Bad obstetrics history, Multiple pregnancy, Perinatal outcome, Protein C deficiency
Citation Information :
Anant M, Yadav S, Paswan A, Sharma M, Raj P, Pritam A. Protein-C Deficiency and Bad Obstetric History: A Rare Successful Outcome in Twin Pregnancy. J South Asian Feder Obs Gynae 2021; 13 (5):339-341.
Inherited thrombophilias in pregnant females have increased risk of venous thromboembolism as well as adverse outcomes in pregnancy like miscarriage, fetal demise, fetal growth restriction, and abruptio placenta. Majority (50–60%) of cases of inherited thrombophilias are due to FVL (factor V Leiden) and prothrombin G20210A (also called the prothrombin gene mutation [PGM]) whereas deficiencies in protein S, protein C, and antithrombin account for the remaining cases. Pregnancy with thrombophilias requires adequate thromboprophylaxis during antenatal and postnatal periods depending upon the type and other factors, but the available evidence for their management is not sharply defined. This case reports a successful outcome in case of twin pregnancy with protein C deficiency with a personal history of venous thromboembolic (VTE) event and a bad obstetric history (BOH). She had multiple factors increasing her VTE risk: (1) previous thrombosis history; (2) inherited thrombophilia; (3) multiple pregnancy and hence was on continued anticoagulant therapy in antenatal and puerperal period. Although only a possible weak association with pregnancy losses has been suggested for protein C deficiency, this case emphasizes that thromboprophylaxis throughout antenatal course improves pregnancy outcome in those with recurrent pregnancy losses.
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