Assessment-based management of placenta-mediated pregnancy complications: Pragmatism until a precision medicine approach evolves

The management of pregnant women with thrombophilia and a history of gestational vascular complications remains debatable. Treatment of the latter is often based on clinical outcome rather than disease mechanism. While the use of venous thromboembolism prophylaxis in pregnancy is recommended for those at increased risk, the ability of anticoagulant and/or antiplatelet agents to lower the risk of placenta-mediated complications in this clinical setting remains controversial. The available guidelines are inconsistent in some situations, which reflects the limited evidence base. This review critically discusses risk assessment models (RAMs) and management strategies of women with thrombophilia and pregnancy complications, using clinical vignettes. RAMs, taking into account obstetric and thrombotic history as well as thrombophilia status, could drive a precision medicine approach, based on disease mechanism, and guide individual therapeutic interventions in high-risk clinical settings.

Automated summary

The management of pregnant women with thrombophilia and gestational vascular complications is still a matter of debate, as current treatment is often based on clinical outcome rather than disease mechanism. Guidelines for venous thromboembolism prophylaxis in pregnancy are inconsistent due to limited evidence. This review critically discusses risk assessment models and management strategies for high-risk pregnant women, emphasizing the importance of an individualized precision medicine approach based on disease mechanism.