Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report.

Abstract

Neonatal hemorrhagic syndrome, which affects several principal organs during the early neonatal period, denotes a deficiency of vitamin K and coagulation factors, respectively.This article presents the case of a patient that gave birth at term, who had congenital heart disease and required several prior surgical interventions including corrected transposition of the great vessels via ventricular septal defect (VSD) repair, atrial septal defect (in childhood) and tricuspid valve replacement (6 years ago), mitral regurgitation (MR), grade I pulmonary regurgitation (PR), grade II mitral and tricuspid valve regurgitation, and grade II heart failure based on the New York Health Association (NYHA) classification. Throughout the pregnancy the patient administered large doses of anticoagulant, specifically Acenocumarolum, until the moment she gave birth. The vaginal delivery was spontaneous, contrary to the recommendations given to the pregnant woman in a secondary healthcare institution. At birth, the newborn was in satisfactory condition, with 8/9 on the Apgar score. However, the newborn’s condition worsened over time, suspected of having neonatal hemorrhagic syndrome caused by medications administered by the mother. Forty-eight hours after birth the newborn died.Anticoagulant therapy cannot be considered absolutely safe during pregnancy because it presents risks for the development of hemodynamic disorders, not only for the mother, but also for the newborn. In such cases, it is recommended that a multidisciplinary team work together to inform the mother about possible complications, collaboratively establish the duration of treatment with vitamin K antagonists (VKAs), establish a plan for monitoring the pregnancy and determining in which institution the mother and newborn can benefit from qualified medical assistance, taking into consideration the higher incidence of perinatal mortality in such cases (10-30%).