EP11.24: Management of a high‐risk pregnancy associating autoimmune diseases, chronic hypertension, prediabetes and inherited thrombophilia

We report the case of a 34 years old woman that came for preconceptional evaluation after 2 first trimester miscarriages. She was known with Graves' disease, chronic anemia, vitiligo, hypertension, PCOS and overweight, both her parents had hypertension and ischemic heart disease. Her treatment: L-thyroxine and ACE-inhibitor. She was referred to a hematologist that diagnosed Biermer anemia and Factor V Leiden gene mutation; B12 therapy was started. Other preconceptional recommendations were: diet, changing ACE-inhibitor to α metil dopa, low dose aspirin, metformin, folic acid. Her pregnancy was followed-up by a multidisciplinary team. Vitamin D, Mg, Ca and low-molecular-weight-heparin were added. She was twice admitted for threatened abortion thus natural micronised progesterone was started. At 35 weeks fetal growth restriction was diagnosed, fetal wellbeing was monitored by Doppler velocimetry until delivery at 39 weeks. The neonate, 2570 gr, needed no NICU admission. Both were discharged after 4 days. The pregnancy outcome was improved due to the compliance of the patient to all treatment options beginning with diet and ending with self-administered low-molecular-weight-heparin and due to the prenatal care offered by the multidisciplinary team. This pregnancy didn't complicate with abortion, preterm birth, acute fetal distress, pre-eclampsia, abruptio placentae or thromboembolic accidents. The only complication that could not be avoided was fetal growth restriction. In such complex associations of diseases there might be a risk of overtreatment in order to minimised maternal, fetal and neonatal risks.