Management of high perinatal risk pregnancy with heterozygous Leiden mutation. A clinical case
- 作者: Mochalova M.N.1, Sidorkina A.G.1, Akhmetova E.S.1, Khaven T.V.2, Kuzmina L.A.2, Durova O.A.2, Tomina E.A.1, Solpov A.V.1, Mudrov V.A.1
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隶属关系:
- Chita State Medical Academy
- Regional Clinical Hospita
- 期: 卷 72, 编号 5 (2023)
- 页面: 115-121
- 栏目: Theory and Practice
- ##submission.dateSubmitted##: 14.06.2023
- ##submission.dateAccepted##: 09.10.2023
- ##submission.datePublished##: 23.11.2023
- URL: https://journals.eco-vector.com/jowd/article/view/492321
- DOI: https://doi.org/10.17816/JOWD492321
- ID: 492321
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This article presents a clinical case of hereditary thrombophilia associated with the heterozygous FV Leiden mutation in a pregnant woman with a burdened obstetric history. The patient was admitted to the third group hospital with a diagnosis of pregnancy 27 weeks 6 days; burdened obstetric history; uterine scar; hereditary thrombophilia associated with heterozygous factor V mutation; stage 1 grade 1 risk 1 hypertension, controlled; grade 1 alimentary obesity; grade 1 diffuse (endemic) goiter, euthyroidism; and chronic gastritis, remission. Upon admission, the patient received Sol. Enoxaparini natrii at a dosage of 0.4 ml subcutaneously twice a day, but according to the thrombodynamics test, thrombotic readiness remained. The purpose of hospitalization was to select anticoagulant therapy in a patient at high risk of perinatal loss. We found from the anamnesis that the woman’s first pregnancy ended in operative delivery on time due to progressive severe premature detachment of a normally located placenta and intrapartum fetal death.
Together with hematologists, we selected the optimal anticoagulant therapy for this patient as follows: Sol. Enoxaparini natrii at a dosage of 0.8 ml subcutaneously in the morning, then Sol. Enoxaparini natrii 0.4 ml subcutaneously in the evening, and Tab. Acidi acetylsalicylici 0.15. During this therapy, positive dynamics was noted, with normal coagulation observed during a thrombodynamic study. After selecting anticoagulant therapy, the woman was discharged from the hospital under the supervision of an obstetrician-gynecologist at the antenatal clinic and a hematologist at the Clinical Medical Center, Chita, Russia. Antenatal hospitalization was planned at 37 weeks of pregnancy. The patient was delivered by urgent caesarean section due to premature rupture of membranes at 35 weeks 1 day, given the aggravated anamnesis in this patient with the uterine scar. A live premature girl was born weighing 2410 g, 44 cm tall with an Apgar score of 8 / 8 points. In the postpartum period, given the high risk of thromboembolic complications (3 points), the patient was prescribed Sol. Enoxaparinum natrium at a dosage of 0.4 ml subcutaneously once per day for six weeks after delivery.
The presented clinical case of pregnancy and childbirth demonstrates the importance of personalization in modern medicine.
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作者简介
Marina Mochalova
Chita State Medical Academy
Email: marina.mochalova@gmail.com
ORCID iD: 0000-0002-5941-0181
SPIN 代码: 1068-3570
MD, Cand. Sci. (Med.), Assistant Professor
俄罗斯联邦, ChitaAnastasia Sidorkina
Chita State Medical Academy
Email: anastasia-sidorkina.17@yandex.ru
ORCID iD: 0000-0003-4509-0698
俄罗斯联邦, Chita
Elena Akhmetova
Chita State Medical Academy
Email: akhmetlena@yandex.ru
ORCID iD: 0000-0002-6568-8905
SPIN 代码: 7543-2483
MD, Cand. Sci. (Med.), Assistant Professor
俄罗斯联邦, ChitaTatyana Khaven
Regional Clinical Hospita
Email: t_khaven@mail.ru
俄罗斯联邦, Chita
Lyubov Kuzmina
Regional Clinical Hospita
Email: prostopochta1804@mail.ru
ORCID iD: 0000-0003-2035-7966
MD
俄罗斯联邦, ChitaOlga Durova
Regional Clinical Hospita
Email: chitha@mail.ru
ORCID iD: 0009-0001-0984-4598
MD
俄罗斯联邦, ChitaElena Tomina
Chita State Medical Academy
Email: elatom07@mail.ru
ORCID iD: 0000-0003-2423-666X
SPIN 代码: 5418-7679
MD, Cand. Sci. (Med.)
