Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 13 , ISSUE 5 ( September-October, 2021 ) > List of Articles

CASE REPORT

Protein-C Deficiency and Bad Obstetric History: A Rare Successful Outcome in Twin Pregnancy

Monika Anant, Sonam Yadav, Anita Paswan, Mrinal Sharma, Priyanka Raj, Anuja Pritam

Keywords : 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.

DOI: 10.5005/jp-journals-10006-1955

License: CC BY-NC 4.0

Published Online: 22-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

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.


PDF Share
  1. Greer IA. The challenge of thrombophilia in maternal-fetal medicine. N Engl J Med 2000;342(6):424–425. DOI: 10.1056/NEJM200002103420610.
  2. Anderson JAM, Weitz JI. Hypercoagulable states. Crit Care Clin 2011;27(4):933–952, vii. DOI: 10.1016/j.ccc.2011.09.007.
  3. Gerhardt A, Scharf RE, Beckmann MW, et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000;342(6):374–380. DOI: 10.1056/NEJM200002103420602.
  4. Martinelli I, Mannucci PM, De Stefano V, et al. Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families. Blood 1998;92(7):2353–2358. PMID: 9746774.
  5. Vaidyanathan A, Bhuvana S. Antepartum cortical vein thrombosis. J South Asian Fed Obstet Gynaecol 2017;9(2):200–202. DOI: 10.5005/jp-journals-10006-1494.
  6. Lussana F, Coppens M, Cattaneo M, et al. Pregnancy-related venous thromboembolism: risk and the effect of thromboprophylaxis. Thromb Res 2012;129(6):673–680. DOI: 10.1016/j.thromres.2012.01.017.
  7. Folkeringa N, Brouwer JLP, Korteweg FJ, et al. Reduction of high fetal loss rate by anticoagulant treatment during pregnancy in antithrombin, protein C or protein S deficient women. Br J Haematol 2007;136(4):656–661. DOI: 10.1111/j.1365-2141.2006.06480.x.
  8. Singh N, Acharya N, Acharya S. Homocysteinemia: a rare cause of recurrent pregnancy loss coexisting with deep vein thrombosis. J South Asian Fed Obstet Gynaecol 2021;12(5):328–330. DOI: 10.5005/jp-journals-10006-1824.
  9. Morrison AE, Walker ID, Black WP. Protein C deficiency presenting as deep venous thrombosis in pregnancy. Case report. Br J Obstet Gynaecol 1988;95(10):1077–1080. DOI: 10.1111/j.1471-0528.1988.tb06518.x.
  10. Maeda Y, Satoh K, Haboshi T, et al. [A case report of congenital protein C deficiency with cerebral venous sinus thrombosis during early pregnancy period]. No Shinkei Geka 2017;45(10):913–918. DOI: 10.11477/mf.1436203617.
  11. Vogel JJ, de Moerloose PA, Bounameaux H. Protein C deficiency and pregnancy: a case report. Obstet Gynecol 1989;73(3 Pt 2):455–456. PMID: 2915872.
  12. Sugiura M. Pregnancy and delivery in protein C-deficiency. Curr Drug Targets 2005;6(5):577–583. DOI: 10.2174/1389450054545971.
  13. Croles FN, Nasserinejad K, Duvekot JJ, et al. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. BMJ 2017;359:j4452. DOI: 10.1136/bmj.j4452.
  14. Hao C, Sun M, Wang H, et al. Low molecular weight heparins and their clinical applications. Prog Mol Biol Transl Sci 2019;163:21–39. DOI: 10.1016/bs.pmbts.2019.02.003.
  15. Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv 2018;2(22):3317–3359. DOI: 10.1182/bloodadvances.2018024802.
  16. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 196: thromboembolism in pregnancy. Obstet Gynecol 2018;132(1):e1–e17. DOI: 10.1097/AOG.0000000000002706.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.