DR. KAVYA. P,DR. EVANGELINE CHRISTABLE,DR. MADHUMITHA M
DOI: https://doi.org/Aim
This case series investigates the correlation between unexplained recurrent pregnancy loss (RPL) and Protein S deficiency, emphasizing the importance of targeted thromboprophylaxis in affected patients.
Background
Recurrent fetal loss (RPL) is one of the most common causes of sterility.Pregnancy as such is a hypercoagulable state with differing levels of coagulatory proteins. Functionally, the enzymatic active form of protein Cregulates blood clot formation. Protein S serves as a cofactor for the anticoagulant effect of protein C(1).In 1999 Brenner et al (1999) identified thrombophilia as a principal cause in more than 40% of women affected by RPL(2). Functional protein C or S levels do not change significantly during pregnancy. Only the free protein S levels tend to fall significantly during the first and second trimesters of pregnancy, but there is no further decrease during the third trimester. Protein S deficiency is more commonly identified than protein C deficiency. Protein S deficiency is a hereditary thrombophilia that can lead to a prothrombotic state, significantly increasing the risk of RPL and adverse pregnancy outcomes.Women with these deficiencies have a higher risk of developing thrombosis of the placental vessels, leading to placental insufficiency and pregnancy loss. This condition exacerbates the naturally occurring hypercoagulable state during pregnancy, raising the likelihood of complications such as placental thrombosis and venous thromboembolism. This case series aims at detecting protein S deficienciesin pregnancy and its effects and outcomes on both mother and baby.
Clinical Significance
This study highlights the critical role of identifying Protein S deficiency in patients experiencing RPL. By implementing targeted management strategies, healthcare providers can mitigate risks associated with this condition, ultimately enhancing pregnancy outcomes. Routine screening for Protein S deficiency should be considered in clinical practice for women with unexplained RPL to facilitate appropriate treatment and care.
Methods: Between December 2023 and May 2024, three antenatal women with a history of recurrent pregnancy losses were evaluated at our institution. Each patient underwent a comprehensive assessment that included detailed obstetric histories, laboratory investigations for thrombophilia (including Protein S activity levels), and imaging studies as needed. The management strategies implemented for each patient included low molecular weight heparin (LMWH) and aspirin therapy, tailored to their specific clinical scenarios. Outcomes were monitored through regular follow-ups, including ultrasound assessments for fetal growth and Doppler flow studies. This case series analyses various risk factors, obstetric histories, gestational ages at presentation, complications encountered, and treatment outcomes for each patient.
Conclusion
The findings from this case series underscore the necessity for routine screening and proactive intervention in high-risk pregnancies. Early diagnosis and management of Protein S deficiency can lead to improved maternal and fetal outcomes, thereby reducing the distress associated with recurrent pregnancy loss.
