A case of catastrophic anti-phospholipid syndrome in pregnant woman with eclampsia

Abstract number: CD029

Makatsaria A., Bitsadze V. O., Hizroeva D. H., Dolgushina N. V.

Moscow Medical Academy, Russia

Patient Z., 24 years old, at term of 27–28 weeks of gestation was admitted to maternity house with severe gestosis. That pregnancy was the second, the first pregnancy was finished with spontaneous abortion. During examination of the patient fetal growth retardation and uterine blood circulation violations were revealed. In one hour after hospitalization eclampsia was developed and patient was delivered with cesarean section. The premature girl (weight 980 g, height 24 cm) was born. Blood loss composed 700 mL. After delivery the infusion therapy was started, including fresh frozen plasma, anti-aggregational agents, hypotensive and uterotonic drugs, corticosteroids and antibiotics. During the first day 3600 mL of fluid was infused (protein solutions – 1200 mL). Diuresis composed 2270 mL, proteinuria – 0.66 g L^-1. BP was 140/80 mm Hg. Next day, the symptoms of polyorganic failure were marked: respiratory failure, renal failure, intestinal paresis, consciousness violations. Due to polyorganic failure plasmapheresis and anti-coagulant therapy (fraxiparin 5600 IU day^-1) were conducted. During hemostasis research LA and APA IgG, IgM (STAGO) (148 GPL, MPL) were revealed, fibrinogen level reached 6.5 g L^-1, d-dimer level – 5.8 mg mL^-1. Infusion therapy and plasmapheresis were continued for 5 days, and only on the 5th day the patient came to senses, and hemodynamic indexes were stabilized. The state of patient was severe for several days, but the level of APA became lower – 87 GPL, MPL, LA was positive. Anti-coagulant therapy (fraxiparin), anti-hypertensive therapy (nifedipine) were continued. On the 20th day after delivery, the woman was discharged home in satisfactory state and was recommended to continue LMWH therapy for 3 months more.

Conclusion  

In pregnant women with gestoses examination of hemostasis and detection of APA is important for early onset of anti-thrombotic treatment and for prophylaxis of catastrophic form of APS. The earlier therapy is started the best result is received.