先天性プロテインＳ欠乏症患者における双胎帝王切開術の麻酔経験

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  • Anesthetic Management of a Cesarean Section for a Twin Pregnancy with Congenital Protein-S Deficiency.

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A 29-year-old woman was referred to our hospital for monitoring of her twin pregnancy at 26 weeks' gestation. Bleeding, decreased platelet, and increased fibrin degradation product and d-dimer were observed at 29 weeks' gestation. Coagulation study showed out of scale from the lower levels of protein S activity. Protein S is decreased during pregnancy and anti-coagulant therapy. Also an exact diagnosis cannot be made until after delivery and discontinuation of anti-coagulant therapy. However, we assumed that she had congenital protein-S deficiency due to the coagulation data and family history. Anti-coagulant therapy was started immediately after confirmation of the lack of deep vein thrombosis and no pulmonary embolism. We continued the anti-coagulant therapy and physical therapy during and after pregnancy for 6 weeks. She did not have any clinical signs of deep vein thrombosis, and coagulation studies showed in a normal range throughout the pregnancy and after delivery. Anesthesia for cesarean section was managed by combined spinal epidural anesthesia at 37 weeks of gestation, and continuous epidural morphine infusion (2.5mg•day-1 0.7ml•hr-1) was used for her early ambulation. There were no complications due to bleeding and no other symptoms during the peri-operative period. We strongly suggest anti-coagulant and physical therapy for patients with congenital protein-S deficiency. A definite diagnosis should be made after delivery after stopping anti-coagulant therapy.

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