage of childbirth.
Plasmapheresis during pregnancy can be performed in the clinic of the Belarusian State Medical University
Recently, the method of blood purification – plasmapheresis – has been increasingly used. It is used for many diseases, for the treatment of which it is effective to remove various harmful substances from the blood.
What is plasmapheresis for?
There are many elements in human blood. These are blood cells, and antibodies to various diseases, and autoimmune complexes, and toxins, as well as bacteria and viruses in the presence of infectious diseases.Some of them, when collected in large quantities, are the cause of diseases such as chronic infections, intoxication, allergies, and systemic skin diseases.
All of them are in the liquid part of the blood – plasma, and they can be removed from the body using plasmapheresis. In addition to cleansing, plasmapheresis improves other blood properties – coagulability, hemodynamics, and during pregnancy – uteroplacental blood flow. Thus, plasmapheresis improves blood circulation and the functioning of all organs, cleanses and rejuvenates the body.
During pregnancy, plasmapheresis is most often prescribed for the treatment and prevention of chronic infections and autoimmune diseases (mainly Rh-conflict), as well as placental insufficiency
How is plasmapheresis performed?
The basis of the plasmapheresis method is the mechanical removal of blood plasma together with harmful substances contained in it. This means that blood is taken from the vein, cellular elements are separated from the plasma and returned to the vein, replacing the plasma with sterile solutions.There are two methods for purifying blood. In gravity, blood is taken into a plastic bag and processed in a centrifuge. After that, the separated plasma is removed from the bag and the blood is diluted with a solution. The filtration method involves passing blood through a filter that allows plasma to pass through and retains the cell mass. Usually, two to ten sessions are prescribed at intervals of several days.
Disadvantages of plasmapheresis
During a session, 20% of harmful substances are removed from the blood, therefore plasmapheresis is not always effective in case of a severe form of the disease.It can be optimally combined with other treatment methods.
Another disadvantage of plasmapheresis is that, together with the plasma, the substances necessary for the body are removed – immunoglobulins, prothrombin, fibrinogen and others. Therefore, plasmapheresis is contraindicated in cases of low blood levels of proteins (hypoproteinemia) and coagulation factors. Studies have not revealed a noticeable decrease in immunity after plasmapheresis.
Plasmapheresis is recommended to cleanse the body in preparation for pregnancy, especially for women who smoke.It is also indicated for the prevention of exacerbation of allergic diseases during pregnancy in allergy sufferers, and is especially useful for infections dangerous for the unborn child – herpes, cytomegalovirus, toxoplasmosis, chlamydia.
There are contraindications, before the plasmapheresis procedure, a consultation with a specialist from the Department of Gravitational Blood Surgery of the BSMU Ufa clinic is required.
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Discounts and bonuses of the medical center “Garant Clinic” , almost universal self-isolation.But life goes on. Every day a new person comes to our world. Millions of pregnant women. A child born into a pandemic. Women on demolition … Are they at particular risk? The columnist for “RG” talks about this with the chief obstetrician-gynecologist of the Ministry of Health of the Russian Federation, academician of the Russian Academy of Sciences Leila Adamyan.
Leila Vladimirovna, first of all I want to congratulate you on a wonderful, wonderful event – you became a great-grandmother for the first time: your grandson Eduard had a son.
Leila Adamyan: The boy is a miracle! This is such happiness for our entire big family.Dear pregnant women! God protects you. There are few pregnant women in the world who are seriously ill with coronavirus infection. True, if they do not suffer from other concomitant diseases. And there are very few cases when mothers with a new virus give birth to children infected with this virus.
Are there such statistics?
Leila Adamyan: General statistics in the world fluctuate. But I can say: in Moscow and specifically in Russia today, from the moment we began to investigate this whole case, only 54 cases of pregnant women in Moscow infected with the virus are being monitored.They are at different times – both early and not early. Of these, 11 have given birth and 34 are in a state of pregnancy. None of our pregnant women, both those who have given birth, and now during pregnancy, are neither on mechanical ventilation nor on any support. That is, predominantly coronavirus infection proceeds more or less calmly … There are no specific regulations around the world on the management of pregnancy with coronavirus infection (COVID-19).
No, because there are no specific drugs specific to the coronavirus.There are no large-scale studies (statistical data) on this issue due to the limited number of patients. As for the figures for Russia: about 70 pregnant women suffer from COVID-19.
Recently, temporary Methodological Recommendations for the management of coronavirus and infection in general were released, which cover all aspects of the disease.
Leyla Adamyan: A special chapter is devoted to children and pregnant women. On the basis of our Scientific Medical Research Center for Obstetrics and Gynecology named after Kulakov, the Federal Remote Consultative Center for Anesthesiology and Reanimatology for Pregnant Women has been created on the diagnosis and treatment of the new coronavirus infection COVID-19 and pneumonia – FDRKTs.
