This is a case of a 40-year-old G2P0 (0010) diagnosed to have reproductive immune failure I, III and V. She underwent lymphocyte immunotherapy and was on aspirin and prednisone prior her second pregnancy. On her second trimester, antiphospholipid syndrome (APS) monitoring revealed positive for lupus anticoagulant. At 26 weeks age of gestation (AOG), she complained of decreased fetal movement and pelvic ultrasound revealed oligohydramnios. Upon admission, referral to immunology service was done. Heparin IV and hydrocortisone were given. Repeat ultrasound still revealed oligohydramnios hence Intravenous immunoglobulin (IVIg) was administered. A few hours after IVIg transfusion, patient complained of difficulty of breathing. She was transferred to the Maternal Intensive Care Unit (MICU) for close monitoring. Chest x-ray revealed bilateral pulmonary congestion, pleural effusion left lower hemithorax. D dimer was elevated at 3050. Patient was transferred back to a regular room after being stable. Serial ultrasound was done to monitor fetal status. At 31 wks AOG, there was recurrence of oligohydramnios. Elective CS was done and patient gave birth to a live preterm baby boy.
- By the end of this module, the learner should be able to:
- Identify the different categories of reproductive immune failure.
- Discuss the possible pathogenesis of each category.
- Enumerate the different work-ups for reproductive immune failure.
- Discuss the management of each category of reproductive immune failure.