Evaluation of thrombophilia screening in women with obstetrical complications: A "Real World" experience

Henrard, Séverine [UCL] Maréchal, Céline [UCL] Lambert, Catherine [UCL] Deneys, Véronique [UCL] Hermans, Cédric [UCL]

Introduction: Growing evidence suggests that thrombophilia is associated with adverse pregnancy outcomes. As a result, thrombophilia screening is increasingly requested for women with obstetrical complications. Methods: We evaluated the utilization of thrombophilia screening at a large academic tertiary centre requested by obstetricians for women with either early or late pregnancy complications. The indications, appropriateness and results of 199 thrombophilia screenings performed between July 2003 and June 2006 for adverse pregnancy outcomes were retrospectively examined. Results: Of the screenings, 89 were ordered for early miscarriages and 122 for late pregnancy complications (intra-uterine foetal death, intra-uterine growth retardation, abruptio placentae, preeclampsia and/or hellp syndrome). Only 77 patients reported at least three successive early foetal losses. In the whole population, 56 (28.1%) women were pregnant and 27 (13.6%) on oral contraception at time of referral. In many patients screening was requested before completion of the routine work-up. Despite these limitations, a thrombophilic abnormality was documented in 26% women referred for early recurrent miscarriages. In this subgroup, factor V Leiden was the most prevalent thrombophilia (n=8, 10.4%). For women with late complications, 19.7% had a thrombophilic trait. The subgroup referred for third trimester foetal loss showed the highest prevalence of positive screening (41.7%), mostly Factor V Leiden (n=10, 8.2%). Conclusions: In spite of the growing awareness of the negative impact of thrombophilia on pregnancy outcomes, screening is frequently ordered sub-optimally. When indicated, screening should preferably be performed in the absence of confounding clinical variables (pregnancy, oral contraception) for women with appropriate indications and after completion of the routine work-up.