Wednesday, April 29, 2009

Suspect #1:Thrombophilia

Now, on to the main issue of what causes umbilical cord-related (stricture, torsion, hypercoiling) deaths to occur. Let's take a look at suspect #1: Thrombophilia.

What is thrombophilia?

Thrombophilia is a group of disorders (can be inherited or acquired) that cause an increased tendency to form blood clots. This can cause serious problems such as heart attacks, strokes, deep vein thrombosis, pulmonary embolism, and pregnancy loss or complications. Read more about it here:

Thrombophilia and why it's dangerous during pregnancy
Information on screening and treatment

There are many studies showing improved pregnancy outcomes in women with thrombophilia who are treated with the anticoagulant heparin. You can find a good study on it here, as well as many other good references.

There is very little research on the effect of heparin treatment in women with a history of pregnancy loss of unknown etiology. See here and here .

And I can find absolutely no research about heparin treatment in women with a history of umbilical-cord related losses. Also, I can find no correlation between thrombophilia and cord pathology. Articles about thrombophilia mention placental abruption, intrauterine growth retardation (IUGR), preeclampsia, and clots in the placenta, but never umbilical cord abnormalities. Articles about umbilical cord abnormalities never mention a correlation with thrombophilia. Why then is heparin prescribed for women with recurrent cord-related losses? My guess is that doctors and patients are desperate to do SOMETHING and in absence of any research to support or refute a thrombophilia connection, just figure heparin is worth a gamble.

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