Intrauterine Upper Limb Ischemia: An Unusual Presentation of Fetal Thrombophilia—A Case Report and Review of the Literature

Abstract

Upper limb ischemia presenting in neonatal period is extremely rare. Moreover, presenting newborn with evidence of intrauterine upper limb vascular occlusion is even rarer. It needs prompt intervention to restore perfusion and avoid morbidity. We present a newborn with right upper limb brachial artery thrombosis causing ischemia that was noted at birth and appeared later to be homozygous for factor V Leiden and glycoprotein IIIa with no other identifiable risk factors. In this report, we present the case, its successful medical management, proper counseling, and review of the literature. We recommend investigating the neonates and their parents for thrombophilia mutations when they present with unusual vascular occlusion site as newborns.

Intrauterine Bilateral Upper Limb Gangrene and Cerebral Infarction in Preterm Infant: A Case Report and Literature Review

“…Neonatal thrombosis is often caused by catheterization of the umbilical artery or less commonly seen as complication of sepsis or coagulation disorders [1][2][3]. The most common reported risk factors of intrauterine thrombosis include; maternal diabetes, pre-eclampsia, sepsis, polycythemia, fetal compression, uterine anomalies, amniotic bands, oligohydramnios, malpresentation of the fetus with limb prolapse and umbilical cord entanglement [5][6][7].…”

“…However, it was unfortunate as the insult was severe in left side and gangrene was propagated to involve most of the forearm. The duration of anticoagulant treatment after resolution of symptoms has been controversial; however, Abdelrazeq et al [2] used LMWH in patient for 17 months and documented the safety of the drug. The infant in present study was administered low molecular weight heparin till discharge after one month.…”

“…The infant in present study was administered low molecular weight heparin till discharge after one month. The infant was also given fresh frozen plasma to improve tissue perfusion and supply any deficient factor as it was recommended in few studies [1][2][3][10][11][12][13][14].…”

“…Majority of the cases occur due to embolization from the aorta, inferior vena cava, or renal vein to upper extremities and brain [1][2][3]. In majority of the cases, no identifiable cause was implicated; although, maternal diabetes was found in about 25% of the cases [2][3][4].…”

“…Majority of the cases occur due to embolization from the aorta, inferior vena cava, or renal vein to upper extremities and brain [1][2][3]. In majority of the cases, no identifiable cause was implicated; although, maternal diabetes was found in about 25% of the cases [2][3][4]. Conservative management is usually indicated to control convulsions, prevent propagation of the thrombosis and control any infection till the gangrene is declared by a line of demarcation to optimize future amputation and reconstruction [4][5][6].…”