Spinal anesthesia for c-section in patients with protein S deficiency: case report and literature review

  • Yosselly Ninoska Carrillo-Aybar Anesthesia, Analgesia and Reanimation Department, Instituto Nacional Materno Perinatal, Lima, Peru
  • Renato Moreno-Gonzales Anesthesia, Analgesia, and Reanimation Department, Instituto Nacional Materno Perinatal, Lima, Peru
  • María Victoria Quispe-Gómez Anesthesia, Analgesia, and Reanimation Department, Instituto Nacional Materno Perinatal, Lima, Peru
Keywords: Protein S Deficiency, Pregnant Women, Anesthesia, Spinal, Thrombosis, Enoxaparin

Abstract

Introduction:

Congenital protein S deficiency is a very rare disease in the population. In pregnant women it is associated with spontaneous abortion and fetal death, among other complications.

Case presentation:

We present the case of a 32-year-old multigravida with a 36-week pregnancy, with thromboprophylaxis with enoxaparin from the 4th week of gestation and with a diagnosis of thrombophilia-due to functional protein S deficiency-which was intervened with elective c-section under spinal anesthesia. In addition, a review of the relevant literature was conducted.

Discussion:

The risk of venous thromboembolism is approximately 4 to 5 times greater during gestation, and the recommendation of thromboprophylaxis in low-risk thrombophilia is based on the presence of associated risk factors. In patients receiving low molecular weight heparin (LMWH) as thromboprophylaxis, an interval of at least 12 hours after the last dose of LMWH before neuropsy and restarting the next dose after at least 4hours of spinal technique use is recommended.

Conclusion:

Neuroaxial techniques should be individualized and receive pre and postpartum thromboprophylaxis. In addition, non-pharmacological thromboprophylaxis measures in the perioperative period should be considered. Spinal anesthesia was effective and safe in this patient.

References

1. Patil AD, Sabu J, D’Souza O. Anesthesia management of the parturient with protein S and C deficiency for cesarean section. J Anaesth Crit Care Case Rep 2017;3:14-15.

2. Muhsin Chisti M, Chinta S, Talavera F, et al. Protein S deficiency [Internet]. 2018; Medscape, New York: [cited 2018 Sep 23]. Available from: https://emedicine.medscape.com/article/205582-overview.

3. Soma-Pillay P, Catherine NP, Tolppanen H, et al. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27:89-94.

4. Springel EH, Ramus RM. Thromboembolism in pregnancy [Internet]. 2018; Medscape, New York: [cited September 26, 2018]. Available from: https://emedicine.medscape.com/article/2056380-overview.

5. Royal College of Obstetricians & Gynaecologists. Thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the Risk (Green-top Guideline No. 37a) [Internet]. 2018; Royal College of Obstetricians and Gynaecologists, London: [cited November 23, 2018]. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37a/.

6. Gupta B, Prakash S, Gujral K. Anaesthetic management of the parturient with protein S deficiency and lumboperitoneal shunt. Anaesth Intensive Care 2003;31:3.

7. Shinozaki N, Ebina Y, Deguchi M, et al. Protein S deficiency complicated pregnancy in women with recurrent pregnancy loss. Gynecol Endocrinol 2016;32:672-674.
How to Cite
1.
Carrillo-Aybar YN, Moreno-Gonzales R, Quispe-Gómez MV. Spinal anesthesia for c-section in patients with protein S deficiency: case report and literature review. Colomb. J. Anesthesiol. [Internet]. 2020Jan.1 [cited 2021May10];48(1):45-9. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/176

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Published
2020-01-01
How to Cite
1.
Carrillo-Aybar YN, Moreno-Gonzales R, Quispe-Gómez MV. Spinal anesthesia for c-section in patients with protein S deficiency: case report and literature review. Colomb. J. Anesthesiol. [Internet]. 2020Jan.1 [cited 2021May10];48(1):45-9. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/176
Section
Case Report / Case Series

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