A CASE OF ABRUPTION TAKEN UNAWARE

Abstract

Abstract : Antiphospholipid antibodies
which are nonspecific may be found in
normal persons in 3-5 population. However
these antibodies also have been
associated with arterial and venous
thromboses and adverse pregnancy outcomes.
A Case of Gravida2Para1Live0,
who had placental abruption in the first
pregnancy, was diagnosed as antiphospholipid
antibody syndrome in the present
pregnancy. She is being reported
for the classical history, clinical presentation
and complications. She had bad obstetric
history, intra-uterine foetal death,
early onset preeclampsia, and abruption
in the first pregnancy. She had regular
follow up at a peripheral level hospital.
She was referred to our institution with
bleeding per vaginum.Her ultrasonography
revealed intrauterine fetal death with
placental abruption.On admission her
blood pressure was 160100mmHg. She
was taken up for Emergency Lower Segment
Caesarean section for GradeII placental
abruption,as she was unresponsive
to syntocin acceleration and delivered
a dead macerated baby of
1.5kg and 750 grams clots was located
retroplacentally.She required 2 units of
blood transfusion and 2 units of fresh frozen
plasma in the post operative period.
She developed an episode of convulsion in
the post operative period and Magnesium
sulfate regimen started as anticonvulsant
regimen. She was started on antihypertensives
and the dosage tapered gradually.
Computed Tomography of the Brain taken
suspecting cortical venous thrombosis, but
the finding was normal. She recovered well
in the postoperative period.In the present
pregnancy,she was investigated for bad
obstetric outcome in the previous pregnancy
and was found be Antiphospholipid
antibodies positive. She was started on
Heparin 5000 IU subcutaneously and Low
Dose Aspirin 75mg throughout the pregnancy.
She had uneventful antenatal period
with normal blood pressure and no
Proteinuria during this pregnancy. She was
delivered by an Elective Repeat Lower
segment Caesarean Section under general
anesthesia after discontinuing heparin 24
hours prior to the surgery and 

Low dose Aspirin 1 week before surgery. She
delivered an alive term girl baby of 2.8kg
weight. She was restarted on subcutaneous
heparin 12hours later and then switched to
Oral warfarin 6mg for antithrombotic prophylaxis
in the post partum period.s