Successful delivery of fetus with fetal inherited thrombophilia after two fetal deaths [Uspješno dovršenje trudnoće s djetetom s nasljednom trombofilijom nakon dvije fetalne smrti]

Juras, Josip and Ivanišević, Marina and Orešković, Slavko and Mihaljević, Slobodan and Vujić, Goran and Đelmiš, Josip (2013) Successful delivery of fetus with fetal inherited thrombophilia after two fetal deaths [Uspješno dovršenje trudnoće s djetetom s nasljednom trombofilijom nakon dvije fetalne smrti]. Collegium Antropologicum, 37 (4). pp. 1353-1355. ISSN 0350-6134

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Abstract

A pregnant woman with inherited thrombophilia (factor II mutation--20210A) had two late pregnancy losses. The first pregnancy was not well documented, but the second pregnancy was complicated by fetal thrombophilia and umbilical artery thrombosis, proven after fetal death. During the third pregnancy enoxaparine was introduced in the therapy and early amniocentesis was performed. Fetal thrombophilia was proven again. Early delivery was induced and performed with no complications, resulting in a live healthy infant. A history of miscarriages or recurrent fetal loss should raise suspicion of thrombophilia as a potential cause. It is debatable whether amniocentesis in pursuit of fetal thrombophilia should be performed and whether this will lead to a better perinatal outcome. When fetal thrombophilia is diagnosed, an earlier induction of delivery should be considered, taking into account the fetal extrauterine viability. The aforementioned approach of early delivery in cases of inherited fetal thrombophilia could be a possible solution for better perinatal outcomes.

Abstract in Croatian

Trudnica s nasljednom trombofilijom (mutacija čimbenika II – 20210A) imala je dva gubitka trudnoće u poodmakloj gestaciji. Tijek prve trudnoće nije detaljno dokumentiran, a druga trudnoća je bila komplicirana trombofilijom fetusa i trombozom umbilikalne arterije, što je ustanovljeno nakon smrti fetusa. Tijekom treće trudnoće trudnica je liječena enoksaparinom te je učinjena rana amniocenteza. Opet je fetus imao nasljednu trombofiliju. Učinjena je prijevremena indukcija porođaja bez komplikacija, što je rezultiralo živim i zdravim djetetom. Pobačaji ili ponavljajuća smrt fetusa trebala bi pobuditi sumnju na trombofiliju kao mogući uzrok. Upitno je je li potrebno izvođenje amniocenteze sa svrhom traženja trombofilije u fetusa i utjecanja na bolji perinatalni ishod. U slučaju prisustva fetalne dijagnoze indukcija porođaja prije termina bi se trebala razmotriti, uvažavajući sposobnost fetusa za život izvan maternice. Spomenuti pristup u slučaju nasljedne fetalne trombofilije bi mogao biti potencijalno rješenje za bolji perinatalni ishod.

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