Successful pregnancy outcome in the woman with thrombophilia and multiple miscarriages

OBJECTIVES: The case of a 25 year-old pregnant woman with a history of miscarriage (8 week) and a triple intrauterine fetal death (35, 25, 21 week) was reported. RESULTS: Personal and family history did not revealed any abnormalities. In the 25th week of gestation routine ultrasonographic examination showed abnormal pulsation indexes in the umbilical artery, as well as the right and left uterine artery. Also extremely high vascular resistance was confirmed in both uterine arteries (notch). The routine laboratory tests were normal. Because of high risks of stillbirth and preliminary pregnancy termination the screening tests for thrombophilia were performed. The presence of a heterozygous form of factor V Leiden mutation and C677T polymorphism of a methylenetetrahydrofolate reductase gene were confirmed. The low doses of LMWH (nadroparine) subcutaneously and aspirin (150 mg per day, orally) were administered until pregnancy termination. In the 35th week of gestation the pregnancy was terminated by cesarean section due to fetus intrauterine asphyxia (boy 1180 g, Apgar 1 min-6, Agar 5 min 9 points). Three months' follow-up after delivery did not revealed any complication in the mother or in the child. CONCLUSIONS: Successful pregnancy outcome in the woman with thrombophilia and multiple miscarriages confirms the necessity for both prophylactic anticoagulant treatment and detailed laboratory testing.