Is he close to the people? Can he help a specific person, be it a pregnant woman or a woman who has already given birth? Or the one who is planning a pregnancy, or the one who has overtaken a disease unrelated to the virus?
Leyla Adamyan: The main functions of the center: conducting telemedicine consultations for pregnant women, women in labor with the new coronavirus infection COVID-19 and (or) pneumonia, problems of respiratory failure. FDRKTs works around the clock.
Don’t read unverified news, follow all hygiene measures and be positive.The placenta and the mother’s health reliably protect the unborn child from the virus.
In the high-risk group, those pregnant women who have various extragenital diseases. Especially in the second half of pregnancy. Such as cardiovascular, respiratory diseases (pneumonia, bronchial asthma), diabetes, arterial hypertension, chronic inflammatory processes. These diseases, along with disorders of the immune status, hemostasis (blood clotting), the presence of malignant tumors during pregnancy, contribute to an increase in the overall load on the body and especially an increase in the volume of circulating blood, a decrease in respiratory rates and the development of various complications.
Risk factor for complications during pregnancy – aggravated obstetric history. So, preeclampsia, increased blood pressure, bleeding, blood clotting disorders, premature birth, miscarriage, various surgical interventions, and so on during a past pregnancy are also risk factors. These pregnant women are at risk and require special attention.
At what stage of pregnancy is coronavirus infection more dangerous?
Leyla Adamyan: More dangerous in the second and third trimester, taking into account the loads on different systems of the body.In no case should we forget about the risk factors of pregnancy itself. In order not to increase the percentage of maternal or infant mortality, one should not forget about the period when the patient should be screened. All pregnant women, regardless of the coronavirus, must undergo examinations within the timeframes clearly established by the pregnancy management protocol. Timely take tests, conduct an ultrasound scan, consult a doctor. Not missing obstetric screening deadlines is a guarantee of reducing obstetric and neonatal complications.
Of course, there may be restrictions due to coronavirus infection. But with the correct organization of the rest regime, physical activity and lifestyle (social distancing and adherence to hygiene and protection methods), these difficulties can be overcome. Hopefully the restrictions won’t last long.
And the fruit itself?
Leila Adamyan: The fetus is not a direct target for coronavirus infection. The virus has no proven teratogenic effect on the fetus. The placental barrier is a really good barrier for the fetus.As a rule, babies are born healthy. Much, of course, depends on the mother’s condition and the severity of the coronavirus infection. Labor is usually easy. That is, children, as a rule, do not suffer, they are born without signs of illness. The most important thing is to isolate them in time. Understanding the general anxiety and tension from everything that happens in the world, I want to say: remember that stress is the main danger of a successful pregnancy. Don’t read unverified news, practice good hygiene and be positive.The placenta and maternal health reliably protect the fetus from the virus.
Does coronavirus infection affect the reproductive functions of the body?
Leyla Adamyan: Every day I receive information from all the world’s medical communities and from my colleagues – the world’s leading gynecologists. There is not a single document and statistical data on the influence of the infection itself on reproduction. And this is natural. Coronavirus infection has been in the human population for only three months.
What should be done for those who are now preparing for the IVF procedure?
Leyla Adamyan: You shouldn’t start it at the moment. But, if the IVF process has already started, stimulation is carried out, there is already hormonal control, then it is better to complete the cycle. But not to carry out the transfer of the embryo, but to subject this embryo to cryopreservation. And it is possible to carry out the transfer in the future with pre-implantation diagnostics. Coronavirus infection is a temporary story, and we need to think about the future and about reproductive health first.And you don’t need to be afraid of anything, you just need to defend yourself well. Dear women, take care of yourself and your pregnancy. These are the words I would say to everyone every day.
I also want to hope that this pandemic will set accents and priorities: medicine is the first link in the defense of the Fatherland. We should not spare funds either for the organization of health care, or for new technologies, or on doctors, on whom our life ultimately depends.
90,000 Heavy burden: risks of COVID-19 for pregnant women turned out to be stronger than expected | Articles
Pregnancy makes the female body more vulnerable to severe COVID-19 .This is evidenced by new data obtained by scientists. According to statistics published by the Centers for Disease Control and Prevention (CDC), expectant mothers are 50% more likely to be admitted to intensive care units (ICU) than other patients. In addition, women in the position are 70% more likely to require mechanical ventilation , although they are less likely to die. In the process of waiting for a child, a double load falls on the body: the cardiovascular system and respiratory organs work in a mode of increased intensity, Russian experts explain.Also at a later date in pregnant women, the lung volume decreases and blood clotting increases, which in a situation with coronavirus can lead to increased thrombus formation . Another danger lies in antiviral drugs – some of which can cause fetal abnormalities .
