EINFACHE FRAKTIONIERUNG FREIER ZIMMERMANN-CHROMOGENE BEI NICHTSCHWANGEREN UND SCHWANGEREN FRAUEN

Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity. Prophylaxis and management of VTE in pregnancy can impact mortality and morbidity. The overall reported incidence of gestational VTE ranges from 0.5 to 2.2 per 1000 maternities with a relative 5–10-fold increase in risk during pregnancy, increasing to a daily risk of 15–35-fold in the puerperium, compared with non-pregnant women of similar age. Risk factors inform the use of thromboprophylaxis usually with low-molecular-weight heparin, which has a better safety profile than unfractionated heparin. VTE can occur at any time in pregnancy, but over 50% of events occur prior to 20 weeks’ gestation. As clinical diagnosis is unreliable, objective assessment is required when there is clinical suspicion of an event. Less than 10% of clinically suspected cases of VTE are confirmed on objective testing. Compression duplex ultrasonography is the first-line investigation for suspected gestational deep venous thrombosis and thoracic imaging with ventilation–perfusion scanning is required for suspected pulmonary embolism. Low-molecular-weight heparin is usually the first choice treatment for gestational VTE based on safety and efficacy.

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Pregnancy changes and early pregnancy complications

10.1093/med/9780199651382.003.0001 ◽

2016 ◽

Author(s):

Stergios K. Doumouchtsis ◽

S. Arulkumaran ◽

Edwin Chandraharan ◽

Christina Coroyannakis ◽

...

Keyword(s):

Urinary Tract ◽

Early Pregnancy ◽

Pregnancy Complications ◽

Gestational Trophoblastic Disease ◽

Metabolic Changes ◽

Physiological Changes ◽

Trophoblastic Disease ◽

Changes In Pregnancy ◽

Physiological Changes In Pregnancy ◽

In Pregnancy

This chapter discusses pregnancy changes and early pregnancy complications. It includes physiological changes in pregnancy (cardiovascular, haematological, respiratory, renal and urinary tract, and metabolic changes), gestational trophoblastic disease (GTD), and nausea and vomiting.

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Antithrombin Deficiency in Pregnancy.

Blood ◽

10.1182/blood.v110.11.1879.1879 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1879-1879

Author(s):

Retter J. Andrew ◽

Hunt J. Beverley

Keyword(s):

Caesarean Section ◽

Post Partum ◽

Case Series ◽

Fold Increase ◽

First Trimester ◽

Antithrombin Deficiency ◽

Sagittal Sinus ◽

Asymptomatic Patients ◽

Estimated Blood Loss ◽

In Pregnancy

Abstract Background: During pregnancy untreated antithrombin deficiency is associated with up to a 50% risk of venous thromboembolism (VTE) and a relative risk of pregnancy loss of 2.1 with a 5-fold increase in stillbirths. Thus thromboprophylaxis is widely used, but little data is available to select type, dose & duration of anticoagulation. Method: We performed a retrospective, single centre observational study of our antithrombin deficient pregnancies since 1996. Results: There were 9 pregnancies in 8 women; median age at conception 33 (age-range 19–37). They separated into 3 groups (1) 4 asymptomatic patients diagnosed on family screening. They received unmonitored enoxaparin 40mg until 16 weeks then 40mg BD. (2) 2 with previous VTE, received intermediate dose enoxaparin (1mg/kg), increased to BD at 16 weeks. Monitoring was done to maintain an anti-Xa trough of <0.12 iu/ml and peak <0.8iu.ml. (3) 2 referred after presenting with VTE in pregnancy. They received enoxaparin 1mg/kg BD and the same monitoring These included a known antithrombin deficient woman, referred in her second pregnancy at 26weeks gestation with premature rupture of the membranes and an iliofemoral deep vein thrombosis which developed on enoxaparin 60mg OD. Enoxaparin was increased to 1mg/kg BD and an IVC filter inserted. Despite the filter however she had a pulmonary embolism. The filter was removed after Caesarean section at 31 weeks. Two had sagittal sinus thromboses in the first trimester associated with severe hyperemesis requiring IV fluids. One was our only thromboprophylaxis failure, receiving enoxaparin 40mg OD, she weighed 80Kg. The second presented at 11weeks gestation. She was intolerant of self injecting and so switched to warfarin at 15 weeks until 35 weeks as did one other mother. All mothers had close feto-maternal monitoring with uterine artery Doppler at 24 weeks if possible and then monthly growth scans thereafter. Delivery: Thromboprophylaxis was stopped at labour initiation or 12hrs prior to Caesarean section (3 women) and 50iu/kg of antithrombin concentrate was given. Anticoagulation was restarted 24hrs after delivery. Six weeks enoxaparin post-partum thromboprophylaxis was given or the women converted back to warfarin. Estimated blood loss at delivery was a median of 200ml (range 200–500ml), no transfusions were required. There were no post partum VTEs. Nine births occurred at a median gestation of 38weeks (range 31–41), median birth weight 3045g (range 1420–4120g). One child has West’s syndrome. Conclusion: This is the largest case series on the management of antithrombin deficiency in pregnancy. The combined use of enoxaparin in pregnancy and post partum combined with antithrombin concentrate during labour appears to improve pregnancy outcome and reduce the rate of VTE. Larger studies are required to confirm this finding.

