ABSTRACT
Thrombophilias have been implicated in complications related to ischemic placental
disease including recurrent pregnancy loss, intrauterine fetal demise, preeclampsia,
fetal growth restriction, placental abruption, and preterm delivery. Maternal screening
and treatment may lower the recurrence of these outcomes. Our objective was to estimate
if antenatal screening for thrombophilias with the intention to offer treatment among
women with a prior adverse pregnancy outcome (APO) is preferable to no screening.
A decision-analytical model was constructed for pregnant women with prior APO, comparing
screening for thrombophilia with intention to treat with no screening. Values obtained
from previously published studies include probability of positive test: 0.3 (0.1 to
0.6); good outcome with treatment: 0.9 (0.3 to 0.99); no thrombophilia, good outcome:
0.75 (0.5 to 0.9); test negative, thrombophilia positive: 0.05 (0.01 to 0.1); test
negative, thrombophilia positive, good outcome: 0.75 (0.5 to 0.9); thrombophilia/test
negative, good outcome: 0.98 (0.5 to 0.99). Sensitivity analyses were run over a wide
range of assumptions. Thrombophilia screening with intention to treat in women with
prior APO associated with ischemic placental disease is the strategy of choice compared
with no testing over a wide range of assumptions. Sensitivity analyses support this
to be robust. Women with poor pregnancy history related to placental ischemic disease
may benefit from thrombophilia screening and treatment in a subsequent pregnancy.
KEYWORDS
Decision analysis - screening - thrombophilia - adverse pregnancy outcome
REFERENCES
- 1
Barbour L A. ACOG Committee on Practice Bulletins--Obstetrics .
ACOG practice bulletin. Thrombembolism in pregnancy.
Int J Gynaecol Obstet.
2001;
75
203-212
- 2
Kujovich J L.
Thrombophilia and pregnancy complications.
Am J Obstet Gynecol.
2004;
191
412-424
- 3
Kovac M, Mitic G, Mikovic Z et al..
Thrombophilia in women with pregnancy-associated complications: fetal loss and pregnancy-related
venous thromboembolism.
Gynecol Obstet Invest.
2010;
69
233-238
- 4
Grandone E, Tomaiuolo M, Colaizzo D, Ames P R, Margaglione M.
Role of thrombophilia in adverse obstetric outcomes and their prevention using antithrombotic
therapy.
Semin Thromb Hemost.
2009;
35
630-643
- 5
Brenner B, Aharon A.
Thrombophilia and adverse pregnancy outcome.
Clin Perinatol.
2007;
34
527-541, v
- 6
Kupferminc M J, Eldor A, Steinman N et al..
Increased frequency of genetic thrombophilia in women with complications of pregnancy.
N Engl J Med.
1999;
340
9-13
- 7
Brenner B.
Inherited thrombophilia and pregnancy loss.
Thromb Haemost.
1999;
82
634-640
- 8
Sibai B M, How H Y, Stella C L.
Thrombophilia in pregnancy: whom to screen, when to treat.
OBG Management.
2007;
19
50-64
- 9
ACOG Committee on Practice Bulletins-Obstetrics .
ACOG Practice Bulletin #68: Antiphospholipid syndrome.
Obstet Gynecol.
2005;
106
(5 Pt 1)
1113-1121
- 10
Paidas M J, Ku D H, Arkel Y S.
Screening and management of inherited thrombophilias in the setting of adverse pregnancy
outcome.
Clin Perinatol.
2004;
31
783-805, vii
- 11
Martinelli I.
Pros and cons of thrombophilia testing: pros.
J Thromb Haemost.
2003;
1
410-411
- 12
Machin S J.
Pros and cons of thrombophilia testing: cons.
J Thromb Haemost.
2003;
1
412-413
- 13
American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics
.
Practice Bulletin No. 113: Inherited thrombophilias in pregnancy.
Obstet Gynecol.
2010;
116
212-222
- 14
Many A, Elad R, Yaron Y, Eldor A, Lessing J B, Kupferminc M J.
Third-trimester unexplained intrauterine fetal death is associated with inherited
thrombophilia.
Obstet Gynecol.
2002;
99
(5 Pt 1)
684-687
- 15
Kupferminc M J, Peri H, Zwang E, Yaron Y, Wolman I, Eldor A.
High prevalence of the prothrombin gene mutation in women with intrauterine growth
retardation, abruptio placentae and second trimester loss.
Acta Obstet Gynecol Scand.
2000;
79
(11)
963-967
- 16
Clark P, Twaddle S, Walker I D, Scott L, Greer I A.
Cost-effectiveness of screening for the factor V Leiden mutation in pregnant women.
Lancet.
2002;
359
1919-1920
- 17
Wu O, Robertson L, Twaddle S Thrombosis: Risk and Economic Assessment of Thrombophilia
Screening (TREATS) Study et al.
Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness
analysis.
Br J Haematol.
2005;
131
80-90
Padmashree Chaudhury WoodhamM.D.
Maternal-Fetal Medicine Fellow, Department of Obstetrics and Gynecology, University
of North Carolina
3010 Old Clinic Building, CB 7516, Chapel Hill, NC 27599
Email: pchaudh@gmail.com
