A case of pregnancy and labor management in patient with recurrent thromboses and multigenic thrombophilia

Abstract number: CD037

Makatsaria A., Bitsadze V. O., Dolgushina N. V.

Moscow Medical Academy, Russia

Patient K., 31 years old, had three pregnancies in anamnesis. The I pregnancy (1993) was complicated with severe gestosis and premature delivery at term of 32 weeks of gestation. The fetus was 950 g weight and 37 cm height, and died soon after labor. The II pregnancy (1998) was also complicated with severe gestosis and eclampsia. Caesarean section was performed at the term of 27 weeks of gestation. The fetus (weight 1000 g) died on the 2nd day. During the III pregnancy (2001) the patient was treated in our center. and presence of homozygous MTHFR C677T mutation and homocystein level of 36.4 mg L^-1 (normal = 10–15 mg L^-1) was revealed. The level of molecular markers of thrombophilia was also increased (TAT, D-dimer). Platelet aggregation function was high, LA-test was positive. Hemoglobin level was 93 g L^-1. The final diagnosis was: 10 weeks of gestation. Fetal loss syndrome. APS. Hyperhomocysteinemia. Anemia. Eclampsia in anamnesis. Treatment included LMWH (Fraxiparin) in the dose of 0.6 mL once a day subcutaneously, folic acid and vitamins of B-group. At the term of 13 weeks of gestation TAT, D-dimer and homocystein levels were considerably decreased till the normal figures. At 36 weeks of gestation, the signs of fetal hypoxia, proteinuria and TAT and D-dimer increase had appeared. At 37 weeks woman was delivered with caesarean section. Alive girl was born (weight 2700 g, height 47 cm). In 8 h after delivery the anticoagulant therapy was resumed and lasted for 10 days. Thus, the revealing of APS and MTHFR mutation at the early term of gestation and early start of pathogenically stipulated treatment in patient K helped to prevent the severe gestosis development and to prolong pregnancy till the term.