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Pregnancy and pulmonary embolism

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https://www.readbyqxmd.com/read/29305367/embolic-stroke-in-a-postpartum-patient-with-fontan-physiology
#1
Katherine VanHise, Linda Li, Emily Smith, Niamh Condon
In cardiac physiology, single ventricle typically refers to the presence of a dominant systemic ventricle along with a hypoplastic ventricle. The Fontan operation is used to repair the single ventricle by directing deoxygenated systemic venous flow to the pulmonary arterial circulation. Normal pregnancy physiology, particularly increased intravascular volume, increased heart rate, increased cardiac output, hypercoagulability and decreased systemic vascular resistance, can exacerbate cardiac disease in patients with Fontan circulation, leading to pregnancy complications...
January 5, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29212594/-false-positive-troponin-i-due-to-heterophile-antibodies
#2
Henrik Nørlund, Ann Bovin
The troponin I (TnI) level is essential in the diagnosis of acute myocardial infarction, but may be elevated by other cardial and non-cardial causes. We report a 32-year-old pregnant woman admitted to hospital because of chest pain and dyspnoea. TnI levels were significantly elevated, although there was no suspicion of acute coronary syndrome or myocarditis, and supplementary diagnostics excluded pulmonary embolism. The TnI level was found to be falsely elevated due to immunoassay interference. We stress the need to be aware of the possibility of false positive TnI, especially during pregnancy...
December 4, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29187254/acute-disseminated-melioidosis-giving-rise-to-pneumonia-and-renal-abscesses-complicated-with-thrombotic-thrombocytopenic-purpura-in-a-post-partum-woman-a-case-report
#3
Piyumi Sachindra Alwis Wijewickrama, Rohini Weerakoon
BACKGROUND: Melioidosis is an established endemic infection in Sri Lanka, caused by Burkholderia pseudomallei, a gram negative bacterium distributed in saprophytes in soil and surface water. Main mode of transmission is via percutaneous inoculation. Pneumonia is the most common presentation in acute disease. CASE PRESENTATION: We report a 33 year old previously healthy Sinhalese female with an occupational exposure to surface water in paddy fields, who was on postpartum day 6 following an uncomplicated pregnancy and delivery via an elective caesarian section...
November 29, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29182088/perinatal-maternal-mortality-in-sickle-cell-anemia-two-case-reports-and-review-of-the-literature
#4
Sanaa Rizk, Elizabeth D Pulte, David Axelrod, Samir K Ballas
As outcomes of patients with sickle cell anemia improve and survival into adulthood with good quality of life and expectation of long-term survival becomes more common, challenges have developed, including issues related to reproduction. Pregnancy is frequently complicated in patients with sickle cell anemia with mortality up to 4.0%. Here we report maternal perinatal mortality in two women with sickle cell anemia who died post-partum due to acute chest syndrome (ACS), caused by bone marrow fat embolism and review the literature pertinent to this subject...
November 28, 2017: Hemoglobin
https://www.readbyqxmd.com/read/29170876/venous-thromboembolism-in-assisted-reproductive-technologies-comparison-between-unsuccessful-versus-successful-cycles-in-an-italian-cohort
#5
Michela Villani, Giovanni Favuzzi, Pasquale Totaro, Elena Chinni, Gennaro Vecchione, Patrizia Vergura, Lucia Fischetti, Maurizio Margaglione, Elvira Grandone
Pregnancies after assisted reproductive technologies (ART) have been associated with an increased risk of venous thromboembolism (VTE). On the contrary, the magnitude of this risk in unsuccessful ART cycles (not resulting in a clinical pregnancy) has not yet been clearly defined. In this study, we evaluated the incidence of VTE in unsuccessful cycles and compared it with that recorded in successful cycles in the same study population. From a cohort of 998 women consecutively referred by local Fertility Clinics to our Atherosclerosis and Thrombosis Unit (April 2002-July 2011), we identified and included women with at least one cycle of ovarian stimulation and a negative history for VTE...
