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Pregnancy and pulmonary embolism

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https://www.readbyqxmd.com/read/28209484/successful-provision-of-inter-hospital-extracorporeal-cardiopulmonary-resuscitation-for-acute-post-partum-pulmonary-embolism
#1
C McDonald, J Laurie, S Janssens, C Zazulak, P Kotze, K Shekar
Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived...
January 9, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28208204/thrombophilic-evaluation-in-patients-with-acute-pulmonary-embolism
#2
Scott M Stevens, Jack E Ansell
Patients with acute pulmonary embolism (PE) are often tested for thrombophilias, which are hereditary and acquired conditions that predispose to thrombosis. If a hereditary condition is identified, then testing is often performed on members of the patient's family. Testing for these conditions can be complex, as the presence of acute thrombosis and antithrombotic therapies can make the results of many tests unreliable. Many risk factors for thrombosis exist that are not routinely assessed by laboratory testing, and it is likely that many hereditary thrombophilia conditions remain to be discovered...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28144025/case-report-of-s1q3t3-electrocardiographic-abnormality-in-a-pregnant-asthmatic-patient-during-acute-bronchospasm
#3
Hafiza Arshad, Rana Rahel Khan, Misbahuddin Khaja
BACKGROUND Asthma is the most common chronic pulmonary disease during pregnancy. Several previous reports have documented reversible electrocardiographic changes during severe acute asthma attacks, including tachycardia, P pulmonale, right bundle branch block, right axis deviation, and ST segment and T wave abnormalities. CASE REPORT We present the case of a pregnant patient with asthma exacerbation in which acute bronchospasm caused S1Q3T3 abnormality on an electrocardiogram (ECG). The complete workup of ECG findings of S1Q3T3 was negative and correlated with bronchospasm...
February 1, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28130684/clinical-characteristics-and-laboratory-findings-of-252-chinese-patients-with-anti-phospholipid-syndrome-comparison-with-euro-phospholipid-cohort
#4
Hui Shi, Jia-Lin Teng, Yue Sun, Xin-Yao Wu, Qiong-Yi Hu, Hong-Lei Liu, Xiao-Bing Cheng, Yu-Feng Yin, Jun-Na Ye, Pojen P Chen, Cheng-de Yang
This study aims to characterize the Chinese Han patients with anti-phospholipid syndrome (APS) and compare the data with those of the Euro-Phospholipid cohort. We conducted a single center study consisting of 252 patients with definite APS from 2000 to 2015. We analyzed the clinical and laboratory characteristics of our cohort and compared the data with those of the Euro-Phospholipid cohort. Our cohort consisted of 216 females and 36 males, with a mean age at entry into this study of 41 years (range 11-74 years)...
January 27, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28124411/imaging-for-the-exclusion-of-pulmonary-embolism-in-pregnancy
#5
REVIEW
Thijs E van Mens, Luuk Jj Scheres, Paulien G de Jong, Mariska Mg Leeflang, Mathilde Nijkeuter, Saskia Middeldorp
BACKGROUND: Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well as unnecessary anticoagulant treatment and future preventive measures. Applied imaging techniques might perform differently in these younger patients with less comorbidity and altered physiology, who largely have been excluded from diagnostic studies. OBJECTIVES: To determine the diagnostic accuracy of computed tomography pulmonary angiography (CTPA), lung scintigraphy and magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism during pregnancy...
January 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28048838/su-f-i-36-in-utero-dose-measurements-within-postmortem-subjects-for-estimating-fetal-doses-in-pregnant-patients-examined-with-pulmonary-embolism-trauma-and-appendicitis-ct
#6
I Lipnharski, N Quails, C Carranza, N Correa, S Bidari, M Bickelhaup, L Rill, M Arreola
PURPOSE: The imaging of pregnant patients is medically necessary in certain clinical situations. The purpose of this work was to directly measure uterine doses in a cadaver scanned with CT protocols commonly performed on pregnant patients in order to estimate fetal dose and assess potential risk. METHOD: One postmortem subject was scanned on a 320-slice CT scanner with standard pulmonary embolism, trauma, and appendicitis protocols. All protocols were performed with the scan parameters and ranges currently used in clinical practice...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28040140/gestational-choriocarcinoma-with-renal-and-pulmonary-metastases-lacking-a-primary-uterine-origin
#7
Hao-Ming Li, Wen-Chien Hou, Yu-Ju Lai, Chien-Chang Kao, Tai-Kuang Chao, Mu-Hsien Yu, Her-Young Su
OBJECTIVE: We describe a case of gestational choriocarcinoma metastasized to the kidney and lung, which presented initially as refractory hematuria after a term pregnancy 5 years earlier. CASE REPORT: A 35-year-old woman, G2P1, with a previous history of full-term pregnancy in 2009, presented to the emergency department complaining of intermittent gross hematuria for 2 months. Abdominal computed tomography showed a suspicious arteriovenous malformation in the right kidney and a thrombus within the right renal vein...
