حاملگی و زایمان در خانم های مبتلا به اختلالات خونریزی دهنده ( ppt )
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حاملگی و زایمان در خانم های مبتلا به اختلالات خونریزی دهنده
Preconception counselling
This is most important for women with severe bleeding disorders or those who could potentially carry a severely affected baby , such as carriers of hemophilia
It provides adequate information for women and their family about
- genetic implications of their disorder
- the available reproductive choices ,
- and options for prenatal diagnosis.
planning for pregnancy
establishing how and where the pregnancy can best be managed .
immunization against hepatitis A and B for those likely to require blood transfusion
general advice such as folic acid supplementation .
A DDAVP test dose can also be carried out to assess response .
the opportunity to speak with a pediatric hematologist regarding the care of a potentially affected child .
Antenatal management
Normal pregnancy is accompanied by
Increased concentrations of several coagulation factors including VIII , VWF , and a pronounced increase in fibrinogen
reduced fibrinolytic activity secondary to increased levels of plasminogen activator inhibitors, especially during the third trimester
All of these changes contribute to the hypercoagulable state of pregnancy and , in women with bleeding disorders , to improved hemostasis