MANAGEMENT OF PREGNANCY AND DELIVERY IN A WOMAN WITH HOMOZYGOUS MUTATION OF PROTHROMBIN (Thr165Met) AND RECURRENT PULMONARY EMBOLISM ON THE BACKGROUND OF HORMONAL CONTRACEPTION
https://doi.org/10.17749/2313-7347.2018.12.1.099-104
Abstract
The article describes a clinical case of planning and managing pregnancy and delivery in a woman at high risk of thrombotic and obstetrical complications related to recent severe bilateral recurrent pulmonary embolism and history of pulmonary infarction and thrombosis of the brachial and subclavian veins on the background of receiving hormonal contraceptives. Prior to the first visit to our clinic, the woman was never examined for inherited or acquired forms of thrombophilia, although her medical and family history was indicative of a hereditary element of the disease. Here, homozygous mutation of prothrombin factor II (Thr165Met) and polymorphisms of the folate cycle and platelet receptor genes were detected. Managing of pregnancy, delivery and the postpartum period included carefully selected doses of low-molecular weight heparin under continuous monitoring of hemostasis and heparin dose correction.
About the Author
N. M. KhamaniRussian Federation
Khamani Nadin Moktarovna – Postgraduate student, Department of Obstetrics and Gynecology, Faculty of Medical and Preventive Medicine.
8, str. 2, ul. Trubetskaya, Moscow, 119048, +7(495)7885840
References
1. Trenor С.С., Chung R.J., Michelson А.D. et al. Hormonal contraception and thrombotic risk: a multidisciplinary approach. Pediatrics. 2011; 127 (2): 347-57.
2. Makatsariya A.D., Saidova R.A. Hormonal contraception and thrombophilic conditions [Gormonal'naya kontracepciya i trombofilicheskie sostoyaniya]. Moskva: Triada-Х. 2004: 240 s (in Russian).
3. Lidegaard O, Edström B, Kreiner S. Oral contraceptives and venous thromboembolism: a five-year national case-control study. Contraception. 2002; 65 (3): 187-96.
4. Liatsikos S.A., Tsikouras P., Manav B. et al. Inherited thrombophilia and reproductive disorders. J Turk Ger Gynecol Assoc. 2016; 17 (1): 45-50.
5. Thrombohemorrhagic complications in obstetric-gynecological practice: a guideline for doctors [Trombogemorragicheskie oslozhneniya v akushersko-ginekologicheskoj praktike: rukovodstvo dlya vrachej (Pod red. A.D. Makacariya)]. Moskva: MIA. 2011: 1050 s (in Russian).
6. Bergendal A., Persson I., Odeberg J. et al. Association of venous thromboembolism with hormonal contraception and thrombophilic genotypes. Obstet Gynecol. 2014; 124 (3): 600-9.
7. Grimes D.A., Stuart G.S., Levi E.E. Screening Women for Oral Contraception: Can Family History Identify Inherited Thrombophilias? Obstet Gynecol. 2012; 120 (4): 889-95.
8. Martinelli I., Taioli E., Bucciarelli P. et al. Interaction Between the G20210A Mutation of the Prothrombin Gene and Oral Contraceptive Use in Deep Vein Thrombosis. Arterioscler Thromb Vasc Biol. 1999; 19 (3): 700-3.
9. Aznar J., Vayа A., Estellés A. et al. Risk of venous thrombosis in carriers of the prothrombin G20210A variant and factor V Leiden and their interaction with oral contraceptives. Haematologica. 2000; 85 (12): 1271-6.
10. Konecny F. Inherited thrombophilic states and pulmonary embolism. J Res Med Sci. 2009; 14 (1): 43-56.
11. Makatsariya A.D., Bitsadze V.O., Akinshina S.V. Thrombosis and thromboembolism in the obstetricgynecological clinic [Trombozy i tromboembolii v akushersko-ginekologicheskoj klinike]. Moskva: MIA. 2007: 1064 s (in Russian).
12. Wiegratz I., Lee J.H., Kutschera E. et al. Effect of four oral contraceptives on hemostatic parameters. Contraception. 2004; 70 (2): 97-106.
13. Jick H., Jick S.S., Gurewich V. et al. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestagen components. Lancet. 1995; 346: 1589-93.
14. Gourdy Р., Bachelot А., Catteau-Jonard S. et al. Hormonal contraception in women at risk of vascular and metabolic disorders: Guidelines of the French Society of Endocrinology. Ann Endocrinol. 2012; 73: 469-87.
15. Rott H., Krümpel A., Kappert G. et al. Contraception and thrombophilia. Hаmostaseologie. 2009; 29 (2): 193-6.
Review
For citations:
Khamani N.M. MANAGEMENT OF PREGNANCY AND DELIVERY IN A WOMAN WITH HOMOZYGOUS MUTATION OF PROTHROMBIN (Thr165Met) AND RECURRENT PULMONARY EMBOLISM ON THE BACKGROUND OF HORMONAL CONTRACEPTION. Obstetrics, Gynecology and Reproduction. 2018;12(1):99-104. (In Russ.) https://doi.org/10.17749/2313-7347.2018.12.1.099-104

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.