A life-threatening second trimester disseminated intravascular coagulopathy with protein s deficiency

Overcoming Recurrent Miscarriages in a 35-Year-Old Female With Thrombophilia

Thrombophilias, which include both hereditary and acquired illnesses, are a range of abnormalities that make persons more prone to developing thromboembolism. Thrombophilic conditions carry significant dangers during pregnancy, such as miscarriage in early pregnancy, intrauterine growth restriction, abruptio placenta, and preeclampsia. According to compiled statistics, an average of 15%-20% of pregnancies end in miscarriage. While the risk of miscarriage in a first pregnancy is 11%, this risk increases to between 13% and 17% in subsequent pregnancies, and after the third miscarriage, it reaches 38%. This research article presents a detailed case report that focuses on a patient who has experienced three previous failed pregnancies. The patient's genetic analysis indicates that she has two copies of a mutated version of the methylenetetrahydrofolate reductase (MTHFR) gene (Ala222Val) and a variation in the plasminogen activator inhibitor 1 (PAI-1) gene known as 4G/5G. In addition, an evaluation of immunological characteristics revealed increased amounts of natural killer (NK) cells with enhanced activity, along with the identification of embryotoxins in a blood test that suppress embryotoxicity in a blood test, assisted by DNA isolation and real-time polymerase chain reaction (PCR) DNA analysis.

Impact of fetal maceration grade on risk of maternal disseminated intravascular coagulation after intrauterine fetal death - A retrospective cohort study

Disseminated intravascular coagulation (DIC) is a life-threatening event that is the endpoint of a pathologically activated cascade leading to excessive consumption of platelets culminating in bleeding. Several diseases are known to be associated with DIC, some of which may also occur during pregnancy or the puerperium. One of the potential risk factors that have been considered as a potential trigger for DIC is the retention of a highly macerated fetus after intrauterine fetal death (IUFD). However, sparse evidence exists on its clinical implication on hemostasis parameters. In this retrospective single-center study, we investigated the role of fetal maceration grades 0-III on the risk of DIC in 91 women following IUFD between gestational weeks (+days) 22 + 0 and 41 + 6 between 2003 and 2017. We calculated the Erez DIC-score after consideration of maternal platelet count (PC), prothrombin time (PT) and fibrinogen (Fib) and correlated the findings with fetal maceration grade. Mean (±SD) age of women was 32.1 ± 6.7 years. Neither maternal hemostasis parameters (PC, PT, Fib), nor the Erez score showed a statistically significant difference between maceration grades 0-III with median values of 1 for all four grades (maceration grade I: range 0 to 27; I: 0 to 51; II: 0 to 52; III: 0 to 39). We therefore conclude, that the pathophysiology of DIC in women after singleton IUFD is unrelated to the degree of fetal maceration.

A Case of Life-threatening Obstetrical Hemorrhage Secondary to Placental Abruption at 17 Weeks of Gestation

A 40-year old woman, gravida 4, para 4, presented with sudden lower abdominal pain and severe vaginal bleeding at 17 weeks of gestation. Clinical symptoms and ultrasonographic finding revealed placental abruption. The volume of bleeding was heavy and led to disseminated intravascular coagulation and hypovolemic shock. We performed blood transfusion and therapy to treat the critical condition. However, the mother’s condition continued to worsen. Therefore, we performed a hysterotomy and aborted the pregnancy to save the mother. Since heavy bleeding caused by placental abruption leading to a life-threatening condition for a mother before the 20 weeks of gestation is very rare, the present case is an important case study.

Multifactorial thrombophilia in a pregnancy: a case report

Thrombophilias are inherited or acquired conditions that predispose individuals to thromboembolism. Thrombophilic disorders increase obstetric complications, such as early pregnancy loss, fetal growth retardation, placental abruption, and preeclampsia. Recurrent pregnancy loss affects 1% to 3% of women of reproductive age, and a large proportion of these losses remain unexplained. Thrombophilic defects were found in 49% to 65% of women with pregnancy complications compared with 18% to 22% of women with normal pregnancies, suggesting a 3- to 8-fold increase in risk. We report a case of a pregnant woman who had a history of recurrent pregnancy losses that was complicated with protein S deficiency, factor V Leiden mutation, methylene tetrahydrofolate reductase mutation, and antiphospholipid syndrome in her pregnancy.