A woman’s body undergoes many physiological changes during pregnancy. Pregnancy and childbirth, though very natural, can involve complications. During delivery, a woman loses a lot of blood. The body needs to react and repair itself at the earliest, to prevent unnecessary complications in the mother’s body. Coagulation disorder is one such condition that can cause serious consequences during and after childbirth.
Coagulation is the natural process where blood changes from a liquid form to a gel form and forms a blood clot. When the blood vessel underneath the skin surface is ruptured or injured, the blood from it starts coming out. The body immediately reacts and starts the coagulation process to prevent any further blood loss.
Blood coagulation is the body’s hemostasis process that prevents excess blood loss. It seals the hole or opening in the blood vessel. This blood clot stays until the tissue can repair itself.
Blood coagulation is very important to stop or prevent spontaneous bleeding. If the blood coagulation does not happen properly in time, it can lead to bruising, and uncontrolled bleeding – more commonly known as hemorrhage or thrombosis – a blood clot that can block the blood flow.
When this entire process of blood clotting is affected, it is known as a coagulation disorder. The different types of blood coagulation disorders are:
● Hemophilia – Clotting factor protein is low
● Von Willebrand disease – Low levels of clotting factor protein known as von Willebrand factor
● Clotting factor deficiencies – Deficiencies that can interfere with the clotting process
● Hypercoagulable states – Also known as thrombophilia, can be inherited or acquired. This condition increases the risk of blood clots and leads to serious health issues.
● Deep venous thrombosis – Blood clots form in deep veins causing pain, swelling, or discolourartion of the affected area. It is more common in the legs than in the hands, hips, or even the pelvic region.
During pregnancy or childbirth, even women with no health issues or history of coagulation disorders can develop coagulopathies. Acquired coagulopathies refers to the uncontrolled activation of the coagulation system. When activated, it can lead to DIC (Disseminated Intravascular Coagulation) and widespread intravascular coagulation. This can interfere with the body’s ability to stop bleeding as the coagulation factors can go below the required levels.
Some other issues that can lead to DIC are:
● Placental abruption – Placenta separates from the uterine wall before fetal birth.
● Amniotic fluid embolism – Amniotic fluid enters the mother’s bloodstream.
● PIH – Pregnancy Induced Hypertension
● Liver disease – A damaged liver can decrease coagulation factors in the blood.
● Platelet abnormalities – Platelet count and platelet function disorders can lower the platelet count leading to coagulation issues.
Coagulation disorders during pregnancy can affect the mother, the baby, or the pregnancy itself.
● Miscarriage
● Preeclampsia
● Severe hemorrhage after delivery
● Anesthesia-related risks
● Bleeding complications
● Intra Uterine Growth Restrictions
● Placental abruption
During pregnancy, a woman’s body undergoes many physiological changes. These changes can affect the coagulation and fibrinolytic systems. The coagulation system refers to the system that is responsible for the blood to clot and the fibrinolytic system refers to the system responsible for the breakdown of the blood clots and fibrin.
When these systems undergo a change during pregnancy, it can impact the mode of delivery too. A doctor will consider these factors before deciding how to deliver the baby with the least amount of risk to both mother and baby.
Coagulation disorders can prolong the bleeding time. So, when a woman bleeds during the delivery, be it through a vaginal delivery or a caesarean section, she will continue to bleed longer and keep losing blood as her body will take more time than usual to form blood clots. As a result, she will lose a lot of blood and can also suffer from haemorrhage.
The type of coagulation disorder a pregnant woman suffers from will also impact the anesthesia she is given during labour.
Coagulation disorder in pregnancy can be treated in the following ways:
● Medications – Blood thinners and anticoagulants can help increase the components in blood that are required for the healthy functioning of the coagulation system.
● Increase Platelet Count – Heparin injections, splenectomy or a high dose of immunoglobin given intravenously can help increase platelet count.
● Heparin – Heparin injections can help stop the blood clots from growing.
If a pregnant woman suffers from coagulation disorders, the doctor will suggest going for pre-pregnancy counseling. They will also prefer taking genetic testing for hemophilia. It is advisable to deliver the baby in a hospital with hemostasis expertise, a tertiary care center with paediatric hematology, and a NICU. DOcotrs should be prepared for emergency delivery in case of a severely affected infant,
Doctors will take a coagulation test before they take the mother in for delivery, if:
● She has a history of coagulation disorders
● Previous physical examination suggested coagulation disorder
● She is on anticoagulation or antiplatelet drugs
● She has an underlying health condition that could be altering or impacting her coagulation system.
You can reduce the risk of developing coagulation disorder in pregnancy by doing the following:
● Be aware of risk factors like a family history of coagulation disorder, and avoid risk factors like smoking, overweight, or an inactive lifestyle.
● Ensure you exercise regularly after getting the doctor’s approval.
● Follow a healthy and active lifestyle.
● Watch out for signs and symptoms and consult your doctor immediately if you experience any.
● Ensure you follow medications and health recommendations given by your gynaecologist.
Coagulation disorders during pregnancy can cause complications for both mother and baby. However, with advancements in science and technology, early detection of this disorder gives doctors time to prepare and come up with a delivery plan that will ensure safety for both mother and baby. If you notice any symptoms, ensure you get them checked, and don’t ignore them.
Coagulation disorder during pregnancy can cause intrauterine growth restriction for the fetus, cause the placenta to separate from the uterine wall before its time for labor, or lead to clotting disorder in the fetus.
When the doctor suspects coagulation issues, they will confirm the diagnosis through a combination of blood tests, physical tests, medical history review, and in some cases, imaging tests can also be taken.
The use of oral anticoagulants as a part of the anticoagulant therapy can increase the risk of developmental deformities and bleeding in fetus. Taking these anticoagulants in the first trimester can cause abnormalities in the formation of bones and facial features.
