肝素和静脉注射免疫球蛋白治疗复发性大量绒毛周围纤维蛋白沉积和慢性绒毛间炎：病例报告
Recurrent Massive Perivillous Fibrin Deposition and Chronic Intervillositis Treated With Heparin and Intravenous Immunoglobulin: A Case Report.
作者信息
Abdulghani Sahar, Moretti Felipe, Gruslin Andree, Grynspan David
机构信息
Department of Obstetrics and Gynecology, College of Medicine, King Khalid University Hospital, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia.
Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital and University of Ottawa, Ottawa, ON.
出版信息
J Obstet Gynaecol Can. 2017 Aug;39(8):676-681. doi: 10.1016/j.jogc.2017.03.089. Epub 2017 Apr 26.
BACKGROUND
Massive perivillous fibrin deposition (MPVFD) and chronic intervillositis (CI) are related rare pathological correlates of severe intrauterine growth restriction (IUGR) and fetal loss with high recurrence rates. No standard management has been established.
CASE
A patient underwent termination of pregnancy at 21 weeks for severe early onset IUGR. Placental histology showed mixed CI with MPVFD. Several months later, the patient became pregnant and was managed with prednisone and aspirin (ASA) but miscarried at 16 weeks. Placental pathology showed MPVFD and focal CI. For two subsequent pregnancies, she was treated with intravenous immunoglobulin (IVIG), heparin, and ASA. Both pregnancies resulted in healthy near-term deliveries with normal placentas.
CONCLUSION
IVIG, heparin, and ASA can be an option in patients with recurrent pregnancy loss due to MPVFD and CI.
背景
大量绒毛周围纤维蛋白沉积（MPVFD）和慢性绒毛间炎（CI）是严重宫内生长受限（IUGR）和胎儿丢失的罕见病理相关因素，复发率高。尚未建立标准的治疗方法。
病例
一名患者因严重早发性IUGR在孕21周时终止妊娠。胎盘组织学显示混合性CI伴MPVFD。几个月后，该患者再次怀孕，接受泼尼松和阿司匹林（ASA）治疗，但在孕16周时流产。胎盘病理显示MPVFD和局灶性CI。在随后的两次怀孕中，她接受了静脉注射免疫球蛋白（IVIG）、肝素和ASA治疗。两次怀孕均顺利分娩出健康的足月婴儿且胎盘正常。
结论
对于因MPVFD和CI导致复发性流产的患者，IVIG、肝素和ASA可以作为一种治疗选择。
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