CASE REPORTS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2016 March;175(3):113-7

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Pregnancy complicated by congenital antithrombin deficiency: a case report, with special reference to placental thrombus formation

Hironori TAKAHASHI ¹, Takashi WATANABE ^{1, 2}, Rie USUI ¹, Hiroki IMADA ³, Yukiko MUKODA ¹, Shigeki MATSUBARA ¹

¹ Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan; ² Department of Obstetrics and Gynecology, Haga Red Cross Hospital, Tochigi, Japan; ³ Department of Pathology, Jichi Medical University, Tochigi, Japan

Congenital antithrombin deficiency (ATD) during pregnancy may cause fetal growth restriction and placental insufficiency. Heparin was administered to a 31-year-old biparous Japanese woman with congenital ATD. Ultrasound revealed three findings: a growth-restricted fetus, an abnormal umbilical artery flow, and importantly, a thick placenta with areas showing different echogenicities. A non-reassuring fetal status necessitated cesarean section in the 35th week, yielding a 1372-gram infant. The placenta showed many thrombi, which were white, brown, and dark red; while some consisted of stratified fibrin deposits reflecting old thrombi, some consisted mainly of red blood cells reflecting fresh thrombi, indicating that the thrombi had formed continuously during pregnancy. At postpartum, heparin and antithrombin were administered, after which an intra-rectus-abdominis-muscle-fascial hematoma developed, requiring surgical removal. In a pregnant woman with ATD, placental thrombi may be formed continuously, possibly leading to placental insufficiency and fetal growth restriction.