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A 27 y/o F presents to you for a preconception visit. Pat home pregnancy tests (+) she is ~7 weeks along given the timing of her last menstrual cycle. She suffered 3 miscarriages between the gestational ages of 8, 10 and 15 wks. DX Lab pending.
Which of the following would be more appropriate for your pat to prevent pregnancy loss?
a) Low dose aspirin alone
b) Warfarin
c) No treatment needed
d) Low molecular weight heparin & low dose aspirin
e) Low molecular weight heparin & cyclophosphamide
f) Steroids and aspirin (81mg)
g) Aspirin and warfarin
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c,
antiphospholipid miscarriages are in later pregnancy, this woman is in an early stage, most likely having aneuploidies, but why so many?, anatomical defect? please explain
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B...antiphospholipid syndrome....anticoagulant is given
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*D* correct.
APS start with POS pregnancy test. Varies, depend pat has thrombotic events &/or experienced miscarriage more/ or 2 unexplained consecutive lost.
Low dose ASPIRIN/usually 81mg daily & HEPARIN/subcutaneous 5000 unit injection 2x a day & last not least IVIG 400mg/kg every day for 300hrs may also prevent abortions.
Glucocorticoids don’t work so forget about that option catastrophic/rare case of APS combo it with anticoagulation, plasmapheresis, and/or IVIG is typically used.
That’s correct Warfarin crosses the placenta speedy way & NEVER ever admin ( Kido can bleed to death/+ you recall fetal protein- carboxyglutamate found blood & bone-> major defect & bone abnom formation) We kill Rat/-> eat, eat and eat until bleed to death days later. So, one can imagine what harm cause in kido
So, if a human ingests rat poison accidental or intentional you Rx w injection or oral Vit K. You monitor PT and “if” its prolong then, YES you transfuse FFP OR clotting factor.
