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coagulation problem in pregnancy

Do you have a burning question you just have to ask our Medical Board Experts about hypertensive pregnancies? Please email your question to expert@preeclampsia.org Keep in mind, however, that we won't be able to answer every question and our docs can't offer medical advice and won't be able to comment on specific medical cases.

coagulation problem in pregnancy

Postby expert@preeclampsia.org » Mon Jul 16, 2007 03:04 pm

I have recently discovered that I carry the PAI-1 4G/5G gene mutation, and understand that this can be a risk factor for preeclampsia, thrombosis, and fetal loss. Both my Ob/Gyn and my hematologist are unsure how to go forward with a pregnancy as this coagulation disorder is not widely studied.

In my first pregnancy, we induced at 38 weeks due to rising blood pressure and a couple of positive dipstick readings. I did not do a 24 hour urine sample, so I do not know if I met the diagnostic criteria for PE. My blood pressure returned to normal after the birth of my son, but 6 days later it spiked at 202/115 with no protein in the urine. I remained on antihypertensives until 4 months postpartum.

I am currently a healthy BMI, 31 years old, blood pressure is 110/70, and will be watched very closely by a OB/Gyn who sees a lot of hypertensive pregnancies. I am not currently pregnant, but would like to have one more child.

My question is, the age old -- what are my chances of getting PE again, and how would you manage my next pregnancy based on my history and this PAI-1 4G/5G mutation we've discovered? I've heard everything from, just watch closely, do low dose aspirin, and even daily Lovenox injections.

I would love an expert opinion on this matter since my local doctors are unsure how to proceed.

**Thank you so much for the service you provide to the women of the preeclampsia foundation. The information I have found here has made a huge impact on me and countless others.



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Re : coagulation problem in pregnancy

Postby expert@preeclampsia.org » Mon Jul 16, 2007 03:05 pm

I am not an expert on PAI-1 but it is my understanding that it is a polymorphism, therefore not rare. It is associated with preeclampsia (1.27x risk per a metaanalysis : Arch Gynecol Obstet 2006 273:322-4) and has also been reported associated with fetal loss. As far as I know we do not screen patients with preeclamsia for this and therefore the issue of treatment in future pregnancies does not come up.
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