ABSTRACT
Protein S is a multifunctional plasma protein, whose deficiency, results in a rare congenital thrombophilia, inherited in an autosomal dominant pattern. It can aggravate the hypercoagulable state of pregnancy, when it presents in parallel with the condition, leading to adverse maternal outcomes and foetal loss. A 35-year-old female third gravida having previous 2 deliveries by Lower Segment Caesarean Section (LSCS) presented to emergency at 10 weeks pregnancy with chief complaints of pain and swelling in left thigh since 4-5 days. After thorough investigations and work-up, the patient was diagnosed with Protein S deficiency. She was managed conservatively and was delivered by elective LSCS with bilateral tubal ligation at 38 weeks of gestation with good foetal and maternal outcomes.The rarity of Protein S deficiency along with the successful outcome of the pregnancy makes this a unique case.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.
ABSTRACT
Introduction: Coronary artery disease complicates 0.01% of pregnancies. In this case study, we illustrate the successful management strategy of a pregnancy with a cardiometabolic disorder who conceived after a ST-elevation myocardial infarction (STEMI). Case Description: A 41-year-old woman in her third pregnancy was referred to our maternal-fetal-medicine unit at 8 weeks of gestation. She had a history of an acute inferior myocardial infarction (MI) Killip 1 with 70% occlusion of the left anterior descending artery and ectatic vessels, which was successfully thrombolysed 1 year prior. On presentation, she had uncontrolled type 2 diabetes, chronic hypertension on treatment, and was morbidly obese with a BMI of 44 kg/m2. She had 2 previous lower segment caesarean sections and an umbilical hernia repair. A systematic effort involving a multidisciplinary team, both at tertiary and community level, was coordinated from the start, which successfully prevented any cardiac events during pregnancy. She recovered from Covid-19 category 4a at 28 weeks with no cardio-respiratory implications. She went on to have a lower segment caesarean section near term with tubal ligation. Post-operative recovery was uneventful, and she continued to see cardiologists and endocrinologists. Discussion: Specific risks such as MI recurrence, pre-eclampsia and low birth weight baby can be minimised through comprehensive antenatal and perinatal plans supported by patient compliance. Our case showed that pregnancy after MI results in good maternal-fetal outcome provided the pre-pregnancy cardiac performance status is good, early multidisciplinary management, patient-centred approach, close antenatal monitoring, adequate delivery preparation and patient compliance.