Hemostasis in Pregnancy and Obstetric Surgery

Normal pregnancy is associated with changes in all aspects of hemostasis, including an increase in concentrations of most clotting factors, decreasing concentrations of some of the natural anticoagulants, and diminishing fibrinolytic activity. These changes help in maintaining placental function during pregnancy and meeting delivery’s hemostatic challenge, but may predispose to thrombosis and placental vascular complications. Pregnancy is considered to be a hypercoagulable state and encompasses all three elements of Virchow’s triad. Coagulation anomalies play an important role in adverse pregnancy outcome. Complications which occur during pregnancy are the cause of morbidity and mortality and necessitate medical intervention aimed at improving the fetal and maternal outcome. Thrombophilias have been investigated in relation to the following obstetric complications: recurrent and nonrecurrent miscarriages in early or late pregnancy, intrauterine death, intrauterine growth retardation, placental abruption, hypertensive disorders of pregnancy, and maternal or neonatal thrombosis.