Published: 2020-05-27

Management and therapeutic implications of combined protein C and S deficiency in pregnancy: a case report

Neha Agrawal, Navdeep Ghuman, Pratibha Singh, Priyanka Kathuria


The pregnancy is an immunocompromised state. Thus, autoimmune diseases may affect pregnancy and get worsen during pregnancy. Here authors discuss a rare autoimmune thrombophilia disorder, protein C and S deficiency which may cause recurrent pregnancy losses by affecting haemostatic mechanisms in the body. This patient with recurrent pregnancy loss when evaluated extensively was found to have combined inherited protein C and S deficiency. It was successfully managed with thromboprophylaxis therapy, which resulted in the delivery of healthy baby. Long term anticoagulant prophylaxis should be considered weighing the risk of bleeding to thrombotic recurrence in such cases. In conclusion, combined protein C and S deficiency and that too presenting as recurrent pregnancy loss is very rare. Thrombophilia screening should be considered in cases of recurrent pregnancy losses. Adequate and appropriate thromboprophylaxis is an important part of the management of pregnant women with inherited thrombophilia.


Case report, Thrombophilia, Protein C, Protein S, Recurrent pregnancy loss

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Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98(5):1103-11.

Markoff A, Bogdanova N, Samama MM. Hereditary Thrombophilic Risk Factors for Recurrent Pregnancy Loss. Hereditary Genet. 2012;S1:001.

Regan L, Rai R. Thrombophilia and pregnancy loss. J Reprod Immunol. 2002;55:163-80.

Chaudhari HK, Shah PK, Pai KR, D’Souza NB. Combined protein C and protein S deficiency with pregnancy. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):245.

Cuker A, Pollak SE. Protein C deficiency. eMedicine; 2009. Available at http:// Accessed on 12th February 2020.

D’Uva M, Di Micco P. Etiology of hypercoagulable state in women with recurrent fetal loss without other causes of miscarriage from Southern Italy: new clinical target for antithrombotic therapy. Biol. 2008;2:897-902.

Reitsma PH, Bernardi F, Doig RG, Gandrille S, Greengard JS, Ireland H, et al. Protein C deficiency: a database of mutations, 1995 update. On behalf of the subcommittee on plasma coagulation inhibitors of the scientific and standardization committee of the ISTH. Thromb Haemost. 1995;73:876-89.

Gandrille S, Borgel D, Ireland H, Lane DA, Simmonds R, Reitsma PH, et al. Protein S deficiency: a database of mutations. For the plasma coagulation inhibitors subcommittee of the scientific and standardization committee of the international society on thrombosis and haemostasis. Thromb Haemost. 1997;77:1201-14.

Lalan DM, Jassawalla MJ, Bhalerao SA. Successful pregnancy outcome in a case of protein s deficiency. J Obstet Gynaecol India. 2012;62(Suppl 1):21-2.

Pabinger I. Thrombophilia and its impact on pregnancy. Thromb Res. 2009;123(3):16-21.