Abstract
Antiphospholipid syndrome (APS) is associated with obstetric complications such as pregnancy loss. Previous research has indicated that heparin and aspirin could potentially increase the likelihood of live births in individuals with APS. However, when experiencing genital bleeding during pregnancy, the decision to discontinue anticoagulant therapy in patients with APS can be challenging. Here, we report a case of APS with a massive subchorionic hematoma (SCH), possibly due to anticoagulation. A 37-year-old woman with APS, receiving heparin and aspirin, experienced excessive bleeding at 18 weeks of gestation. Transvaginal ultrasonography and magnetic resonance imaging revealed a massive SCH. The patient had a history of five previous miscarriages and one ectopic pregnancy, yet she was determined to continue the current pregnancy, even if it meant risking her life. Thus, we decided to discontinue aspirin while continuing heparin, considering that aspirin may increase the risk of SCH and heparin may enhance the likelihood of achieving a successful live birth. After stopping aspirin, the bleeding gradually subsided, allowing the woman to carry the pregnancy to term. She eventually gave birth at 38 weeks of gestation. In APS-complicated pregnancies, even with heavy bleeding or massive SCH, continuation of anticoagulation therapy may lead to live births. 〔Adv Obstet Gynecol, 76(1):16-24, 2024(R6.2)〕
