MANAGEMENT OF PREGNANCY AND DELIVERY IN A WOMAN WITH HOMOZYGOUS MUTATION OF PROTHROMBIN (Thr165Met) AND RECURRENT PULMONARY EMBOLISM ON THE BACKGROUND OF HORMONAL CONTRACEPTION

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.

Keywords

• genetic thrombophilia
• combined oral contraceptives
• prothrombin mutation thr165met
• recurrent pulmonary embolism
• thrombotic complications
• anticoagulant therapy
• hemostasis disorders