December 2016: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28005587/diagnosis-and-management-of-hellp-syndrome-complicated-by-liver-hematoma
#8
Agnès Ditisheim, Baha M Sibai
Subcapsular liver hematoma is a rare but potentially life-threatening complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. It may present with nonspecific signs and symptoms, none of which are diagnostic, and can mimic pulmonary embolism of cholecystitis. There is no consensus on the management of subcapsular liver hematoma. Unruptured liver hematoma can be conservatively managed. When rupture occurs, surgical, endovascular approaches and, rarely, liver transplantation, may be required...
March 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005272/prophylactic-versus-selective-blood-transfusion-for-sickle-cell-disease-in-pregnancy
#9
REVIEW
Babasola O Okusanya, Olufemi T Oladapo
BACKGROUND: Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies...
22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27975099/paradoxical-bleeding-and-thrombotic-episodes-of-dysprothrombinaemia-due-to-a-homozygous-arg382his-mutation
#10
Qiulan Ding, Likui Yang, Xiaoqing Zhao, Wenman Wu, Xuefeng Wang, Alireza R Rezaie
We have characterised the pathogenic basis of dysprothrombinaemia in a patient exhibiting paradoxical bleeding and thrombotic defects during pregnancy and postpartum. Genetic analysis revealed that the proband is homozygous for the prothrombin Arg382His mutation, possessing only ~1 % clotting activity. The proband experienced severe bleeding episodes during her pregnancy, which required treatment with prothrombin complex concentrates, and then pulmonary embolism and deep-vein thrombosis at 28 days postpartum, which required treatment with LMWH and fresh frozen plasma...
December 15, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27917690/pharmacological-management-of-pulmonary-embolism
#11
Bobby Gouin, Helia Robert-Ebadi, Marc Righini, Marc Blondon
Pulmonary embolism (PE) is a common and potentially severe manifestation of venous thromboembolism. Its management has relied on anticoagulation by vitamin K antagonists (VKA) for the past fifty years. Recently, new alternative drugs have been developed and dramatically modified both the treatment of acute PE and its secondary prevention. Areas covered: This review discusses the contemporary pharmacological treatment for PE, with a focus on anticoagulation options for non-high risk PE. In particular, the advent of direct oral anticoagulants (rivaroxaban, apixaban, edoxaban and dabigatran) and modalities for long-term prevention will be described...
January 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27913507/diagnosis-of-suspected-venous-thromboembolism
#12
Clive Kearon
The primary goal of diagnostic testing for venous thromboembolism (VTE) is to identify all patients who could benefit from anticoagulant therapy. Test results that identify patients as having a ≤2% risk of VTE in the next 3 months are judged to exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Clinical evaluation, with assessment of: (1) clinical pretest probability (CPTP) for VTE; (2) likelihood of important alternative diagnoses; and (3) the probable yield of D-dimer and various imaging tests, guide which tests should be performed...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27878206/new-findings-on-venous-thrombogenesis
#13
James R Byrnes, Alisa S Wolberg
Venous thrombosis (VT) is the third most common cause of cardiovascular death worldwide. Complications from VT and pulmonary embolism are the leading cause of lost disability-adjusted life years. Risks include genetic (e.g., non-O blood group, activated protein C resistance, hyperprothrombinemia) and acquired (e.g., age, surgery, cancer, pregnancy, immobilisation, female hormone use) factors. Pathophysiologic mechanisms that promote VT are incompletely understood, but involve abnormalities in blood coagulability, vessel function, and flow (so-called Virchow's Triad)...
