A CLINICAL CASE OF A SUCCESSFUL TREATMENT OF FETAL GROWTH RESTRICTION IN A WOMAN WITH ANTIPHOSPHOLIPID SYNDROME AND SUBCHORIONIC HEMATOMA (CLINICAL ANALYSIS OF A PATIENT’S CARD)
DOI:
https://doi.org/10.11603/24116-4944.2024.1.14737Keywords:
subchorionic hematoma, antiphospholipid syndrome, pregnancyAbstract
The aim of the study – to describe the successful completion of a clinical case in a pregnant woman with the formation of a large subchorionic hematoma (SCH) in the second trimester of pregnancy and antiphospholipid syndrome (APS) using clinical instrumental and laboratory tests, as well as improving the algorithm for providing medical care.
Materials and Methods. The examination of the patient L., 28 years old, was carried out from the moment of the formation of a SCH measuring 115x30mm at the term gestation 17 weeks and 5 days. The clinical research involves general research methods; coagulogram test; express method of visual assessment of platelet aggregation; quantitative determination of soluble fibrin-monomer complexes (SFMCs); lupus anticoagulant tests (LA), cardiolipin antibodies and β2 glycoprotein in blood serum. Also, it involves the instrumental methods of examination – ultrasonography of pelvic organs; thromboelastography (TEG).
Results and Discussion. Thrombocytopenia of the unknown etiology, which was accompanied by an impaired platelet function, led to the increased consumption of thrombin – the main agonist of platelet function, the formation of a thrombophilia state, and, as a result, the occurrence of vaginal bleeding with the formation of SCH. Detection of LA, analyzed in the blood coagulation test, in the average titer, became the reason for prescribing low molecular weight heparin (LMWH) in prophylactic dosage.
Conclusions. The comprehensive approach in the diagnosing of disorders of the hemostasis system in pregnant women at second trimester who have a large SCH, and their examination for APS (when an increased coagulation potential is detected) – can contribute to a successful carrying full term pregnancy.
References
1. Nevhadovska, P.M., Chechuha, S.B., Nochvina, O.A., & Dzis, N.P. (2020). Clinical characteristics of women with habitual miscarriage and chronic endometritis. Visnyk Vinnytskoho Natsionalnoho Medychnoho Universytetu (Bulletin of Vinnytsia National Medical University), 24(4), 629–633. https://doi.org/10.31393/reports-vnmedical-2020-24(4)-12 [in Ukrainian].
2. Tomnyuk, O.M. (2020). Prevention of miscarriage and perinatal pathology in women with antiphospholipid syndrome and retrochorial hematoma. Reproductive Health of Woman, 3(43). https://doi.org/10.30841/2708-8731.3.2020.215013 [in Ukrainian].
3. Fung, T.Y., To, K.F., Sahota, D.S., Chan, L.W., & Leung, T.Y. (2009). Massive subchorionic thrombohematoma: A series of 10 cases. Acta Obstetricia et Gynecologica Scandinavica, 89, 1357–1361. https://doi.org/10.3109/00016349.2010.512063
4. Palatnik, A., & Grobman, W.A. (2015). The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth. American Journal of Obstetrics and Gynecology, 213(3), 403.e1–403.e4. https://doi.org/10.1016/j.ajog.2015.05.022
5. Koifman, A., Levy, A., Zaulan, Y., Harlev, A., Mazor, M., Wiznitzer, A., & Sheiner, E. (2008). The clinical significance of bleeding during the second trimester of pregnancy. Archives of Gynecology and Obstetrics, 278(1), 47–51. https://doi.org/10.1007/s00404-007-0520-0
6. Biesiada, L., Krekora, M., & Krasomski, G. (2010). Subchorionic hematoma as a risk factor of pregnancy and delivery in women with threatening abortion. Ginekologia Polska, 81(12), 902–906.
