مرجع دانلود پاورپوینت های درسی

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IN THE NAME OF GOD 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 however, women with bleeding disorders often do not achieve the same levels of clotting factors that other women do and, therefore, are still at an increased risk of bleeding complications.

Except :
Carriers of Hemophilia A
vWD type 1


Baseline factor VIII and von Willebrand factor levels should be checked at some stage early in the pregnancy, such as during the first consultation with an obstetrician and in the third trimester (ideally at around 34 weeks).

The level of vWF may not rise significantly during the first or even second trimester and therefore an early miscarriage may be accompanied by significant bleeding There is a profound increase in the risk of miscarriage and placental abruption resulting in fetal loss or preterm delivery in women with deficiencies of fibrinogen or factor XIII

Factor replacement is recommended and used to reduce the risk of miscarriage and fetal loss in these women
in women with other bleeding disorders is less clear the risk of:
miscarriage,
antepartum bleeding,
and adverse outcome

Also consider...