What is the primary concern when using thrombolytics during pregnancy?

The primary concern when using thrombolytics during pregnancy is the increased risk of hemorrhage. Thrombolytics are medications designed to dissolve blood clots, and their primary action is to enhance fibrinolysis, the process that breaks down clots. While this is beneficial in treating conditions such as pulmonary embolism or myocardial infarction, it can lead to significant risks during pregnancy.

Pregnancy itself is known to cause changes in hemostasis, including an increase in clotting factors and a heightened risk for thrombosis. Introducing thrombolytics into this already delicate balance can override the body's natural coagulation processes, leading to excessive bleeding, particularly in sensitive areas such as the uterus and during delivery. This is especially critical as maternal hemorrhage can endanger both the mother and the fetus, necessitating careful consideration and risk assessment before administering such treatments.

The other concerns listed, such as infection, decreased clotting ability, and liver toxicity, while important in their own contexts, are not the primary risks associated with thrombolytics during pregnancy. The focus on hemorrhage highlights the critical nature of ensuring safety for both the mother and the developing baby when considering pharmaceutical interventions in this unique physiological state.