7. Maso, G., D'Ottavio, G., De Seta, F., Sartore, A., Piccoli, M., & Mandruzzato, G. (2005). First-trimester intrauterine hematoma and outcome of pregnancy. Obstetrics & Gynecology, 105(2), 339–344. https://doi.org/10.1097/01.AOG.0000152000.71369.bd
8. Seki, H., Kuromaki, K., Takeda, S., & Kinoshita, K. (1998). Persistent subchorionic hematoma with clinical symptoms until delivery. International Journal of Gynecology & Obstetrics, 63(2), 123–128. https://doi.org/10.1016/s0020-7292(98)00153-2
9. Oliver-Williams, C.T., & Steer, P.J. (2015). Racial variation in the number of spontaneous abortions before a first successful pregnancy, and effects on subsequent pregnancies. International Journal of Gynecology & Obstetrics, 129(3), 207–212. https://doi.org/10.1016/j.ijgo.2014.11.023
10. Koshova, I.M. (2022). Placental dysfunction in women with retrochorial hematomas in the first trimester of pregnancy: Diagnosis and management tactics. Perinatology and Reproduction: From Scientific Achievements to Practice, 1(3), 10–15. 10.52705/2788-6190-2022-03-2 [in Ukrainian].
11. Asato, K., Mekaru, K., Heshiki, C., et al. (2014). Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 181, 41–44. https://doi.org/10.1016/j.ejogrb.2014.07.018
12. Tuuli, M.G., Norman, S.M., Odibo, A.O., Macones, G.A., & Cahill, A.G. (2011). Perinatal outcomes in women with subchorionic hematoma: A systematic review and meta-analysis. Obstetrics & Gynecology, 117(5), 1205–1212. https://doi.org/10.1097/AOG.0b013e31821568de
13. Ahangari, N., Doosti, M., Mousavifar, N., Attaran, M., Shahrokhzadeh, S., & Memarpour, S. (2019). Hereditary thrombophilia genetic variants in recurrent pregnancy loss. Archives of Gynecology and Obstetrics, 300, 777–782. https://doi.org/10.1007/s00404-019-05250-0
14. Ledford-Kraemer, M., Moore, G.W., & Bottenus, R. (2014). Laboratory testing for the lupus anticoagulant; approved guideline. CLSI document H60-A. Clinical and Laboratory Standards Institute. Retrieved from: https://clsi.org/media/1386/h60a_sample.pdf
15. Elovitz, M.A., Ascher-Landsberg, J., Saunders, T., & Phillippe, M. (2000). The mechanisms underlying the stimulatory effects of thrombin on myometrial smooth muscle. American Journal of Obstetrics and Gynecology, 183(3), 674–681. https://doi.org/10.1067/mob.2000.107561
16. Barbhaiya, M., Zuily, S., Naden, R., Hendry, A., Manneville, F., Amigo, M.C., Erkan, D., et al. (2023). The 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Arthritis & Rheumatology, 75(10), 1687–1702. https://doi.org/10.1002/art.42562
17. Devreese, K.M.J., de Groot, P.G., de Laat, B., Erkan, D., Favaloro, E.J., Mackie, I., & Cohen, H. (2020). Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis: Update of the guidelines for lupus anticoagulant detection and interpretation. Journal of Thrombosis and Haemostasis, 18(11), 2828–2839. https://doi.org/10.1111/jth.15047
18. Markin, L.B., Popovych, O.I., & Popovych, A.I. (2022). Prognosis and prevention of uterus bleedings in early postpartum period for women with idiopathic arterial hypotension. Wiadomości Lekarskie, 75(1), 102–106. https://doi.org/10.36740/WLek202201119
19. Bao, S.H., Chigirin, N., Hoch, V., Ahmed, H., Frempong, S.T., & Zhang, M. (2019). Uterine radial artery resistance index predicts reproductive outcome in women with recurrent pregnancy losses and thrombophilia. BioMed Research International, 2019, 8787010. https://doi.org/10.1155/2019/8787010
20. Oron, G., Ben-Haroush, A., Goldfarb, R., Molad, Y., Hod, M., & Bar, J. (2010). Contribution of the addition of anti-β2-glycoprotein I antibodies to the classification of antiphospholipid syndrome in predicting adverse pregnancy outcome. Journal of Maternal-Fetal and Neonatal Medicine, 24(4), 606–609. https://doi.org/10.3109/14767058.2010.511340
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