November 23, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29170316/19%C3%A2-accuracy-of-biomarkers-for-venous-thromboembolism-in-pregnancy-the-diagnosis-of-pulmonary-embolism-in-pregnancy-dipep-biomarker-study
#6
Steve Goodacre, Beverley Hunt, Kiran Parmar, Neil Shephard, Kimberley Horspool
OBJECTIVE: To estimate the accuracy of biomarkers for venous thromboembolism (VTE) in pregnant and postpartum women with suspected pulmonary embolism (PE). DESIGN: Observational cohort study augmented with additional cases with VTE. SETTING: Emergency departments and maternity units at eleven prospectively recruiting sites. PARTICIPANTS: Pregnant or postpartum women presenting with suspected PE or diagnosed DVT. INTERVENTIONS: Research nurses/midwives collected a blood sample from women with suspected PE or diagnosed DVT and data relating to diagnostic imaging, treatment and adverse outcomes...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170307/10%C3%A2-decision-analysis-modelling-of-diagnostic-strategies-for-suspected-pulmonary-embolism-in-pregnancy-the-dipep-economic-evaluation
#7
Daniel Pollard, Steve Goodacre, Matthew Stevenson, Gordon Fuller
BACKGROUND: Using diagnostic imaging for suspected pulmonary embolism (PE) in pregnancy involves weighing the benefits, harms and costs of different approaches to selecting women for imaging. OBJECTIVES: To estimate the effectiveness of diagnostic strategies for PE in pregnancy and postpartum, in terms of adverse outcomes from venous thromboembolism, bleeding and radiation exposure, and cost effectiveness, measured as the incremental cost per quality-adjusted life year (QALY)...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29169973/-maternal-death-by-venous-thromboembolic-disease
#8
M Rossignol, E Morau, M Dreyfus
Pregnancy and postpartum are very high-risk periods for venous thromboembolism events (TEE), which seems to extend far beyond the classical 6-8 weeks after childbirth. Pulmonary embolism (PE) is one of the 3 main causes of direct maternal death in western countries. Between 2010 an 2012 in France, 24 deaths were related to PE giving a maternal mortality ratio of 1/100,000, which is not different from the former report (2007-2009). PE is responsible of 9% of maternal deaths, in equal position with postpartum hemorrhage and amniotic fluid embolism...
November 20, 2017: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/29143222/quantitative-analysis-of-the-level-of-readability-of-online-emergency-radiology-based-patient-education-resources
#9
David R Hansberry, Michael D'Angelo, Michael D White, Arpan V Prabhu, Mougnyan Cox, Nitin Agarwal, Sandeep Deshmukh
PURPOSE: The vast amount of information found on the internet, combined with its accessibility, makes it a widely utilized resource for Americans to find information pertaining to medical information. The field of radiology is no exception. In this paper, we assess the readability level of websites pertaining specifically to emergency radiology. METHODS: Using Google, 23 terms were searched, and the top 10 results were recorded. Each link was evaluated for its readability level using a set of ten reputable readability scales...
November 15, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/29141890/british-thoracic-society-clinical-statement-on-pulmonary-arteriovenous-malformations
#10
Claire L Shovlin, Robin Condliffe, James W Donaldson, David G Kiely, Stephen J Wort
Pulmonary arteriovenous malformations (PAVMs) are structurally abnormal vascular communications that provide a continuous right-to-left shunt between pulmonary arteries and veins. Their importance stems from the risks they pose (>1 in 4 patients will have a paradoxical embolic stroke, abscess or myocardial infarction while life-threatening haemorrhage affects 1 in 100 women in pregnancy), opportunities for risk prevention, surprisingly high prevalence and under-appreciation, thus representing a challenging condition for practising healthcare professionals...
December 2017: Thorax
https://www.readbyqxmd.com/read/29109853/mesenteric-vein-thrombosis-following-impregnation-via-in-vitro-fertilization-embryo-transfer
#11
Masaaki Hirata, Hiroko Yano, Tomoe Taji, Yoshiharu Shirakata
Pregnancy is an acquired hypercoagulable state. Most patients with thrombosis that develops during pregnancy present with deep vein leg thrombosis and/or pulmonary embolism, whereas the development of mesenteric vein thrombosis (MVT) in pregnant patients is rare. We report a case of MVT in a 34-year-old woman who had achieved pregnancy via in vitro fertilization-embryo transfer (IVF-ET). At 7 wk of gestation, the patient was referred to us due to abdominal pain accompanied by vomiting and hematochezia, and she was diagnosed with superior MVT...
October 27, 2017: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/29066439/pulmonary-hypertension-and-pregnancy-outcomes-insights-from-the-national-inpatient-sample
#12
Erin Thomas, Jie Yang, Jianjin Xu, Fabio V Lima, Kathleen Stergiopoulos
BACKGROUND: Pregnant women with pulmonary hypertension (PH) are at risk for adverse cardiac outcomes, particularly at the time of labor and delivery. The purpose of this study is to define the impact of PH on pregnancy outcomes and the risk of major adverse cardiac events (MACE). METHODS AND RESULTS: The National Inpatient Sample was screened for hospital admissions of women delivering during the years 2003 to 2012. The primary outcome was MACE, a composite of death, cardiac arrest, cardiogenic shock, myocardial infarction, respiratory failure, arrhythmia, stroke, and embolic event...
October 24, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28987552/is-infection-an-independent-risk-factor-for-venous-thromboembolism-a-population-based-case-control-study
#13
Kevin P Cohoon, Aneel A Ashrani, Daniel J Crusan, Tanya M Petterson, Kent R Bailey, John A Heit
BACKGROUND: The independent association of recent infection with venous thromboembolism is uncertain. The purpose of the study was to test both overall infection (site unspecified) and specific infection sites as potential risk factors for deep vein thrombosis and pulmonary embolism adjusting for other known venous thromboembolism factors. METHODS: Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident deep vein thrombosis or pulmonary embolism over the 13-year period, 1988-2000 (cases; n=1303), and 1-2 residents without venous thromboembolism matched to each case on age, sex and incident venous thromboembolism date (controls; n=1494)...
