Prediction and prevention of venous thrombosis in pregnancy

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dc.contributor.advisor Higgins, John R. en
dc.contributor.advisor Norris, Lucy en
dc.contributor.author Ismail, Siti Khadijah
dc.date.accessioned 2013-07-16T09:07:33Z
dc.date.issued 2013
dc.date.submitted 2013
dc.identifier.citation Ismail, S.K. 2013. Prediction and prevention of venous thrombosis in pregnancy. PhD Thesis, University College Cork. en
dc.identifier.endpage 242
dc.identifier.uri http://hdl.handle.net/10468/1176
dc.description.abstract Venous thromboembolism (VTE) remains the leading cause of maternal mortality. Reports identified further research is required in obese and women post caesarean section (CS). Risk factors for VTE during pregnancy are periodically absent indicating the need for a simple and effective screening tool for pregnancy. Perturbation of the uteroplacental haemostasis has been implicated in placenta mediated pregnancy complications. This thesis had 4 main aims: 1) To investigate anticoagulant effects following a fixed thromboprophylaxis dose in healthy women post elective CS. 2) To evaluate the calibrated automated thrombogram (CAT) assay as a potential predictive tool for thrombosis in pregnancy. 3) To compare the anticoagulant effects of fixed versus weight adjusted thromboprophylaxis dose in morbidly obese pregnant women. 4) To investigate the LMWH effects on human haemostatic gene and antigen expression in placentae and plasma from the uteroplacental , maternal and fetal circulation. Tissue factor pathway inhibitor (TFPI), thrombin antithrombin (TAT), CAT and anti-Xa levels were analysed. Real-time PCR and ELISA were used to quantify mRNA and protein expression of TFPI and TF in placental tissue. In women post CS, anti-Xa levels do not reflect the full anticoagulant effects of LMWH. LMWH thromboprophylaxis in this healthy cohort of patients appears to have a sustained effect in reducing excess thrombin production post elective CS. The results of this study suggest that predicting VTE in pregnant women using CAT assay is not possible at present time. The prothrombotic state in pregnant morbidly obese women was substantially attenuated by weight adjusted but not at fixed LMWH doses. LMWH may be effective in reducing in- vivo thrombin production in the uteroplacental circulation of thrombophilic women. All these results collectively suggest that at appropriate dosage, LMWH is effective in attenuating excess thrombin generation, in low risk pregnant women post caesarean section or moderate to high risk pregnant women who are morbidly obese or tested positive for thrombophilia. The results of the studies provided data to inform evidence-based practice to improve the outcome for pregnant women at risk of thrombosis. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2013, Siti Khadijah Ismail. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Venous thromboembolism en
dc.subject Pregnancy and haemostasis en
dc.subject Low molecular weight heparin en
dc.subject Uteroplacental haemostasis en
dc.subject Haemostasis in obese pregnancy en
dc.subject.lcsh Hemostasis en
dc.subject.lcsh Thromboembolism en
dc.subject.lcsh Thrombosis en
dc.subject.lcsh Heparin en
dc.subject.lcsh Blood coagulation disorders in pregnancy en
dc.subject.lcsh Blood diseases in pregnancy en
dc.title Prediction and prevention of venous thrombosis in pregnancy en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text available en
dc.description.version Accepted Version
dc.contributor.funder ANU Research Centre, College of Medicine and Health, University College Cork en
dc.description.status Not peer reviewed en
dc.internal.school Obstetrics and Gynaecology en
dc.check.reason This thesis is due for publication or the author is actively seeking to publish this material en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false *
dc.check.entireThesis Entire Thesis Restricted
dc.check.embargoformat Both hard copy thesis and e-thesis en
ucc.workflow.supervisor cora@ucc.ie *


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