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https://www.readbyqxmd.com/read/29627779/low-dose-warfarin-maternal-anticoagulation-and-fetal-warfarin-syndrome
#1
Ana R Sousa, Rita Barreira, Edmundo Santos
Fetuses exposed to warfarin during pregnancy are at an increased risk of developing an embryopathy known as fetal warfarin syndrome or warfarin embryopathy. The most consistent anomalies are nasal hypoplasia and stippling of vertebrae or bony epiphyses. Management of pregnant patients on anticoagulation is challenging. Current guidelines suggest the use of warfarin if the therapeutic dose is ≤5 mg/day. We report the case of a newborn with signs of warfarin embryopathy born from a mother anticoagulated with warfarin due to mechanical mitral and aortic heart valves...
April 7, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29608495/medical-management-of-rheumatic-heart-disease-a-systematic-review-of-the-evidence
#2
E Anne Russell, Warren F Walsh, Ben Costello, Alex Ja McLellan, Alex Brown, Christopher M Reid, Lavinia Tran, Graeme P Maguire
Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990-2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular (LV) dysfunction, rate control in mitral stenosis (MS), atrial fibrillation (AF), anticoagulation, infective endocarditis prophylaxis and management in pregnancy...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29590159/motivations-of-women-in-uganda-living-with-rheumatic-heart-disease-a-mixed-methods-study-of-experiences-in-stigma-childbearing-anticoagulation-and-contraception
#3
Andrew Y Chang, Juliet Nabbaale, Haddy Nalubwama, Emmy Okello, Isaac Ssinabulya, Christopher T Longenecker, Allison R Webel
BACKGROUND: Rheumatic heart disease (RHD) is a leading cause of premature mortality in low- and middle-income countries (LMICs). Women of reproductive age are a unique and vulnerable group of RHD patients, due to increased risk of cardiovascular complications and death during pregnancy. Yet, less than 5% of women of childbearing age with RHD in LMICs use contraceptives, and one in five pregnant women with RHD take warfarin despite known teratogenicity. It is unclear whether this suboptimal contraception and anticoagulant use during pregnancy is due to lack of health system resources, limited health literacy, or social pressure to bear children...
2018: PloS One
https://www.readbyqxmd.com/read/29576632/maternal-thrombophilia-and-recurrent-miscarriage-is-there-evidence-that-heparin-is-indicated-as-prophylaxis-against-recurrence
#4
Ana-Luisa Stefanski, Christoph Specker, Rebecca Fischer-Betz, Wolfgang Henrich, Ekkehard Schleussner, Thomas Dörner
Background: Recurrent miscarriage, also referred to as recurrent spontaneous abortion (RSA), affects 1 - 5% of couples and has a multifactorial genesis. Acquired and congenital thrombophilia have been discussed as hemostatic risk factors in the pathogenesis of RSA. Method: This review article was based on a selective search of the literature in PubMed. There was a special focus on the current body of evidence studying the association between RSA and antiphospholipid syndrome and hereditary thrombophilia disorders...
March 2018: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/29562788/retrievable-inferior-vena-cava-filter-utilization-in-obstetric-patients
#5
Amihai Rottenstreich, Yosef Kalish, Uriel Elchalal, Alexander Klimov, Allan I Bloom
OBJECTIVES: To evaluate patterns of use and outcomes of retrievable inferior vena cava filters (rIVCF) in obstetric patients. METHODS: A single center review of consecutive patients who underwent rIVCF placement during pregnancy/postpartum in 2005-2016. A pooled analysis of the relevant cases in the English literature was conducted. RESULTS: The current cohort comprised 24 women, median age 27 [interquartile range 24-30] years. Among 10 filters placed during pregnancy, the most common indication (n = 4) was the need to withhold anticoagulation therapy before delivery, in the presence of acute thrombosis...
March 21, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29556149/mechanical-mitral-valve-replacement-during-the-2nd-trimester-of-pregnancy
#6
Anas Boulemden, Gemma L Malin, Suzanne V F Wallace, Amr Mahmoud, William H T Smith, Adam A Szafranek
We report the case of a 44-year-old pregnant woman who was diagnosed with symptomatic severe mitral stenosis that did not respond to optimal medical therapy and balloon valvuloplasty. After a multidisciplinary team discussion on the timing and risks of interventions and postoperative optimization of peripartum anticoagulation, the patient underwent mechanical mitral valve replacement during the 2nd trimester of pregnancy. The outcome was excellent for the mother and the infant. This case emphasizes the importance of a multidisciplinary approach in managing unusual cases...
February 2018: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/29541874/update-on-antiphospholipid-syndrome-ten-topics-in-2017
#7
REVIEW
Ilaria Cavazzana, Laura Andreoli, Maarteen Limper, Franco Franceschini, Angela Tincani
PURPOSE OF REVIEW: This review focuses on new clinical aspects of antiphospholipid syndrome (APS) in the last 5 years. RECENT FINDINGS: The pathogenesis of APS is related to endothelial activation by mechanisms other than autoantibody-mediated massive coagulation. These include Toll-like receptors, the m-TORC pathway, and neutrophil activation, inducing an uncontrolled inflammatory cascade. Given these new pathogenetic hypotheses, the treatment of APS could be directed towards a fine balance between anticoagulation and immunomodulation...
