PROTEIN S DEFICIENCY IN PREGNANCY: TO TREAT OR NOT TO TREAT. A CASE SERIES.

Abstract

Introduction: Protein S deficiency is rare occurring in only about 3 out of 10,000 women. Thrombophilias,  whether inherited or acquired, have been associated with adverse reproductive outcomes such as recurrent  first trimester pregnancy losses, second and third trimester pregnancy losses, pre-eclampsia, fetal growth  restriction, placental abruption and venous thrombo-embolism. Treatment of protein S deficiency with  anticoagulation in pregnancy is usually individualized depending on patient prior history and presenting  symptoms. We report of 2 cases of women with protein S deficiency in pregnancy who had varied  management and conduct a literature review on the salient features of this condition in pregnancy. 

Cases: Two women, who were sisters and had a prenatal diagnosis of protein S deficiency, were managed  in their current pregnancies. One was on her fifth pregnancy having had adverse pregnancy outcomes and  the other in her first pregnancy. One of the lady was on anti-thrombotic agents prior to the pregnancy which  was continued during the pregnancy and the other was not started on anti-coagulation. They both had good  pregnancy outcomes in the documented pregnancies. 

Conclusion: Protein S deficiency in pregnancy is a rare medical condition which most clinicians may  not come across in their practice. The patients outlined had a prenatal diagnosis and hence presented no  diagnostic dilemma. However, thrombophilias should be suspected in women with recurrent adverse  pregnancy outcomes that have not been explained with other causes. The management of these patients  largely involve use of anti-thrombotic agents with multi-disciplinary care being of benefit in improving  outcomes.