Publication:

A rare manifestation in anti-phospholipid syndrome

Pregnancy per se is a state of immuno suppression and hypercoagulability. When associated with auto immune disorders, we encounter life threatening situations. Antiphospholipid syndrome still represents an important treatable cause of pregnancy morbidity. Known for its systemic arterial and venous thrombotic manifestations. There exist a complexity and heterogeneity of the mechanisms beyond the poor obstetric outcome in APS. Thrombotic events in these patients consist in deep vein thrombosis (32%), stroke (13%), superficial thrombophlebitis (9%), pulmonary embolism (9%) and transient ischemic attack (7%), among other clinical manifestations. Stroke is the most frequent arterial thrombosis. Rarely, APS can manifest in the form of hemorrhage. We encountered Subdural haematoma in pregnancy which is an infrequent manifestation. Our patient had gone through all bitter experiences on account of APS mentioned in domain 4-obstetric: prefetal death, fetal death, preeclampsia with severe features, central nervous system dysfunction, placental insufficiency with severe features. She has prosthetic aortic valve and on anticoagulants. This pregnancy she reported in emergency room with subdural haematoma and miscarriage with the multidisciplinary team work we were able to treat the uncommon manifestation successfully.  Embarking on pregnancy in future after a critical episode is debatable. In certain situations, the decision making is vital to minimize the morbidity.