At special risk
The world’s leading scientific journal Science published an article that the risks of coronavirus in pregnant women have still been underestimated: expecting a baby seems to make the female body more vulnerable to severe COVID-19.As the text says, the indicative data was released by the US Centers for Disease Control and Prevention at the end of June . Among 91,412 women of reproductive age with a confirmed diagnosis, 8207 were enrolled who were 50% more likely to be admitted to intensive care units than their non-pregnant peers . They also required mechanical ventilation 70% more often, although they were less likely to die.
No less important information has been published by the Swedish Public Health Agency.The researchers found that women who are pregnant or have just given birth with COVID-19 are almost six times more likely to be admitted to intensive care units than their peers. future mothers, but women who have already given birth. – Izvestia).
Photo: Global Look Press / Davide Fracassi
“It is well known that pregnancy increases the risk of serious illness from respiratory viral infections.During the 2009 h2N1 flu epidemic, pregnant women accounted for 5% of US deaths, although they made up about 1% of the population. One study found that pregnant women with severe acute respiratory syndrome (SARS), caused by a virus that is a close relative of SARS-CoV-2, were significantly more likely to be hospitalized and died more often than , ”the authors of the article argue.
Health for two
Viral infections can have more serious consequences in pregnant women in part because “the entire immune system is designed not to elicit any kind of contraceptive immune response.The mother must compromise her own immune defenses to keep the baby healthy , ”Science quotes Yale School of Medicine immunologist Akiko Iwasaki.
In addition, SARS-CoV-2 affects the lungs and cardiovascular system, which are already under stress during pregnancy .
– As the uterus grows, less and less space is left for the lungs. This is why pregnant women often experience shortness of breath. And it affects respiratory function, ” said Denise Jameison, head of the Department of Obstetrics and Gynecology at Emory University School of Medicine.
Photo: Global Look Press
Russian specialists agree with their foreign colleagues. Although pregnancy is considered a physiologically normal phenomenon, a woman’s body bears a double burden, Galina Reva, a professor at the Department of Fundamental Medicine at the School of Biomedicine at the Far Eastern Federal University, a university participating in the 5-100 Education Competitiveness Project, said in a conversation with Izvestia.
– The kidneys and liver, the cardiovascular system and the respiratory system operate at increased intensity.If we add to this the additional load that the body experiences during the fight against coronavirus, we get a high probability that the mother who gave birth will end up in intensive care unit , the specialist emphasized.
Moreover, the process of childbirth itself requires high energy costs, so any respiratory pathologies, including those associated with COVID-19 , affect it. For this reason, women in labor are more likely to require artificial ventilation, says Galina Reva.
– The blood of pregnant women has an increased tendency to clot, which is believed to be associated with the need to quickly stop bleeding after childbirth. But a similar effect, as stated in the above article, can be caused by the coronavirus itself, ”Elena Belova, an infectious disease doctor, employee of the scientific and clinical department of the Moscow AIDS Center and the International Training and Methodological Center of Human Virology at the RUDN Medical Institute, told Izvestia.
Consequently, pregnant women have an increased risk of thrombosis, which is considered one of the leading causes of death from COVID-19 .
The Ministry of Health warned
The fact that this category of the population may have higher risks is also said in the second edition of the guidelines of the Ministry of Health of the Russian Federation for the treatment of pregnant women. As one of the examples, experts cite an Iranian study.
“ In Iran, out of nine pregnant women with severe COVID-19 at the time of publication, seven have died, one remains in serious condition and is on mechanical ventilation, and only one patient recovered after a long hospitalization .Compared to other family members (33 people), in each specific case, the outcomes in pregnant women were more severe, ”the document says.
Photo: Izvestia / Konstantin Kokoshkin
The recommendations also indicate that in pregnant women with COVID-19, a sudden development of a critical condition is possible against the background of a stable course of the disease. And the group of the highest risk is expectant mothers with somatic diseases (chronic lung diseases, including bronchial asthma of moderate and severe severity), diseases of the cardiovascular system, diabetes mellitus, immunosuppression (including against the background of cancer treatment) , obesity (body mass index> 40), chronic kidney disease and liver disease.
At the same time, it is noted in the document: so far everything related to the course of coronavirus infection in pregnant women has been studied very little and such studies must be continued.
Test for the body
Coronavirus infection is a test for the human body and, of course, does not increase the likelihood of a favorable pregnancy outcome for either the mother or the fetus, the deputy head of the laboratory for analysis of population health indicators and digitalization of healthcare emphasized in a conversation with Izvestia MIPT Stanislav Otstavnov.
Photo: Izvestia / Andrey Ershtrem
– The therapy of coronavirus infection can also make a significant negative contribution, the expert added.