Background
The hypercoagulable state of pregnancy predisposes mother’s to venous thromboembolic (VTE) and is the most common cause of direct maternal death in Australia1. The risk is increased with inherited thrombophilia and is responsible for 50% of the diagnosis of VTE in pregnancy2.
Aim
Discuss a case of inherited thrombophilia diagnosed in pregnancy.
Discussion
38-year-old ‘B’ had a spontaneous vaginal delivery complicated by a 1.5L post-partum haemorrhage, manual removal of placenta and repair of second degree tear in theatre. She represented 4-days postpartum with swelling of the left thigh and ultrasound revealed an 8 cm posterior tibial vein thrombosis which was treated with 6-weeks of therapeutic clexane.
B is a non-smoker with no family history of VTE, However, her risk factors include a BMI of 30, immobility due to foot pain in the third trimester and a flight to Bali. Thrombophilia screening revealed heterozygous Factor V Leiden Mutation and Prothrombin G20210A mutation.
She was counselled on her life-long risk of developing VTE in high risk situations and in light of this, we recommended thromboprophylaxis in future pregnancies, thromboprophylaxis safe for breastfeeding and to avoid estrogen-containing contraception.
Despite the known high risk of VTE in pregnancy, there is inconsistent recommendations between the British and American Society for Hematology in regards to screening for thrombophilia in pregnancy3,4. The decision to treat screen and treat compound heterozygous FVLM/PTM is primarily based on clinical symptoms rather than the presence of thrombophilia5. Therefore each patient should be stratified based on risk and counselled accordingly.