March 15, 2018: Current Rheumatology Reports
https://www.readbyqxmd.com/read/29538673/recurrent-pregnancy-loss-evaluation-combined-with-24-chromosome-microarray-of-miscarriage-tissue-provides-a-probable-or-definite-cause-of-pregnancy-loss-in-over-90-of-patients
#8
F Popescu, C R Jaslow, W H Kutteh
STUDY QUESTION: Will the addition of 24-chromosome microarray analysis on miscarriage tissue combined with the standard American Society for Reproductive Medicine (ASRM) evaluation for recurrent miscarriage explain most losses? SUMMARY ANSWER: Over 90% of patients with recurrent pregnancy loss (RPL) will have a probable or definitive cause identified when combining genetic testing on miscarriage tissue with the standard ASRM evaluation for recurrent miscarriage...
March 12, 2018: Human Reproduction
https://www.readbyqxmd.com/read/29532744/associations-between-maternal-clinical-features-and-fetal-outcomes-in-pregnancies-of-mothers-with-connective-tissue-diseases
#9
Ayako Ohyama, Hiroto Tsuboi, Hisashi Noma, Mayu Terasaki, Masaru Shimizu, Hirofumi Toko, Fumika Honda, Mizuki Yagishita, Hiroyuki Takahashi, Hiromitsu Asashima, Shinya Hagiwara, Yuya Kondo, Isao Matsumoto, Takayuki Sumida
OBJECTIVES: The purpose of this study is to clarify associations between maternal clinical features and adverse pregnancy outcomes (APOs) in mothers with connective tissue diseases (CTDs). METHODS: We retrospectively examined maternal clinical features including backgrounds, autoantibodies, CTD flare-ups, and therapies during pregnancies as well as fetal outcomes in 90 pregnancies (66 mothers) at our hospital from January 2006 to September 2016. RESULTS: Underlying CTDs were SLE (N = 41), MCTD (N = 10), RA (N = 15), SS (N = 10), and others (N = 14)...
March 13, 2018: Modern Rheumatology
https://www.readbyqxmd.com/read/29531735/portal-vein-thrombosis-after-cesarean-section-in-a-patient-on-prolonged-bed-rest-due-to-threatened-preterm-labor
#10
Arata Hibi, Kazumasa Mogi
Portal vein thrombosis is a rare but life-threatening complication during pregnancy and postpartum period. Color Doppler ultrasound is useful for prompt diagnosis. Although the risk of complications should be considered, successful pregnancy with comorbid portal vein thrombosis is possible with appropriate anticoagulation therapy and close monitoring.
March 2018: Clinical Case Reports
https://www.readbyqxmd.com/read/29523280/can-thrombophilia-worsen-maternal-and-perinatal-outcomes-in-cases-of-severe-preeclampsia
#11
Fernanda Spadotto Baptista, Maria Rita de Figueiredo Lemos Bortolotto, Fabiola Roberta Marim Bianchini, Vera Lucia Jornada Krebs, Marcelo Zugaib, Rossana Pulcinelli Vieira Francisco
OBJECTIVE: To evaluate whether thrombophilia worsens maternal and foetal outcomes among patients with severe preeclampsia (PE). METHOD: From October 2009 to October 2014, an observational retrospective cohort study was performed on pregnant women with severe PE diagnosed before 34 weeks of gestation and their newborns hospitalized at the Clinics Hospital, FMUSP. Patients who had no heart disease, nephropathies, pre-gestational diabetes, gestational trophoblastic disease, foetal malformation, or twin pregnancy and who underwent thrombophilia screening during the postnatal period were included...
January 2018: Pregnancy Hypertension
https://www.readbyqxmd.com/read/29516548/malignant-atrophic-papulosis-with-motor-aphasia-and-intestinal-perforation-a-case-report-and-review-of-published-works
#12
Pan Hu, Zhi Mao, Chao Liu, Xin Hu, Hongjun Kang, Feihu Zhou
Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil...
March 8, 2018: Journal of Dermatology
https://www.readbyqxmd.com/read/29515307/nail-patella-syndrome-a-rare-cause-of-nephrotic-syndrome-in-pregnancy
#13
I N Aboobacker, A Krishnakumar, S Narayanan, B Hafeeque, J C Gopinathan, F Aziz
Nail-Patella syndrome (NPS) is an inherited disease with characteristic nail, limb, and renal anomalies. While almost all patients manifest classical skeletal and nail abnormalities, renal involvement is seen in only 40% of patients. Asymptomatic proteinuria is the most common renal presentation. Although a substantial number of patients can progress to nephrotic range proteinuria, development of end-stage kidney disease is rare. Pathological abnormalities are appreciable only by electron microscopy. Our patient who had not been diagnosed with NPS previously presented with new-onset proteinuria during the second trimester of her first pregnancy...
