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Re: Lupus anticoagulant and pregnancy From: Bernard Cristalli (bcrist@club-internet.fr) Wed Jul 30 15:13:38 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Bruce Speyer: "OBGYN.net chat times" Previous message: DoctorJoe@aol.com: "Re: Lactation Consultant and Breastfeeding Promotion" Maybe in reply to: Douglas L. Madsen: "Lupus anticoagulant and pregnancy" Next in thread: Malcolm Griffiths: "Re: Lupus anticoagulant and pregnancy" Douglas L. Madsen wrote: > > Hello from Washington state > The following is a case presentation I'd be interested in getting input > from list members on. > The patient is a 35 y.o. caucasion G2P1 currently 12-13 weeks pregnant with > singleton. > > First pregnancy delivered 8/94 at 41 weeks gestation, induction with PGE2 > and pitocin, vaginal delivery of 7#13oz female. Treated intrapartum with > Pen G for 37 wk pos Group B Step. Pt. Rh neg and received Rhogam. Post > partum developed breast abscess, rxed by drainage successfully. > She was noted to have a biologic false positive RPR on first visit and > Rheumatoid factor, ANA, Lupus anticoagulant all neg. Anticardiolipin IgG > 441 Gpl/ml (nl <10 Gpl/ml, *high* >100 Gpl/ml) > Anticardiolipin IgM <10 Gpl/ml, Anticardio IgA 32 SDU (neg <10 SDU) AFP at > 15 wks 2.2 MOM. > Pt. experienced some mild 1st trimester spotting. Initial BP 110/68, Never > above 122/80 remainder of pregnancy or labor. Weight gain 37 lbs. Begun on > 81 mg. ASA at 14 weeks. Anticardio IgG peaked at 574 Gpl/ml. > > Digging into past hx revealed hand arthralgias with *neg* Work up in > college. She did develop chloasma on combo OC's. > > With this pregnacy, she experienced some spotting at 8-9 weeks that has > stopped. Anticardio IgG is 71 Gpl/ml (nl < 23.9 Gpl/ml) > Lupus Anticoag is now POSITIVE. > (PTT8.9 sec Nl 22-36 sec) (DRVVT(LAC) 73.8 sec Nl < 46 sec) (LAC/CNF > ratio 2.22 Nl < 1.46) > Interestingly enough, her RPR is now neg. Initial BP 124/80. She is on ASA > 81 mg daily. > > The question is, in light of her lab abnormalities should she be considered > for Heparin and/or steroid administration. My tendency is to not treat > based solely on lab data, and since her first pregnancy proceeded without > hypertension, IUGR, etc., I have every reason to expect no different this > gestation. > -- Consider her as an anti phospholipid syndrome. What do you risk to loose? Low Molecular Weight Heparin + aspirin 100mg -- Bernard Cristalli MD CNGOF AIHP - ACCA Paris - France http://www.obgyn.net/corresp/cristalli.htm Next message: Bruce Speyer: "OBGYN.net chat times" Previous message: DoctorJoe@aol.com: "Re: Lactation Consultant and Breastfeeding Promotion" Maybe in reply to: Douglas L. Madsen: "Lupus anticoagulant and pregnancy" Next in thread: Malcolm Griffiths: "Re: Lupus anticoagulant and pregnancy"

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