Clinical case of high perinatal risk pregnancy with heterozygous Leiden mutation

This article presents the clinical case of hereditary thrombophilia associated with the heterozygous FV (Leiden) mutation. The patient was admitted to the hospital of the 3rd group with diagnosis: «Pregnancy 27 weeks 6 days. Burdened obstetric history. Scar on the uterus. Hereditary thrombophilia associated with a heterozygous mutation of factor V. The state of thrombotic readiness. Hypertension I stage, 1 degree, risk 1, controlled. Alimentary-constitutional obesity of the 1st degree. Endemic diffuse goiter of the 1st degree, euthyroidism. Chronic gastritis, remission.» On admission, the patient received Sol. Enoxaparini natrii at dosage of 0.4 ml subcutaneously 2 times every day, but according to the results of thrombodynamics, thrombotic readiness remained. The purpose of hospitalization was to select anticoagulant therapy. From the anamnesis, it was found that the woman's first pregnancy ended in operative delivery on time due to progressive severe premature detachment of a normally located placenta, intrapartum fetal death. Together with hematologists, the optimal anticoagulant therapy for this patient was selected: Sol. Enoxaparini natrii at dosage of 0.8 ml subcutaneously in the morning, then Sol. Enoxaparini natrii 0.4 ml subcutaneously in the evening, Tab. Acidi acetylsalicylici 0.15. Against the background of this therapy, positive dynamics was noted, normocoagulation was noted during the study of thrombodynamics. After the selection of anticoagulant therapy, the woman was discharged from the hospital under the supervision of an obstetrician-gynecologist of the antenatal clinic and the hematologist of the Clinical Medical Center. Antenatal hospitalization was planned for the period of 37 weeks. The patient was delivered by urgent caesarean section due to prenatal rupture of amniotic fluid at 35 weeks 1 day, given the aggravated anamnesis in patient with the uterine scar. A live premature girl was born weighing 2410 g, 44 cm tall and with an Apgar score of 8 and 8 points. In the postpartum period, given the high risk of thromboembolic complications, the patient was prescribed Enoxaparinum natrium at dosage of 0.4 ml subcutaneously 1 time per day for 6 weeks after delivery. The presented clinical case of pregnancy and childbirth demonstrates the importance of personalization in modern medicine.