A CASE OF ABRUPTION TAKEN UNAWARE

Abstract : Antiphospholipid antibodies which are nonspecific may be found in normal persons in 3-5 population. However these antibodies also have been associated with arterial and venous thromboses and adverse pregnancy outcomes.A Case of Gravida2Para1Live0, who had placental abruption in the first pregnancy, was diagnosed as antiphospholipid antibody syndrome in the present pregnancy. She is being reported for the classical history, clinical presentation and complications. She had bad obstetric history, intra-uterine foetal death, early onset preeclampsia, and abruption in the first pregnancy. She had regular follow up at a peripheral level hospital. She was referred to our institution with bleeding per vaginum.Her ultrasonography revealed intrauterine fetal death with placental abruption.On admission her blood pressure was 160100mmHg. She was taken up for Emergency Lower Segment Caesarean section for GradeII placental abruption,as she was unresponsive to syntocin acceleration and delivered a dead macerated baby of 1.5kg and 750 grams clots was located retroplacentally.She required 2 units of blood transfusion and 2 units of fresh frozen plasma in the post operative period. She developed an episode of convulsion in the post operative period and Magnesium sulfate regimen started as anticonvulsant regimen. She was started on antihypertensives and the dosage tapered gradually. Computed Tomography of the Brain taken suspecting cortical venous thrombosis, but the finding was normal. She recovered well in the postoperative period.In the present pregnancy,she was investigated for bad obstetric outcome in the previous pregnancy and was found be Antiphospholipid antibodies positive. She was started on Heparin 5000 IU subcutaneously and Low Dose Aspirin 75mg throughout the pregnancy. She had uneventful antenatal period with normal blood pressure and no Proteinuria during this pregnancy. She was delivered by an Elective Repeat Lower segment Caesarean Section under general anesthesia after discontinuing heparin 24 hours prior to the surgery and A CASE OF ABRUPTION TAKEN UNAWARE RAMYA CHITRA Department of Obstetrics and Gynaecology, MADRAS MEDICAL COLLEGE AND GOVERNMENT GENERAL HOSPITAL An Initiative of The Tamil Nadu Dr M.G.R. Medical University University Journal of Surgery and Surgical Specialities Low dose Aspirin 1 week before surgery. She delivered an alive term girl baby of 2.8kg weight. She was restarted on subcutaneous heparin 12hours later and then switched to Oral warfarin 6mg for antithrombotic prophylaxis in the post partum period.s