SPONTANEOUS RESOLUTION OF HYPOFIBRINOGENEMIA IN A TRIPLET GESTATION ASSOCIATED WITH 2ND TRIMESTER IN-UTERO DEATH OF 2 FETUSES

Multiple gestations are increasing in frequency secondary to assisted reproductive technologies; therefore, it will become increasingly impo rtant to know how to manage a multiple pregnancy in which an in utero fetal death has occurred. This case report describes the spontaneous r esolution of maternal hypofibrinogenemia associated with the deaths of two fetuses in a triplet gestation. A 29-year-old woman with a triple t gestation had in utero death of two monoamniotic fetuses between 15 and 17 weeks' gestation. Maternal plasma fibrinogen levels were obtain ed weekly and were initially in the normal range for pregnancy. At 31 weeks' gestation, the fibrinogen level decreased to 239 mg/dl and reac hed a nadir of 150 mg/dl 11 days later. Although the patient received no treatment, her fibrinogen level increased to 307 mg/dl over the nex t 4 days and then remained above 260 mg/dl for the rest of her pregnan cy. At 35 weeks' gestation, a healthy 2090 gm female was delivered. Th e infant is alive and well and developing normally. When there is an i n utero death of one fetus of a multiple gestation in the second or ea rly third trimester, some authors advocate heparinization to reverse m aternal coagulopathy; others describe spontaneous resolution of hypofi brinogenemia. The role of heparin in treating hypofibrinogenemia remai ns unclear. Hypofibrinogenemia may resolve spontaneously without expos ing the patient to the potentially serious risks associated with hepar in therapy.