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.