October 4, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28984372/adverse-maternal-and-birth-outcomes-in-women-admitted-to-hospital-for-hyperemesis-gravidarum-a-population-based-cohort-study
#14
Linda Fiaschi, Catherine Nelson-Piercy, Jack Gibson, Lisa Szatkowski, Laila J Tata
BACKGROUND: Evidence for risks of adverse maternal and birth outcomes in women with hyperemesis gravidarum (HG) is predominantly from small studies, unknown, or conflicting. METHODS: A population-based cohort study using secondary health care records (Hospital Episode Statistics covering all of England from 1997 to 2012) was used to calculate odds ratios (OR) with 99% confidence intervals (CI) for the association between HG hospital admission and adverse outcomes, adjusting for maternal and pregnancy confounders...
October 6, 2017: Paediatric and Perinatal Epidemiology
https://www.readbyqxmd.com/read/28954835/retrospective-uk-multicentre-study-of-the-pregnancy-outcomes-of-women-with-a-fontan-repair
#15
Matthew Cauldwell, Philip J Steer, Samantha Bonner, Omar Asghar, Lorna Swan, Kenneth Hodson, Catherine E G Head, Adam Daniel Jakes, Nicola Walker, Margaret Simpson, Aidan P Bolger, Farah Siddiqui, Katherine M English, Lucy Maudlin, Dilip Abraham, Andrew J Sands, Aarthi R Mohan, Stephanie L Curtis, Louise Coats, Mark R Johnson
BACKGROUND: The population of women of childbearing age palliated with a Fontan repair is increasing. The aim of this study was to describe the progress of pregnancy and its outcome in a cohort of patients with a Fontan circulation in the UK. METHODS: A retrospective study of women with a Fontan circulation delivering between January 2005 and November 2016 in 10 specialist adult congenital heart disease centres in the UK. RESULTS: 50 women had 124 pregnancies, resulting in 68 (54...
September 27, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28935434/diagnosis-of-venous-thromboembolism-in-pregnancy
#16
Wee-Shian Chan
The diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) during pregnancy still relies on objective imaging. Ancillary testing such as clinical prediction rules and D-dimer testing may have a role in excluding both DVT and PE in these pregnant patients even as we await results from prospective management studies. The anatomical distribution of DVT in pregnancy differs from those in non-pregnant patient with a greater propensity for proximal iliac vein thrombosis. Using leg ultrasonography with compression maneuvers from the femoral vein to popliteal vein and doppler assessment of the iliac vein in a single examination, appears adequate in most pregnant women with suspected DVT, in excluding DVT...
September 5, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28930373/venous-thromboembolism-in-obese-pregnant-women-approach-to-diagnosis-and-management
#17
Ann Kinga Malinowski, Dorota Bomba-Opoń, Jacqueline Parrish, Urszula Sarzyńska, Dan Farine
Venous thromboembolism (VTE) remains among the leading causes of maternal mortality in the developed world, presenting variably as deep vein thrombosis (DVT), pulmonary embolism (PE) or cerebral vein thrombosis (CVT), among others. Obesity in particular has been recognized as the principal contributing factor to the risk of VTE in pregnancy and with the global increase in the rates of obesity affecting reproductive age women, heightened awareness of the risk and consequences of VTE in this population are vital...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28913590/challenges-of-anticoagulation-therapy-in-pregnancy
#18
REVIEW
Annemarie E Fogerty
Thrombotic complications in pregnancy represent a major cause of morbidity and mortality. Pregnancy is a primary hypercoagulable state due to enhanced production of clotting factors, a decrease in protein S activity, and inhibition of fibrinolysis. These physiologic changes will yield a collective rate of venous thromboembolism (VTE) of about 1-2 in 1000 pregnancies for the general obstetric population, which represents a five- to tenfold increased risk in pregnancy compared to age-matched non-pregnant peers...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28891082/thrombolysis-for-massive-pulmonary-embolism-in-pregnancy
#19
Mojdeh S Heavner, Min Zhang, Chelsea E Bast, Lindsey Parker, Rachel F Eyler
Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Nonpregnant patients who develop PE with hypotension or show signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics, and all data available in this population are published as case reports or case series...
September 11, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28885339/role-of-chemotherapy-and-thrombolysis-in-treatment-of-choriocarcinoma-accompanied-with-pulmonary-embolism-a-case-report-with-literature-review
#20
Mei Yang, Li Peng
RATIONALE: Choriocarcinoma accompanied with pulmonary embolism (PE) is rare and difficult to diagnose and treat. There are about 25 cases reported in literature, which presented variable clinical characteristics and prognosis. PATIENT CONCERNS: We reported a case of choriocarcinoma presenting PE as the first manifestation in a 26-year-old Chinese female. DIAGNOSES: Four months before her admission to our hospital, she presented to a local hospital with respiratory manifestations, and was first diagnosed as bronchitis and treated with antibiotics without improvement, and subsequently suspected of having pulmonary tuberculosis and receive anti-tuberculosis therapy, with no response...
September 2017: Medicine (Baltimore)
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