January 2018: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/29510235/treatment-of-antiphospholipid-syndrome-beyond-anticoagulation
#14
Chrisanna Dobrowolski, Doruk Erkan
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder marked by thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). At the present time, treatment is primarily focused on anticoagulation. However, there is increasing awareness of the mechanisms involved in APS pathogenesis, which has led to the trial of novel therapies targeting those mechanisms. Following a brief review of the etiopathogenesis of and current management strategies in APS, this paper focuses on the evidence for these potential, targeted APS treatments, e...
March 3, 2018: Clinical Immunology: the Official Journal of the Clinical Immunology Society
https://www.readbyqxmd.com/read/29490410/effect-of-additional-treatments-combined-with-conventional-therapies-in-pregnant-patients-with-high-risk-antiphospholipid-syndrome-a-multicentre-study
#15
Amelia Ruffatti, Marta Tonello, Ariela Hoxha, Savino Sciascia, Maria J Cuadrado, José O Latino, Sebastian Udry, Tatiana Reshetnyak, Nathalie Costedoat-Chalumeau, Nathalie Morel, Luca Marozio, Angela Tincani, Laura Andreoli, Ewa Haladyj, Pier L Meroni, Maria Gerosa, Jaume Alijotas-Reig, Sara Tenti, Karoline Mayer-Pickel, Michal J Simchen, Maria T Bertero, Sara De Carolis, Véronique Ramoni, Arsène Mekinian, Elvira Grandone, Aldo Maina, Fátima Serrano, Vittorio Pengo, Munther A Khamashta
The effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal-foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal-foetal complications (Group II)...
February 28, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29471673/identifying-additional-risk-factors-for-thrombosis-and-pregnancy-morbidities-among-antiphospholipid-antibodies-carriers
#16
Yu Zuo, Jennifer Fan, Ravi Sarode, Song Zhang, Una E Makris, David R Karp, Yu-Min Shen
The evaluation of thrombotic and pregnancy risks associated with antiphospholipid antibodies (aPL)in individual patients without antiphospholipid syndrome (APS) clinical manifestation is challenging. Our aim is to identify additional risk factors or potential candidate "second hits" for APS clinical events in a large cohort of ethnically diverse aPL-positive patients. We included 219 consecutive aPL-positive patients who attended clinic at our institution. All patients had at least 1 persistent high titer (≥99 percentiles) aPL...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29470181/prevention-and-management-of-thromboembolism-in-pregnancy-when-heparins-are-not-an-option
#17
Andra H James
Heparins, unfractionated heparin, and low molecular weight heparin, are the preferred anticoagulants in pregnancy. There are circumstances, however, in which an alternative to heparin should be considered. These circumstances include, the presence of heparin resistance, a heparin allergy manifesting as heparin-induced skin reactions or heparin-induced thrombocytopenia, and the presence of a mechanical heart valve. From time to time, the obstetrician is called on to make recommendations about anticoagulants in pregnancy, including in circumstances in which an alternative to heparin has been suggested or is necessary...
February 21, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29458733/fertility-and-pregnancy-in-women-with-transfusion-dependent-thalassemia
#18
REVIEW
Katie T Carlberg, Sylvia T Singer, Elliott P Vichinsky
As more women with transfusion-dependent thalassemia are seeking pregnancy, ensuring the best outcomes for both the mother and baby requires concerted, collaborative efforts between practitioners and the family. Proactive counseling, early fertility evaluation, recent developments in reproductive technology, and optimal management of iron overload, have resulted in more successful pregnancies and the birth of healthy newborns. With advances in technology for prenatal screening and increased awareness to perform screening for hemoglobinopathies, healthy pregnancy outcomes have become the expectation...
April 2018: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/29451664/update-on-antiphospholipid-antibody-syndrome
#19
Michelle Remião Ugolini Lopes, Adriana Danowski, Andreas Funke, Jozelia Rêgo, Roger Levy, Danieli Castro Oliveira de Andrade
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by antiphospholipid antibodies (aPL) associated with thrombosis and/or pregnancy morbidity. Most APS events are directly related to thrombotic events, which may affect small, medium or large vessels. Other clinical features like thrombocytopenia, nephropathy, cardiac valve disease, cognitive dysfunction and skin ulcers (called non-criteria manifestations) add significant morbidity to this syndrome and represent clinical situations that are challenging...
November 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/29436886/anti-xa-based-dose-changes-during-low-molecular-weight-heparin-anticoagulation-for-mechanical-prosthetic-heart-valves-during-pregnancy
#20
Eleanor Snape, Jecko Thachil, Bernard Clarke, Sarah Vause
No abstract text is available yet for this article.
February 13, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
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