Optimal treatment of hypothyroidism associated with live birth in cases of previous recurrent placental abruption and stillbirth.
OBJECTIVE
To examine the clinical management of and placentas from pregnant women with hypothyroidism and obstetric history of recurrent stillbirth in order to identify possible etiologic mechanisms.


METHODS
Two cases involving 26-year-old women with hypothyroidism and history of recurrent stillbirth are reported. Placentas from all of the women's pregnancies were compared in order to identify histologic similarities.


RESULTS
In both cases, multifocal hemorrhagic infarctions and abruptions were seen, indicating progressive uteroplacental ischemic damage leading to stillbirth. Thrombophilia, infection, and diabetes tests were all negative. With meticulous monitoring and normalization of thyroid function by end of first/early second trimester in subsequent pregnancies, there were live births and no evidence of infarction on placental histology.


CONCLUSIONS
The 2 reported cases raise the possibility of uteroplacental ischemia and placental abruption being mechanisms by which hypothyroidism can lead to stillbirth; they also highlight the potential of minimizing this risk via adequate levothyroxine treatment from early pregnancy.
Birmingham Women's Foundation Trust, Birmingham, UK.
Neil K
NK
Vanes
Dorreh
D
Charlesworth
Rabia
R
Imtiaz
Philip
P
Cox
Mark D
MD
Kilby
Shiao Y
SY
Chan
D000037:Abruptio Placentae / Q000517:prevention & control*; D000328:Adult; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000188:drug therapy*; D007511:Ischemia / Q000150:complications / Q000473:pathology; D050498:Live Birth; D010920:Placenta / Q000098:blood supply / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000503:physiopathology; D011256:Pregnancy Outcome; D012008:Recurrence; D050497:Stillbirth; D013974:Thyroxine / Q000008:administration & dosage / Q000627:therapeutic use*
D013974:Thyroxine
Hypothyroidism; Obstetrics; Placental abruption; Pregnancy outcome; Stillbirth