俄罗斯联邦, ChitaAlexey Solpov
Chita State Medical Academy
Email: alexeysolpov@yandex.ru
ORCID iD: 0000-0003-3509-0301
SPIN 代码: 1313-8437
MD, Dr. Sci. (Med.)
俄罗斯联邦, ChitaVictor Mudrov
Chita State Medical Academy
编辑信件的主要联系方式.
Email: mudrov_viktor@mail.ru
ORCID iD: 0000-0002-5961-5400
SPIN 代码: 5821-3203
MD, Dr. Sci. (Med.), Assistant Professor
俄罗斯联邦, Chita参考
- Venoznye oslozhneniya vo vremya beremennosti i poslerodovom periode. Akusherskaya tromboemboliya. Klinicheskie rekomendatsii (protokol lecheniya). Ministerstvo zdravookhraneniya Rossiiskoi Federatsii. 2022. (In Russ.) [cited 2023 Aug 21]. Available from: https://cr.minzdrav.gov.ru/schema/723_1
- Markovsky AV. Frequency of inherited thrombophilia gene polymorphism in women with reproductive health disorders. Aterotromboz/Atherothrombosis. 2018;(1):70–75. (In Russ.) doi: 10.21518/2307-1109-2018-1-70-75
- Ivanov DO. Rukovodstvo po perinatologii. Saint Petersburg: Informnavigator; 2019. (In Russ.)
- Dautaj A, Krasi G, Bushati V, et al. Hereditary thrombophilia. Acta Biomed. 2019;90(10-S):44–46. doi: 10.23750/abm.v90i10-S.8758
- Khalife S, Geitani R. Association of inherited thrombophilia with recurrent pregnancy loss in a population of lebanese women: a case control study. Int J Fertil Steril. 2022;16(3):247–251. doi: 10.22074/ijfs.2022.540950.1205
- Colucci G, Tsakiris DA. Thrombophilia screening revisited: an issue of personalized medicine. J Thromb Thrombolysis. 2020;49(4):618–629. doi: 10.1007/s11239-020-02090-y
- Vrotniakaite-Bajerciene K, Tritschler T, Jalowiec KA, et al. Thrombophilia impact on treatment decisions, subsequent venous or arterial thrombosis and pregnancy-related morbidity: a retrospective single-center cohort study. J Clin Med. 2022;11(14). doi: 10.3390/jcm11144188
- Shehata H, Ali A, Silva-Edge M, et al. Thrombophilia screening in women with recurrent first trimester miscarriage: is it time to stop testing? – a cohort study and systematic review of the literature. BMJ Open. 2022;12(7). doi: 10.1136/bmjopen-2021-059519
- Linehan LA, San Lazaro Campillo I, Hennessy M, et al. Reproductive outcomes following recurrent first-trimester miscarriage: a retrospective cohort study. Hum Reprod Open. 2022;2022(4). doi: 10.1093/hropen/hoac045
- Balandina AN, Koltsova EM, Shibeko AM, et al. Thrombodynamics: a new method to the diagnosis of hemostasis system disorders. Pediatric Hematology/Oncology and Immunopathology. 2018;17(4):114–126. doi: 10.24287/1726-1708-2018-17-4-114-126
- Hamulyák EN, Scheres LJ, Marijnen MC, et al. Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy loss. Cochrane Database Syst Rev. 2020;5(5). doi: 10.1002/14651858.CD012852.pub2
- Normal’naya beremennost’. Klinicheskie rekomendatsii (protokol lecheniya). Ministerstvo zdravookhraneniya Rossiiskoi Federatsii. 2020. (In Russ.) [cited 2023 Aug 21]. Available from: https://cr.minzdrav.gov.ru/schema/288_1
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