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Delayed hemolysis, elevated liver enzymes, low platelet count syndrome in succession of switches of preventive anticoagulant treatment in a 41-year-old patient with a history of recurrent assisted implantation failures: a case report.
- Source :
-
Journal of medical case reports [J Med Case Rep] 2019 Jan 19; Vol. 13 (1), pp. 16. Date of Electronic Publication: 2019 Jan 19. - Publication Year :
- 2019
-
Abstract
- Background: For the past decades the mean age of primiparae in Western societies is constantly increasing. At the same time, there is a growing demand for assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection. Subsequently, a higher prevalence of pregnancy-associated diseases such as gestational hypertension and preeclampsia is observed. To improve pregnancy rates after in vitro fertilization/intracytoplasmic sperm injection and to reduce the risk of pregnancy-associated diseases with a cardiovascular pathophysiology, two anticoagulants are the focus of current research: low molecular weight heparin and acetylsalicylic acid (aspirin).<br />Case Presentation: A 41-year-old white woman, gravida 3, para 0, received low molecular weight heparin to reduce the risk of abortion after five unsuccessful intracytoplasmic sperm injections and two miscarriages. She autonomously discontinued the medication with low molecular weight heparin at 12 weeks and 2 days of gestation and took aspirin instead until 24 weeks and 2 days of gestation as preeclampsia prophylaxis. However, the pregnancy ended with an urgent cesarean section at 27 weeks and 4 days of gestation due to a fast progressing hemolysis, elevated liver enzyme levels, and low blood platelet count syndrome, a potentially life-threatening variant of preeclampsia.<br />Conclusion: Based on the current demographic trend toward late-in-life pregnancy it is mandatory to establish clear guidelines concerning preventive treatment options of preeclampsia for patients with risk factors. The establishment of a special first-trimester screening for these women should be discussed. Moreover, it is necessary to raise the awareness among physicians of these contemporary issues to guarantee the best possible medical care.
- Subjects :
- Adult
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Pregnancy
Premature Birth
Treatment Outcome
Anticoagulants therapeutic use
Aspirin therapeutic use
Cesarean Section
HELLP Syndrome drug therapy
HELLP Syndrome physiopathology
HELLP Syndrome prevention & control
Heparin, Low-Molecular-Weight therapeutic use
Sperm Injections, Intracytoplasmic
Subjects
Details
- Language :
- English
- ISSN :
- 1752-1947
- Volume :
- 13
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of medical case reports
- Publication Type :
- Academic Journal
- Accession number :
- 30658715
- Full Text :
- https://doi.org/10.1186/s13256-018-1943-1