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作者：Alan E. Beer 翻译：金鑫 校正和修订：赵金霞 刘湘源
正常情况下，孕妇会保证胎儿的血液供给，抑制子宫和胎盘内血栓形成。但不少女性为易栓体质，易在怀孕时形成血栓，导致不能着床、流产、先兆子痫甚至不明原因的胎停。这要非常重视，需要积极治疗。 孕妇易栓体质，多数并非深静脉血栓形成，而是难以发现的微小血管血栓，尤其是连接母体与胎儿血管中的血栓。 怀孕妇女本身就是高凝状态，易形成血栓（防止母体分娩大出血死亡）。部分反复流产的女性在未怀孕时已处于高凝状态，或因体内基因突变导致易栓体质。 血循环不良是导致着床失败、早期流产和反复流产的首要因素，在不明原因的胎停患者中，约三分之二的女性是易栓体质。 有些女性完全不知道自己是易栓体质，也不知道这就是导致不孕和流产的原因。易栓体质，可能是先天遗传的，也可能是后天的，可能引起的问题包括：先兆子痫、胎死腹中、胎儿发育不良、羊水少、绒毛膜下出血或血肿、胎盘早剥、孕毒血症、HELLP综合征（溶血，肝酶增加和血小板减低，一种严重的先兆子痫）、子宫颈闭锁不全综合征、流产、妊娠高血压、早产、胎停。血栓对母体也有风险，可引起中风、动静脉血栓、深静脉血栓、自身免疫性血小板减少症、贫血、肺动脉栓塞、脑血栓、短暂性脑缺血发作等。 Blood Clotting Defects “In a normal pregnancy the mother’s ability to produce blood clots in the uterus and placenta is suppressed and the blood flows freely to the baby. Some mothers have a condition called thrombophilia where this clotting of the blood is not suppressed. This can cause many things to go wrong, including implantation failure, miscarriage, preeclampsia and even unexplained fetal death. Doctors are prone to counsel patients saying “it will be better next time” or “these complications occur for no good reason.” This is simply bad advice and poor judgment. Once diagnosed, this disorder can be treated and healthy, normally grown babies can be born.” Alan E. Beer, M.D. Mention the world thrombophilia and most people think of deep vein thrombosis (DVT) where a blood clot that forms in the leg travels to other parts of the body. Throbophilia (“thrombus” means clot and “philia” means a liking for) in the context of this Category 2 immune problem is associated with blood clotting, not in the veins of the body, but in the very smallest arteries and blood vessels- essentially the very lifelines that support the developing fetus. Pregnancy is a time when the blood is hypercoagulable or prothrombotic, meaning it has a tendency to clot (thought to be due to an evolutionary trait to stop women from dying in childbirth). A proportion of women with recurrent miscarriages are in a prothrombotic state even when they are not pregnant. Alternatively, they may carry genes that make it even more likely for blood clots to happen. Blood flow, or principally the lack of it, is one of the most important issues associated with chronic disease and is a prime consideration when addressing the problems of implantation failure, early pregnancy loss and recurrent miscarriage. Indeed, thrombophilia is found in approximately two thirds of women with unexplained pregnancy loss. Many women have absolutely no idea they have a blood clotting disorder and that it may be a major factor in their inability to conceive or successfully gestate a baby. Thrombophilia, both inherited and acquired, is very common and is associated with the following conditions: Preeclampsia Intrauterine fetal death Poor fetal growth Low amniotic fluid level Subchorionic hemorrhages or hematomas Placental abruption Toxemia of pregnancy HELLP syndrome (Hemolsis, Elevated Liver enzymes, and Low Platelets, a severe form. of preeclampsia) Premature labor (often called incompetent cervix syndrome) Miscarriage Pregnancy induced hypertension (high blood pressure of pregnancy) Preterm birth Stillbirth Risk to the mother may include: Stroke Thrombophlebitis (blood clots in the veins or the arteries that can occur during pregnancy) Deep vein thrombosis Autoimmune thrombocytopenia (low platelet count) Anemia (low red blood cell count) A blood clot in the lung (pulmonary embolism) A blood clot in the brain TIAs (transient ischemic attacks or “mini strokes”)
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