Hereditary thrombophilia and recurrence of ischemic placental disease.

OBJECTIVE: We sought to evaluate whether testing for hereditary thrombophilia alone or in combination with second-trimester uterine artery Doppler (UAD) is useful in predicting recurrent complications in patients with previous preeclampsia, placental abruption, or stillbirth. STUDY DESIGN: Between 2001 and 2005, 110 consecutive women were included in the study and received 100 mg of aspirin daily. Adjustment was made for several maternal confounding factors using a logistic regression model. RESULTS: After multivariable logistic regression analyses, only abnormal UAD assessment was significantly associated with recurrent complications (odds ratio, 11.2; 95% confidence interval, 3.8-32.6) Combining the results of UAD and the presence of laboratory markers of thrombophilia failed to improve the accuracy of UAD to predict recurrent complications. CONCLUSION: Hereditary thrombophilia testing is not useful in predicting recurrent complications in subsequent pregnancy.

Fetal death in a patient with intrahepatic cholestasis of pregnancy.

BACKGROUND: Treatment with ursodeoxycholic acid in intrahepatic cholestasis of pregnancy reduces concentration of transaminases and bile acids in maternal serum, and is thought to reduce fetal death. We report a case of fetal death in a patient with intrahepatic cholestasis of pregnancy who had responded well to ursodeoxycholic acid, demonstrated by a low bile level. CASE: A young nulliparous woman presented with intrahepatic cholestasis of pregnancy at 28 weeks of gestation. Transaminases and bile acids decreased after ursodeoxycholic acid administration. The patient was discharged from the hospital until delivery and received biochemical markers and conventional fetal monitoring twice weekly. Due to low bile acid values (< 13 UI/L) and unfavorable cervix, the patient was followed up expectantly. Fetal death occurred at 39 weeks and 3 days, although cardiotocograph testing results were normal the day before. CONCLUSION: When lung maturity is achieved for patients with intrahepatic cholestasis of pregnancy, delivery should be considered.