Sarah is a 31yo, G3 P1101, who is seen for an ultrasound evaluation and assessment for FTS and a consultation due to her clotting abnormalities. The patient does have a history of a 20 week IUFD and had a full thrombophilia work-up and ended up with several test results that were positive. She is heterozygous for factor V Leiden and heterozygous for prothrombin gene mutation, which is a combination that is a risk factor for thrombosis that is equal to being homozygous for either factor V Leiden or homozygous for prothrombin gene mutation. The patient herself has never had a thrombotic event. She also is heterozygous for MTHFR and PAI 4G/5G positive. She also has a positive anticardiolipin IgG antibody. In her 2nd pregnancy she was treated…show more content… The nuchal translucency measurement fell within the normal range. The nasal bone was identified and there was normal ductus flow. She therefore underwent laboratory testing and the complete result of this screen should be available in the next 4-7 days. If the result of this screen returns with decreased risks, we would recommend a good fetal anatomical survey between 18-22 weeks gestation.
Regarding her thrombophilia history, we would recommend that she continue on this regiment up to delivery and if there is any question, increasing her Lovenox to 60 mg in the last 4 weeks. The recommendation previously was to keep these patients on Lovenox for about 6 weeks but a couple of recent studies have suggested that the risk of thrombosis is still elevated somewhat up to 12 weeks. Because of the number of abnormalities that she has, if she does have a repeat cesarean delivery, she does have risk factors and you might consider extending her treatment to 12 weeks.
Currently at this time, she has not been scheduled to follow-up in our office, but if you would like us to perform any of her future scans, please feel free to reschedule her with