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.

This article presents the case of a patient who gave birth at term, 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 received 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 received by the mother. Forty-eight hours after birth, the newborn died.

Anticoagulant therapy cannot be regarded as 100 percent risk-free during pregnancy due to the potential for hemodynamic disorders to develop in both the mother and the unborn child. Considering the high incidence of perinatal mortality in such cases (10-30%), it is advised that a multidisciplinary team work together to inform the mother about potential complications, collaboratively determine the length of treatment with vitamin K antagonists (VKAs), develop a plan for monitoring the pregnancy, and determine which institution the mother and newborn would benefit from receiving qualified medical assistance.