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Successful pregnancy requires trophoblast invasion into the maternal uterine spiral arteries converting them into large dilated vessels. Microthrombi are frequently found in the vessels of the placentas from women who have experienced pregnancy loss and placental infarction has been described in the placentas of some, but not all, women who have a pregnancy loss and who have thrombophilia. Published meta-analyses suggest that factor V Leiden, prothrombin G20210A, and protein S deficiency are associated with an increased risk of recurrent early pregnancy loss and non-recurrent late pregnancy loss. Women with a history of pregnancy loss merit increased surveillance in subsequent pregnancies and should be given folic acid during pregnancy. Despite the lack of evidence from randomized, double-blind, placebo-controlled trials, many clinicians are offering women with a history of pregnancy loss found to have a heritable thrombophilia self-administered prophylactic doses of low molecular weight heparin daily low dose aspirin in subsequent pregnancies.
The haematological malignancies comprise the acute and chronic leukaemias, myelodysplastic syndromes (MDS), chronic myeloproliferative disorders, Hodgkin's disease and non-Hodgkin's lymphomas and multiple myeloma. This chapter is devoted to the rare but problematic situation in which pregnancy occurs during therapy or, more commonly, the haematological disease is diagnosed as a result of simple blood investigations during an established pregnancy. The acute leukaemias reflect a situation of maturation arrest in blood cell development resulting in proliferation and accumulation of immature precursors of the myeloid or lymphoid lineages. Chronic myeloid leukaemia (CML) typically presents in the chronic phase but terminates in blast crisis, a condition very similar to, but more resistant to therapy than acute leukaemia. Appropriate management will depend on due consideration of the underlying disease, the disease status, its treatment, and the immediacy of the requirement for that treatment.
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