Discusssion
The etiology for MPVFD remains unknown but it can recur in future pregnancies (12-78% reported8) as was the case in our patient. The pathogenesis remains unclear, but there is some evidence to suggest that a maternal autoimmune or alloimmune condition may be contributory. Treatment modalities have been reported with some success including primarily thrombolytic therapies (aspirin, heparin) with or without combining immunologically directed treatments (e.g., IVIG, prednisolone)1,9. One report notes a live birth with normal postnatal follow-up at 2 years in a woman with a history of four consecutive losses presumably all due to MPVFD who was treated with a combination of thrombolytic therapy (aspirin and heparin), IVIG, and pravastatin to correct the angiogenic/antiangiogenic imbalance thought to be causational of recurrent MPVFD10. These reports of isolated successes, but also failures, with a variety of treatments, are not without concerns and there is need for further study.
Based on the success in the case reported here with recurrent MPVFD, we propose treatment with daily aspirin and prophylactic enoxaparin dosing in addition to close follow-up and frequent antepartum testing in patients with a history of MPVFD.