妊娠合并获得性维生素K依赖性凝血因子缺乏症一例报告及文献复习

目的探讨妊娠合并获得性维生素K依赖性凝血因子缺乏症(ADVKCF)的临床特点及诊治方法。方法报告一例妊娠合并ADVKCF患者的诊治经过,以"获得性维生素K依赖性凝血因子缺乏症""超级华法林(鼠药)中毒""妊娠"的中英文为检索词分别在PubMed、Embase、Web of Science、CNKI和万方数据知识服务平台检索国内外相关病例,总结妊娠合并ADVKCF的临床特点、治疗方案及母儿结局。结果该文报道1例妊娠合并ADVKCF患者,因皮肤淤斑及胎死宫内入院,被诊断为妊娠合并ADVKCF,排胎同时予输注血制品、补充维生素K等治疗后,病情好转出院。笔者共检索到国内外相关病例5例,患者首发症状主要表现为肉眼血尿、口腔黏膜出血。5例患者的凝血酶原时间及活化部分凝血时间均明显延长,有1例出现胎死宫内,2例新生儿死亡。结论妊娠合并ADVKCF非常罕见,易因凝血指标异常与其不同程度的出血表现误诊为DIC,多合并不良的妊娠结局,对该类患者尽早诊断、及时治疗或可改善预后。

Pregnancy complicated with acquired deficiency of vitamin K-dependent coagulation factors: one case report and literature review

Objective To summarize the diagnosis, management and clinical characteristics of acquired deficiency of vitamin K-dependent coagulation factors (ADVKCF) in a pregnant woman. Methods We reported the diagnosis and treatment of one pregnant woman complicated with ADVKCF. Literature review was performed from PubMed, Embase, Web of Science, CNKI and Wanfang Database by using the keywords of “acquired deficiency of vitamin K-dependent coagulation factors”, “superwarfarin poisoning” and “pregnancy” in both English and Chinese. The clinical characteristics, treatment regime, maternal and infantile outcomes were summarized. Results The patient was admitted to our hospital due to dermal ecchymosis and intraunterine fetal death. She was diagnosed with pregnancy complicated with ADVKCF. After blood product transfusion, vitamin K supplementation and vaginal pregnancy termination, the patient was discharged after the physical condition was improved. Five cases at home and abroad were retrieved. The initial symptoms mainly included gross hematuria and oral mucosal bleeding. The prothrombin time and acivated partial thromboplastin time were significantly prolonged in five cases. Among them, intrauterine fetal death occurred in one cases and neonatal death in two cases. Conclusions ADVKCF in pregnancy is extremely rare. It is often misdiagnosed as disseminated intravascular coagulation due to abnormal coagulation indicators and varying degrees of bleeding. Pregnant women with ADVKCF are likely to obtain adverse pregnancy outcomes. Early diagnosis and timely treatment may improve the prognosis of pregnancy complicated with ADVKCF.