Thromophilia Case Summary

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Megan is a 30yo, G2 P0010, who was seen for a consultation due to her history of seizures. She has had seizures since she was about 8 years old and is currently on Lamictal. She was on 600 mg daily but did have a seizure about 3 weeks ago and was seen by her neurologist and her Lamictal was increased to 800 mg daily. She has not had a seizure in the past 3+ weeks. Overall on today’s assessment she has no complaints.

The patient also has a question about thrombophilia. The father of the baby is reportedly factor V positive but we do not know whether he is heterozygous or homozygous. The patient states that her sister was tested for thrombosis and was found to be PAI 4G/4G. The patient is uncertain as to whether she has been tested but
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No abnormalities were seen in the intraamniotic cavity on today’s assessment.

We did have a long discussion with the patient regarding seizures in pregnancy. Lamictal is one of our medications that we prefer to use and therefore she was told to maintain this throughout the pregnancy. If she were to have another seizure again we recommended that she get in touch with her neurologist but would recommend increasing the dosage. If another medication were needed, we would lean towards Keppra.

We also discussed thrombophilia issues. She essentially has no family history and therefore do not believe that she would require any treatment. In addition, we are uncertain as to why her sister was tested unless it had to do with pregnancy losses. If the patient is concerned about the potential for 4G/4G than at most we would recommend starting low-dose aspirin. She does not have a history that would suggest testing her for all the potential thrombophilias. Regarding the father of the baby, if he is heterozygous there is a 50% chance that the child would be a carrier. If he is homozygous than the child will be a carrier but again it is unlikely that this patient is a carrier for factor V Leiden. Upon completion of the ultrasound evaluation and assessment all of their questions were answered in detail. At this time we have not scheduled her back for a follow-up evaluation

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