Hepatic infarction in a pregnant woman with antiphospholipid
Case report
This case report describes a 35-year-old woman, gravida 1, para 0, who was diagnosed as APS. At her first pregnancy, she was referred to our hospital because of severe FGR, oligohydramnios, and chronic hypertension at 17 weeks of gestation. Multiple serum markers were elevated in the quad test (alpha-fetoprotein, 8.273 multiples of the median [MoM]; human chorionic gonadotropin, 1.396 MoM; inhibin-A, 7.321 MoM), implicating possible uteroplacental insufficiency. On the basis of her clinical features, APS was suspected and subsequent laboratory tests confirmed the diagnosis. Treatment with low-dose aspirin (LDA, 100 mg daily) and low molecular weight heparin (LMWH, enoxaparin 40 mg daily) was started. Nonetheless, her first pregnancy ended at 21 weeks of gestation because of fetal death in utero.
During her second pregnancy, treatment with high-dose LMWH (enoxaparin 40 mg, twice a day) and LDA was started from 6 weeks of gestation, considering her previous pregnancy loss and triple antibody positivity with high titers. At 16 weeks, elevation of multiple serum makers (alpha-fetoprotein, 2.93 MoM; human chorionic gonadotropin, 5.44 MoM; inhibin A, 6.75 MoM) was found again. Furthermore, lagging of fetal growth was observed (283 g, 19 weeks sized) at 20 weeks. Considering her previous pregnancy loss history, triple antibody positivity with high titers, and delayed fetal growth despite anticoagulation, we decided to start treatment with intravenous heparin target activated partial thromboplastin time to improve uteroplacental microcirculation....