Rh-Isoimmunization in a Primigravida Skydiver

Abstract

There is a paucity of data on risks of skydiving while pregnant. Although the American College of Obstetricians and Gynecologists states to avoid the activity in pregnancy, women may underestimate potential complications from it and may continue to skydive while pregnant or may do so inadvertently if unaware of their pregnancy. We present a unique case of a primigravida who completed 100 jumps at 10,000 feet throughout her gestation, as she was unaware of her pregnant state, associated with Rh-isoimmunization presumably from chronic placental abruption. A 20-year-old Caucasian female presented to an urgent care center for abdominal cramping thought to be secondary to constipation. A urine pregnancy test was performed due to irregular menstruation history. Although the patient denied being pregnant, urine chorionic gonadotrophic hormone testing was positive with physical examination suggesting 32 - 34 weeks of gestation. The patient was a professional skydiving photographer with 100 logged jumps from the start of her pregnancy (by estimated gestational age calculation). She stated irregular vaginal bleeding every 4 - 6 weeks throughout the time of pregnancy, which she interpreted as her menstruation. Her abdominal discomforts were diagnosed as active labor, and she progressed to preterm delivery at 34 weeks (gestational age assigned to the newborn at delivery based on neonatal assessment). Port-wine-stained amniotic fluid was noted at the time of spontaneous membrane rupture suspicious for chronic abruption. The patient was Rh negative and found to possess anti-D antibody, confirming Rh sensitization. Placental histology revealed a placental mass of 438 g, retroplacental adherent fibrin deposition with placental parenchymal compression. A 40% parenchymal infarct was present. Skydiving while pregnant poses several risks to the maternal-fetal unit. Rapid deceleration from parachute canopy deployment and/or repeated impact from landing(s) may lead to placental abruption (acute or chronic). This can result in Rh-isoimmunization in the susceptible patient, and preterm birth. In cases of massive or repeated abruption events, fetal death may be a potential outcome. Beyond the rarity and novel nature of habitual skydiving while pregnant, this case underscores the need for increased access to contraceptive agents, especially for those persons with physical risk-taking behaviors.

J Clin Gynecol Obstet.2023;12(1):15-18
doi: https://doi.org/10.14740/jcgo845