Nilsson I M, Astedt B, Hedner U, Berezin D
Acta Med Scand. 1975 Mar;197(3):153-9. doi: 10.1111/j.0954-6820.1975.tb04897.x.
A report is presented of a young, otherwise apparently healthy, woman who had three pregnancies which for some unknown reason terminated in intrauterine death (macerated foetuses). During the third pregnancy a coagulation defect was diagnosed, which was characterized by prolonged coagulation times and prolonged one-stage prothrombin time. This defect disappeared after the end of the pregnancy, but returned during the fourth pregnancy. This time a circulating anticoagulant was found, which inhibited the action of thromboplastin. The values found for the various coagulation factors were normal. The anticoagulant titre rose during the pregnancy from 1/2 to 1/10. Leucocyte agglutinating as well as lymphocytotoxic antibodies directed against the husband's cells were demonstrated in the patient during the pregnancy. In this case, by passage of cell fragments and thromboplastic substances to the mother, the foetus had probably induced the development of antibodies against the foetal tissues. The foetus may be regarded as an incompatible transplant. The fourth pregnancy was terminated by caesarean section in the 34th week. The child weighed 1440 g and, after three exchanges of blood, did very well. The placenta was severely infarcted. It is postulated that the development of antithromboplastin during pregnancy may be a contributory cause of intrauterine death.
本文报告了一位年轻且表面上看来健康的女性，她经历了三次怀孕，但不知何故均以宫内死亡（胎儿浸软）告终。在第三次怀孕期间，诊断出一种凝血缺陷，其特征为凝血时间延长和一期凝血酶原时间延长。这种缺陷在妊娠结束后消失，但在第四次怀孕时再次出现。这次发现了一种循环抗凝物质，它抑制了凝血活酶的作用。各种凝血因子的值均正常。抗凝抗体滴度在怀孕期间从1/2升至1/10。在怀孕期间，患者体内检测到针对其丈夫细胞的白细胞凝集抗体以及淋巴细胞毒性抗体。在这种情况下，通过细胞碎片和凝血活酶物质进入母体，胎儿可能诱发了针对胎儿组织抗体的产生。胎儿可被视为不相容的移植物。第四次怀孕在第34周通过剖宫产终止。婴儿体重1440克，经过三次换血后情况良好。胎盘严重梗死。据推测，怀孕期间抗凝血活酶的产生可能是宫内死亡的一个促成因素。
