EC Gynaecology

Prolonged isolated activated partial thromboplastin time (aPTT) is among coagulation anomalies encountered during pregnancy. We report a case of a 31-year-old woman at 31 weeks of gestation initially admitted with intrahepatic cholestasis of pregnancy and preeclampsia. Additional manifestations, particularly an aPTT of 78.8 sec, led to further investigation. She was later diagnosed with systemic lupus erythematosus, secondary antiphospholipid syndrome and fetal growth restriction. She underwent urgent caesarean section at 34 weeks of gestation due to severe hypertension and a non-reassuring fetal status. This case reinforces the importance of recognizing coagulation disorders during pregnancy to correctly identify haemorrhagic or thromboembolic risk and ensure adequate management.

Keywords: Activated Partial Thromboplastin Time; Antiphospholipid Syndrome; Lupus Anticoagulant

1. Katz D., et al. “Disorders of coagulation in pregnancy”. British Journal of Anaesthesia 115 (2015): ii75-ii88.
2. Rasmussen K., et al. “Unexpected, isolated activated partial thromboplastin time prolongation: A practical mini‐review”. European Journal of Haematology6 (2020): 519-525.
3. Garcia D., et al. “Diagnosis and management of the antiphospholipid syndrome”. New England Journal of Medicine21 (2018): 2010-2021.
4. Hirsh J., et al. “The seventh ACCP conference on antithrombotic and thrombolytic therapy”. Chest3 (2004).
5. Miyakis S., et al. “International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)”. Journal of Thrombosis and Haemostasis2 (2006): 295-306.
6. Aringer M., et al. “2019 European League against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus”. Arthritis and Rheumatology9 (2019): 1400-1412.
7. Pengo V., et al. “Clinical course of high-risk patients diagnosed with antiphospholipid syndrome”. Journal of Thrombosis and Haemostasis2 (2010): 237-242.