Nghi had struggled with infertility for five years due to polycystic ovary syndrome and had one previous pregnancy terminated at 18 weeks due to fetal abnormalities. She received treatment at Tam Anh General Hospital HCMC, successfully becoming pregnant. However, at 12 weeks, she experienced abdominal pain and was admitted to the hospital, where numerous blood clots were found obstructing her portal and mesenteric veins. Doctors diagnosed her with antiphospholipid syndrome and systemic lupus erythematosus.

Lupus can attack multiple organs, including the skin, joints, kidneys, blood vessels, and digestive system. Antiphospholipid syndrome, on the other hand, increases the mother's risk of blood clots, which can easily cause blockage of placental microvessels, reducing blood flow to the fetus and increasing the risk of fetal growth restriction.

According to Doctor of First Degree Specialist Tran Lam Khoa from the Obstetrics and Gynecology Center at Tam Anh General Hospital HCMC, Nghi's concurrent conditions meant her risk of miscarriage, stillbirth, preterm birth, placental insufficiency, preeclampsia, pulmonary embolism, myocardial infarction, and cerebral infarction was many times higher than in a normal pregnancy. As the pregnancy was still premature, the biggest challenge in treatment was selecting appropriate medication. The team sought an optimal solution to control blood clots and the autoimmune disease, aiming to protect the mother's life and maintain the pregnancy. Many immunosuppressants and anticoagulants essential for the mother posed potential risks to the fetus.

A team of obstetricians, cardiologists, and clinical immunologists consulted to select an optimal anticoagulant regimen that controlled the mother's condition without affecting the fetus. After one week, ultrasound revealed a significant reduction in blood clots. Nghi was discharged and continued high-dose injectable anticoagulants and low-dose aspirin to prevent further clot formation.

Throughout her pregnancy, Nghi underwent examinations across multiple specialties during each follow-up visit to promptly detect and manage potential complications. At 38 weeks, Nghi went into labor, but due to a narrow pelvis, doctors performed a C-section.

Before surgery, doctors had the expectant mother stop anticoagulants for one day to reduce the risk of heavy bleeding during the procedure. A healthy baby boy weighing 3,2 kg was born, and the mother lost only 300 ml of blood, comparable to a normal C-section.

Doctor Lam Khoa (center) performs a C-section for Nghi. Photo: *Tue Diem*

On 22/1, Nghi brought her son home from the hospital, concluding a six-year journey of longing for a child's cry.

Systemic lupus erythematosus and antiphospholipid syndrome can silently exist for many years without clear symptoms, but they can easily manifest and cause severe complications during pregnancy. Doctor Lam Khoa advises pregnant women to seek early medical attention if they have a history of recurrent miscarriages or unexplained stillbirths, early preeclampsia; severe edema, high blood pressure, sudden chest pain, shortness of breath, unusual skin rashes, prolonged joint pain, severe fatigue, or anemia. Early detection, close monitoring, and timely treatment can help maintain the pregnancy and ensure the mother's safety.

*The patient's name has been changed