Chapter 149 - Hematologic Changes in Pregnancy

Abstract

Hematologic conditions are often seen during pregnancy as part of normal physiology and as complications of varying severity. The primary physiologic, hematologic changes during pregnancy relate to the expansion of plasma volume, and the prothrombotic state develops as the pregnancy advances, which is thought to prepare the mother and fetus for eventual placental separation. Understanding the complex physiology of pregnancy and the interplay with hematology facilitates proper planning, anticipation, and discussion with the treating physicians as well as the patient. Preexisting hematologic conditions may affect pregnancy, and conversely, the effect of pregnancy on proceeding conditions should be considered. The evolving clinical picture as the pregnancy progresses must also be taken into account. Multidisciplinary planning and communication are essential, especially between the obstetrics and hematology teams. Common new onset hematologic conditions, such as anemia and thrombocytopenia, are seen for a variety of reasons during pregnancy and addressed in this chapter. The management of preceding congenital and acquired cytopenias will also be covered. Management of hematologic malignancies presents a particular challenge. Inherited and acquired bleeding disorders affect pregnant women, and coagulation parameters must be monitored during pregnancy and delivery, and attention paid to the use of spinal anesthesia. Venous thromboembolism (VTE) during pregnancy remains a high-morbidity high-risk situation that can be challenging. These hematologic problems in management are discussed in this chapter.