November 23, 2016: Hämostaseologie
https://www.readbyqxmd.com/read/27766527/high-prevalence-of-congenital-thrombophilia-in-patients-with-pregnancy-related-or-idiopathic-venous-thromboembolism-pulmonary-embolism
#14
Makoto Ikejiri, Hideo Wada, Norikazu Yamada, Maki Nakamura, Naoki Fujimoto, Kaname Nakatani, Akimasa Matsuda, Yosihito Ogihara, Takeshi Matsumoto, Yuki Kamimoto, Tomoaki Ikeda, Naoyuki Katayama, Masaaki Ito
Congenital thrombophilia which is characterized by deficiencies in proteins such as antithrombin (AT), protein C (PC) and protein S (PS), is a major cause of venous thromboembolism (VTE). A total of 130 patients with VTE were evaluated for congenital thrombophilia based on the activity of AT, PC, or PS. Fifteen VTE patients with congenital AT deficiency (11.5 %), 16 with congenital PC deficiency (12.3 %) and eight with congenital PS deficiency (6.2 %) were diagnosed using DNA analysis. The frequency of congenital AT deficiency was significantly higher in subjects with pregnancy-related and idiopathic VTE than in those with VTE due to other causes, and congenital PC and PS deficiency were frequently associated with idiopathic VTE...
October 20, 2016: International Journal of Hematology
https://www.readbyqxmd.com/read/27764878/environmental-and-genetic-risk-factors-associated-with-venous-thromboembolism
#15
Marta Crous-Bou, Laura B Harrington, Christopher Kabrhel
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism, and a combination of environmental and genetic risk factors contributes to VTE risk. Within environmental risk factors, some are provoking (e.g., cancer, surgery, trauma or fracture, immobilization, pregnancy and the postpartum period, long-distance travel, hospitalization, catheterization, and acute infection) and others are nonprovoking (e.g., age, sex, race/ethnicity, body mass index and obesity, oral contraceptive or hormone therapy use, corticosteroid use, statin use, diet, physical activity, sedentary time, and air pollution)...
November 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27720446/use-of-clinical-prediction-rules-and-d-dimer-tests-in-the-diagnostic-management-of-pregnant-patients-with-suspected-acute-pulmonary-embolism
#16
REVIEW
L M Van der Pol, A T A Mairuhu, C Tromeur, F Couturaud, M V Huisman, F A Klok
Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy...
September 29, 2016: Blood Reviews
https://www.readbyqxmd.com/read/27673091/poster-335-pulmonary-embolism-and-other-challenges-associated-with-acute-spinal-cord-injury-during-pregnancy
#17
Jack M Smith, William McKinley
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/27644095/optimizing-survival-outcomes-for-adult-patients-with-nontraumatic-cardiac-arrest
#18
REVIEW
Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/27512501/management-of-venous-thromboembolism-secondary-to-ovarian-hyperstimulation-syndrome-a-case-report-documenting-the-first-use-of-a-superior-vena-caval-filter-for-upper-limb-venous-thromboembolism-in-pregnancy-and-the-difficulties-and-complications-relating-to
#19
Nicola Mitchell-Jones, Michael McEwan, Mark Johnson
The management of venous thromboembolism and subsequent pulmonary embolism in pregnancy remains hugely challenging. In this case, we report the first use of a superior vena caval filter in pregnancy as an adjunct to pharmacological anticoagulation. This is the first reported use of a superior vena caval filter in pregnancy. We discuss the complexities of managing thromboembolism in pregnancy and the peri-partum period.
June 2016: Obstetric Medicine
https://www.readbyqxmd.com/read/27441306/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital
#20
Elizabeth Janette Hamilton, Alistair Quentin Green, Jennifer Ann Cook, Henry Nash
This was a retrospective review of five years' data relating to patients referred to the Acute Medical Unit (AMU) of a large teaching hospital with suspected Pulmonary Embolism (PE) during pregnancy or 6 weeks postpartum. During this period, 210 patients in this group underwent half-dose perfusion scanning as investigation for possible PE and were managed via our ambulatory pathway. Pulmonary embolism was diagnosed in 5.2% of patients compared to 18% of non-pregnant patients identified in a previous audit. Half-dose Q scanning enabled exclusion of PE in almost 90% of patients without the need for further imaging...
2016: Acute Medicine
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