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Successful and Safe Treatment of Chronic Spontaneous Urticaria with Omalizumab in a Woman during Two Consecutive Pregnancies

Case Reports in Medicine ◽

10.1155/2015/368053 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 18

Author(s):

Misbah Nasheela Ghazanfar ◽

Simon Francis Thomsen

Keyword(s):

Monoclonal Antibody ◽

Female Patient ◽

Chronic Urticaria ◽

Skin Disease ◽

Randomised Controlled Trials ◽

Chronic Spontaneous Urticaria ◽

Controlled Trials ◽

Safe Treatment ◽

Randomised Controlled ◽

In Pregnancy

Chronic spontaneous urticaria is an itching skin disease characterised by wheals, angioedema, or both present for more than six weeks. Omalizumab is a humanized anti-IgE monoclonal antibody recently approved for treatment of chronic urticaria. Several randomised controlled trials have investigated the safety, tolerability, and efficacy of omalizumab for chronic urticaria. The safety of omalizumab in pregnancy is not known. We describe a female patient with chronic spontaneous urticaria who was treated with omalizumab continuously through two consecutive pregnancies with convincing results and no apparent toxicity.

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Effects of in utero heat stress on subsequent reproduction performance of first-calf Holstein heifers

Spanish Journal of Agricultural Research ◽

10.5424/sjar/2020182-15721 ◽

2020 ◽

Vol 18 (2) ◽

pp. e0404

Author(s):

María I. Chavez ◽

José E. García ◽

Francisco G. Véliz ◽

Leticia R. Gaytán ◽

Ángeles De Santiago ◽

...

Keyword(s):

Heat Stress ◽

Pregnancy Rate ◽

Reproductive Performance ◽

Fold Increase ◽

In Utero ◽

Northern Mexico ◽

Reproduction Performance ◽

In Pregnancy

Aim of study: To determine the reproductive performance of heifers gestated under maternal conditions of heat stress in late gestation.Area of study: Northern Mexico (25° 32’ N, 103° 23’ W).Material and methods: The study included reproductive records of 4976 first-calf Holstein heifers in a hot environment.Main results: Heifers born to cows experiencing no heat stress three months before parturition but with a THI >83 at calving were older (p<0.05) at first calving (743 ± 67 vs. 729 ± 55 days) than heifers gestated under maternal conditions of heat stress. A two-fold increase (p<0.01) in pregnancy rate occurred in heifers gestated under maternal conditions of no heat stress during two or three months before pregnancy and no heat stress at parturition, compared with heifers gestated under maternal conditions of no heat stress. Overall, across in utero heat stress one, two or three months before calving, pregnancy rate to all services was higher (p<0.05) for first-calf heifers gestated under maternal conditions of no heat stress during delivery, compared with heifers gestated under maternal conditions of heat stress (66.7 vs. 51.1%). Median days for getting pregnant was higher (140 d) for heifers whose dams were exposed to THI >83 at calving than heifers whose mothers were exposed to <76 or 76-83 (117 and 114 d) at calving.Research highlights: These data suggest that in utero heat stress during the last three months of gestation negatively affects the reproductive performance of first-calf Holstein heifers.

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Adverse childhood experiences are associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort

10.21203/rs.3.rs-33576/v2 ◽

2020 ◽

Author(s):

Cheryl L. Currie ◽

Suzanne C Tough

Keyword(s):

Drug Use ◽

Pregnant Women ◽

Adverse Childhood Experiences ◽

Illicit Drug ◽

Illicit Drug Use ◽

Fold Increase ◽

Childhood Experiences ◽

Adverse Childhood ◽

The Impact ◽

In Pregnancy

Abstract Background: Adverse childhood experiences (ACEs) are associated with illicit drug use among pregnant women who are socioeconomically vulnerable. While it is assumed that the impact of ACEs on illicit drug use in pregnancy is reduced among women with higher socioeconomic status (SES), this assumption is not well tested in the literature. The objective of this study was to examine the impact of maternal ACEs on illicit drug use in a community-based sample of pregnant women with middle to high SES. Methods: This study is a secondary analysis of a prospective cohort study that collected data from 1,660 women during and after pregnancy in Calgary, Canada between 2008-2011 using mailed surveys. Illicit drug use in pregnancy was self-reported by women at 34-36 weeks gestation. An established scale examined maternal ACEs before 18 years. Logistic regression models and 95% confidence intervals tested associations between maternal ACE scores and illicit drug use in pregnancy. Results: Overall, 3.1% of women in this predominantly married, well-educated, middle and upper middle income sample reported illicit drug use in pregnancy. Women with 2-3 ACEs had more than a two-fold increase, and women with 4 or more ACEs had almost a four-fold increase in illicit drug use in pregnancy, relative to women with 0-1 ACEs after adjustment for confounders. Exposure to child abuse was more consistently associated with illicit drug use in pregnancy than exposure to household dysfunction in childhood. Conclusions: Maternal ACEs were common and associated with a moderate increase in the odds of illicit drug use in pregnancy among Canadian women with middle to high SES.

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Bilirubin and bile acids in the blood of pregnant women

Kazan medical journal ◽

10.17816/kazmj52934 ◽

2020 ◽

Vol 22 (2) ◽

pp. 246

Author(s):

V. Gruzdev

Keyword(s):

Pregnant Women ◽

Bile Acids ◽

Metabolic Changes ◽

In Pregnancy

Ssstrunk (Zeit. F. Geb. u. Gyn., Bd. LXXXIX. H. I) in his studies could establish in pregnant women a 35% increased bilirubin content in the blood, while during childbirth this figure rose to 71%. The author could not notice any parallelism between this phenomenon and the increased content of bile acids in the blood usually observed during pregnancy. S. sees the reason for this phenomenon in the metabolic changes inherent in pregnancy, but not in the stagnation of bile. Among the diseases of pregnant women, the author did not find an increased content of bilirubin in the blood with the "kidney of pregnant women", and with eclampsia. on the contrary, I saw a significant increase in it.

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Adverse Childhood Experiences are Associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort

10.21203/rs.3.rs-33576/v1 ◽

2020 ◽

Author(s):

Cheryl L. Currie ◽

Suzanne C Tough

Keyword(s):

Drug Use ◽

Pregnant Women ◽

Adverse Childhood Experiences ◽

Illicit Drug ◽

Illicit Drug Use ◽

Fold Increase ◽

Childhood Experiences ◽

Adverse Childhood ◽

The Impact ◽

In Pregnancy

Abstract Background: Adverse childhood experiences (ACEs) are associated with illicit drug use among pregnant women who are socioeconomically vulnerable. While it is assumed that the impact of ACEs on illicit drug use is reduced among pregnant women who are well educated and have higher socioeconomic status, this assumption has not been well tested in the literature. The objective of this study was to examine the impact of maternal ACEs on illicit drug use among pregnant women who are well-educated women, have middle to high household incomes, and seeking regular prenatal care. Findings can inform clinicians about potential associations between ACEs and drug use in pregnancy within a population that they are frequently in contact with. Methods: This study is a secondary analysis of a prospective cohort study that collected data from 1,680 women during and after pregnancy in Calgary, Canada between 2008-2011 using mailed surveys. Illicit drug use in pregnancy was self-reported by women at 34-36 weeks gestation. An established scale examined maternal ACEs before 18 years. Logistic regression models and 95% confidence intervals tested associations between maternal ACE scores and illicit drug use in pregnancy. Results: Overall, 3.3% of women in this predominantly married, well-educated, middle and upper middle income sample (mean age 31 years) reported illicit drug use in pregnancy. Women with 2-3 ACEs had more than a two-fold increase, and women with 4 or more ACEs had almost a four-fold increase in illicit drug use in pregnancy, relative to women with 0-1 ACEs after adjustment for confounders. Exposure to child abuse was more consistently associated with illicit drug use in pregnancy than exposure to household dysfunction in childhood. Conclusions: Findings combine with others to speak to the public health significance of maternal ACEs on substance use among expectant mothers across the socioeconomic spectrum; particularly child abuse. This information, can be used by women and the clinicians serving them, to better understand the role that ACEs could play in their decision to use illicit drugs in pregnancy.

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Diabetes management in pregnancy

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.1499 ◽

2011 ◽

pp. 1908-1919

Author(s):

David R. McCance

Keyword(s):

Diabetes Management ◽

Blood Glucose Control ◽

Perinatal Outcomes ◽

Fold Increase ◽

Evidence Base ◽

Fetal Outcome ◽

Background Population ◽

Therapeutic Landscape ◽

Near Term ◽

In Pregnancy

Although the outlook for the woman with diabetes has greatly improved since the discovery of insulin, the goal of the St. Vincent Declaration (1989) that the outcome of diabetic pregnancy should approximate that of nondiabetic pregnancy has still not been realized. In the mid 1990s, a number of regional UK centres reported a four-fold to ten-fold increase in congenital malformations and three- to five-fold increase in perinatal mortality, compared with the background population. A general increase in the prevalence of type 2 diabetes is being translated into the pregnancy context and outcomes appear similar to those of type 1 diabetes. The problem of pregnancy planning and other key demographic and pregnancy-related features were highlighted in a major UK Confidential Enquiry into Maternal and Child Health (CEMACH) during 2002–2003, which has provided a largely unrivalled source of reference (1). While the relevance of overt hyperglycaemia to maternal and perinatal outcomes is now clearly established, the significance of minor degrees of hyperglycaemia for maternal/fetal outcome has been the subject of much controversy and dogma. The lack of a robust evidence base is reflected in the lack of consensus among published guidelines (2). Despite these limitations, the outcome of pregnancy for most women with diabetes is good, and this undoubtedly reflects improved obstetric surveillance and better management of maternal hyperglycaemia over the last several decades. The aim is, through education and maternal empowerment, to optimize blood glucose control both before and during pregnancy, so that pregnancy may proceed as normally as possible and result in the birth of a normal baby at near term. The last few years have seen the publication of a number of landmark observational studies and randomized trials (3–8), which have the potential to alter the diagnostic and therapeutic landscape considerably. Some guidance for the management of diabetes in pregnancy has recently been published (9, 10).

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Thrombosis in pregnancy

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0269 ◽

2020 ◽

pp. 2606-2612

Author(s):

Peter K. MacCallum ◽

Louise Bowles

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Scoring Systems ◽

Fold Increase ◽

Normal Pregnancy ◽

Vein Thrombosis ◽

Clinical Scoring ◽

Pregnant State ◽

Deep Vein ◽

In Pregnancy

Pregnancy and the puerperium are associated with a 10-fold increase in the risk of venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism, compared to the non-pregnant state. Pulmonary embolism has been the leading direct cause of maternal mortality in most of the United Kingdom’s triennial Confidential Enquiries into Maternal Deaths over the past 30 years, attesting to the importance of prevention and prompt diagnosis and treatment of venous thromboembolism during pregnancy and following delivery. The diagnosis of venous thromboembolism is challenging in pregnancy because it can be difficult to distinguish features of venous thromboembolism, such as leg swelling and breathlessness, from those of normal pregnancy, and there are no validated clinical scoring systems. All women should undergo risk assessment for venous thromboembolism in early pregnancy, at the time of hospital admission or change in clinical condition, and after delivery.

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