Clinical cure of severe, early onset preeclampsia with low molecular weight heparin therapy in primigravida with hyperreactio luteinalis and thrombophilia.
Inherited thrombophilias, suggested to be risk factors for ovarian hyperstimulation syndrome and known to be associated with venous thromboembolism during pregnancy, may also increase the risk for preeclampsia (PE). We describe the case of a 29-year-old woman with primary infertility with no history of thrombosis, hypertension or renal disorders. In her first pregnancy, achieved by frozen embryo transfer, she developed severe early-onset (23rd gestational week) PE with heavy proteinuria, and at the same time was found to have enlarged ovaries with hyperreactio luteinalis. After admission we found that she was a heterozygotic carrier of the factor V Leiden mutation. After administering low molecular weight heparin (LMWH) therapy, her blood pressure normalized, proteinuria diminished and her d-dimer values returned to that of a normal pregnant level. The fetus grew normally. Her ovaries normalized during the pregnancy, as determined by ultrasound examinations. At term she delivered spontaneously a normal weight, healthy girl. Previously, only prophylactic LMWH, in subsequent pregnancy, have been administered in patients with thrombophilia and a history of severe PE. We describe a case of spontaneous hyperreactio luteinalis, where the clinical characteristics of PE improved after beginning LMWH therapy in severe, very early onset PE. Inherited thrombophilia, spontaneous hyperreactio luteinalis and PE may be associated phenomena.
Saisto
Terhi
T
Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, PO Box 140, FIN-00290 HUS Helsinki, Finland. terhi.saisto@hus.fi
Tiitinen
Aila
A
Ulander
Veli-Matti
VM
Kaaja
Risto
R
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D010049:Ovarian Diseases / Q000150:complications*; D010298:Parity; D011225:Pre-Eclampsia / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011256:Pregnancy Outcome; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight