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Haemostasis in pregnancy

M Lambert, C Hocké, C Jimenez, S Frantz, A Papaxanthos, H Creux
OBJECTIVES: Investigate the proportion of abnormalities identified on the diagnostic assessment performed after at least two previous failed IVF attempts. Discuss the real benefit of this evaluation. METHODS: Retrospective descriptive study. Between January 2008 and January 2012, 205 couples with at least two consecutive failed IVF attempts had a diagnosis evaluation which consisted in couple's karyotypes; autoimmune and haemostasis biological check-up, pelvic ultrasound-Doppler and hysteroscopy for women...
September 14, 2016: Gynécologie, Obstétrique & Fertilité
Elvira Grandone, Elena Chinni, Michela Villani, Natale Sciannamè, Giovanni L Tiscia, Giovanni Favuzzi, Filomena Cappucci, Francesco Petruzzelli, Maurizio Margaglione
PURPOSE: In placentae from uneventful pregnancies a direct relationship between expression of tissue factor (TF) and tissue-factor pathway inhibitor type 2 (TFPI2) was found, as well as between TF and vascular endothelial growth factor (VEGF). Furthermore, placentae from gestational vascular complications (GVCs) lack these correlations. Aims of the present study are (1) to evaluate a possible role of low-molecular-weight-heparins (LMWHs) in the modulation of the expression of TF, TFPI, TFPI2 and VEGF in placentae from thrombophilic women and (2) to study the possible role of endothelium in the placental expression of markers involved in haemostasis and angiogenesis...
August 26, 2016: Archives of Gynecology and Obstetrics
Orly Lavee, Giselle Kidson-Gerber
Inherited bleeding disorders have the potential to cause bleeding complications during pregnancy, childbirth and the postpartum period as well as effect fetal outcomes. There is an evolving understanding of the need for specialised and individualised care for affected women during these times. The aim for each patient is to estimate the risk to mother, fetus and neonate; to implement measures to minimise these risks; and to anticipate complications and develop contingencies for these scenarios. This includes accurate diagnosis, preconceptual care, prenatal diagnostic options, antenatal care, delivery and postpartum care as well as care of an affected neonate...
June 2016: Obstetric Medicine
Y L Tan, H Suharjono, N L J Lau, H Y Voon
BACKGROUND: The contemporary obstetrician is increasingly put to the test by rising numbers of pregnancies with morbidly adherent placenta. This study illustrates our experience with prophylactic bilateral internal iliac artery occlusion as part of its management. METHODS: Between January 2011 to January 2014, 13 consecutive patients received the intervention prior to scheduled caesarean delivery for placenta accreta. All cases were diagnosed by ultrasonography, color Doppler imaging and supplemented with MRI where necessary...
June 2016: Medical Journal of Malaysia
Daimon P Simmons, Adrianna Z Herskovits, Elisabeth M Battinelli, Peter H Schur, Susan J Lemire, David M Dorfman
BACKGROUND: Antiphospholipid antibody syndrome (APS) is characterized by laboratory evidence of antiphospholipid antibodies (aPL) [e.g. lupus anticoagulant (LA), anticardiolipin (ACL), and/or antiβ2-glycoprotein I (aB2GPI)] in a clinical setting of thrombosis or pregnancy morbidity. The International Society on Thrombosis and Haemostasis recommends two different testing modalities to detect LA. To evaluate these recommendations in a clinical setting, our hospital, a tertiary care center with a specialized coagulation laboratory, added the dilute Russell's viper venom time to be performed in parallel with the PTT-lupus anticoagulant to detect LA...
June 15, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Billy Ming Hei Lai, John Sing Fai Shum, Chi Yeung Chung, Sherwin Shing Wai Lo, Kam Ying Lau
INTRODUCTION: To identify predictors of outcome and clinical efficacy of emergency pelvic artery embolisation (PAE) for primary postpartum haemorrhage (PPH) and to assess post-embolisation fertility of PAE in a regional hospital setting. METHODS: A 12-year retrospective study of patients undergoing emergency PAE was conducted at a regional acute general hospital. Clinical and procedural parameters, clinical outcome and post-embolisation pregnancy success rates were analysed...
April 19, 2016: Singapore Medical Journal
Birgit Linnemann, Ute Scholz, Hannelore Rott, Susan Halimeh, Rainer Zotz, Andrea Gerhardt, Bettina Toth, Rupert Bauersachs
Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational stu-dies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE...
2016: VASA. Zeitschrift Für Gefässkrankheiten
Birgit Linnemann, Rupert Bauersachs, Hannelore Rott, Susan Halimeh, Rainer Zotz, Andrea Gerhardt, Barbara Boddenberg-Pätzold, Bettina Toth, Ute Scholz
Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period...
2016: VASA. Zeitschrift Für Gefässkrankheiten
Ming Y Lim, Allison M Deal, Steven Kim, Michael D Musty, Jacqueline Conard, Paolo Simioni, Fabienne Dutrillaux, Suhair S Eid, Saskia Middeldorp, Walter M Halbmayer, Bernard Boneu, Marco Moia, Stephan Moll
The risk of thrombosis in individuals with rare compound thrombophilias, homozygous factor V Leiden (FVL) plus heterozygous prothrombin G20210A (PTM), homozygous PTM plus heterozygous FVL, and homozygous FVL plus homozygous PTM, is unknown. We identified, worldwide, individuals with these compound thrombophilias, predominantly through mailing members of the International Society on Thrombosis and Haemostasis. Physicians were sent a clinical questionnaire. Confirmatory copies of the genetic results were obtained...
October 2016: European Journal of Haematology
D Jurkovic, J Knez, A Appiah, L Farahani, D Mavrelos, J A Ross
OBJECTIVES: To assess the efficacy of ultrasound-guided suction curettage for management of pregnancies implanted into the lower uterine segment Cesarean section scar. METHODS: This was a retrospective study including women diagnosed with Cesarean section scar pregnancy at two large tertiary referral early pregnancy units between 1997 and 2014. Surgical evacuation was offered to selected women presenting in the first trimester ≤ 14 weeks' gestation. All procedures were performed transcervically under ultrasound guidance using suction curettage...
April 2016: Ultrasound in Obstetrics & Gynecology
J Chudej, I Plameňová, J Hudeček
OBJECTIVE: Bring a comprehensive overview of the available knowledge about thrombophilia in pregnat women. DESIGN: Overview study. SETTING: Departmentof Haematology and Transfusion Medicine, National Centre for Haemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia. METHODS: Analysis of literary sources. CONCLUSION: Anticoagulation may provide benefit for women both as prophylaxis and as treatment for venous thrombosis during pregnancy...
December 2015: Ceská Gynekologie
D Katz, Y Beilin
The process of haemostasis is complex and is further complicated in the parturient because of the physiological changes of pregnancy. Understanding these changes and the impact that they have on the safety profile of the anaesthetic options for labour and delivery is crucial to any anaesthetist caring for the parturient. This article analyses current theories on coagulation and reviews the physiological changes to coagulation that occur during pregnancy and the best methods with which to evaluate coagulation...
December 2015: British Journal of Anaesthesia
Michela Villani, Donatella Colaizzo, Giovanni L Tiscia, Elena Chinni, Carl'Antonio Bodenizza, Nicola Cascavilla, Elvira Grandone
Coagulation disorder associated with essential thrombocythemia may exacerbate the prothrombotic state physiologically occurring during pregnancy. We report a case of a severe postpartum haemorrhage in a 35-year-old woman previously diagnosed with essential thrombocythemia and carrying the somatic calreticulin mutation. She was referred to our Thrombosis and Haemostasis Unit for pregnancy management. A treatment with low-dose aspirin was prescribed until the labour started, as the platelets count raised above 1000 × 10/l...
September 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
J Davies, A Harper, R A Kadir
INTRODUCTION: Women with factor XI (FXI) deficiency are at an increased risk of bleeding complications at delivery. Obstetric management is complicated by a lack of correlation between FXI level and bleeding risk. AIM: The aims of this study were to assess the difference in rotational thromboelastometry (ROTEM(®) ) in parturient women with FXI deficiency compared to parturient and non-parturient controls and to evaluate the usefulness of ROTEM(®) in assessing bleeding risk at delivery in women with FXI deficiency...
November 4, 2015: Haemophilia: the Official Journal of the World Federation of Hemophilia
Michela Villani, Francesco Dentali, Donatella Colaizzo, Giovanni Luca Tiscia, Patrizia Vergura, Tiziana Petruccelli, Francesco Petruzzelli, Walter Ageno, Maurizio Margaglione, Elvira Grandone
OBJECTIVE: To evaluate in an Italian cohort the incidence of venous thromboembolic events (VTE) in pregnancies after assisted reproductive technologies (ART). SETTING: Thrombosis and Haemostasis Unit at I.R.C.C.S. 'Casa Sollievo della Sofferenza', S. Giovanni Rotondo. PARTICIPANTS: A prospective cohort of 998 women advised to undergo ART was referred by local fertility clinics from April 2002 to July 2011. Follow-up information was obtained during the check-up and/or by phone interviews...
2015: BMJ Open
Y Song, J H Shin, H-K Yoon, J W Kim, G-Y Ko, H-S Won
AIM: To evaluate safety and clinical outcomes of uterine artery embolisation (UAE) for bleeding after dilatation and curettage (D&C) performed for abortion or termination. MATERIALS AND METHODS: The outcomes were analysed in 11 patients who underwent UAE for bleeding after D&C for missed abortions (n=8), caesarean scar pregnancies (n=2), or planned termination (n=1) between October 2001 and December 2013. Angiograms and medical records were retrospectively reviewed in order to obtain the patients' baseline characteristics, technical/clinical success rate, complications, and follow-up data regarding menstruation...
December 2015: Clinical Radiology
M Sinha, R Kaur, R Gupta, R Rani, A Aggarwal
Gestational trophoblastic neoplasms (GTN) are proliferative degenerative disorders of placental elements and include complete or partial mole (90%), invasivemole (5-8%), choriocarcinoma (1-2%) and placental site tumor (1-2%). Chorioadenoma destruens is a trophoblastic tumor, characterized by myometrial invasion through direct extension or via venous channels. We present a case of invasive mole eroding uterus and uterine vasculature, causing sudden rupture of uterus with massive haemoperitoneum mimicking ectopic pregnancy...
October 2014: Kathmandu University Medical Journal (KUMJ)
R Ramakrishna, A Rehman, S Ramakrishna, W Alexander, W W Yeo
INTRODUCTION: In patients with chronic idiopathic thrombocytopenic purpura (cITP), the platelet count tends to be quite variable and, in the majority of cases, specific therapy is not warranted on a regular basis. However, patients with low platelet count (<30 nL) or with bleeding complications would require therapy, such as prednisolone, intravenous immunoglobulin infusions, splenectomy and/or immunosuppression. Romiplostim, a thrombopoietin agonist, has also proven to be useful in improving platelet counts...
July 2015: Internal Medicine Journal
Serkan Oral, Yaşam Kemal Akpak, Nilay Karaca, Ali Babacan, Kadir Savan
Heterotopic pregnancy is the simultaneous occurrence of two or more implantation sites. A 25-year-old infertile patient with a history of bilateral salpingectomy, uterine septum resection, and left cornual resection was diagnosed with heterotopic pregnancy in her second in vitro fertilization trial. She attended our clinic when she was 7-week pregnant, complaining initially of severe abdominal pain. Findings associated with peritoneal irritation were positive during the physical examination. Transvaginal ultrasound revealed right cornual ectopic pregnancy with a live fetus in the middle of the uterine cavity...
2014: Case Reports in Obstetrics and Gynecology
M Simonidesova, J Simko, K Holoman
Properly functioning coagulation in gravidity is not necessary only to provide the continuity of circulation in placenta. Today we recognize that proteins and cells of haemostasis in the maternal blood cooperate with the components of a coagulation cascade produced by embryonic trophoblast cells. Such coordination on the embryomaternal interface is necessary for an intact embryogenesis. Other findings discuss the ability of coagulation components to act also outside the hemocoagulation process, especially as signal molecules, regulators of immune reactions, cell proliferation and others...
2014: Bratislavské Lekárske Listy
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