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Aspirin in pregnancy

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https://www.readbyqxmd.com/read/27920020/repeated-failed-non-invasive-prenatal-testing-in-a-woman-with-immune-thrombocytopenia-and-antiphospholipid-syndrome-lessons-learnt
#1
C Y Y Hui, W C Tan, E L Tan, L K Tan
We present a case of a 37-year-old Chinese woman (gravida 4 para 0) with a history of immune thrombocytopenia and type IIb antiphospholipid syndrome. She was started on 100 mg of aspirin, 20 mg of prednisolone and 20 mg of subcutaneous low-molecular-weight heparin daily for her fourth pregnancy. She opted for non-invasive prenatal testing for aneuploidy screening but had failed results three times consecutively from insufficient fetal cfDNA initially or high variance in cfDNA counts on redraws. She declined invasive karyotyping...
December 5, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27913550/prevention-of-thrombosis-in-antiphospholipid-syndrome
#2
Wendy Lim
Antiphospholipid syndrome (APS) is an acquired autoimmune condition characterized by thrombotic events, pregnancy morbidity, and laboratory evidence of antiphospholipid antibodies (aPL). Management of these patients includes the prevention of a first thrombotic episode in at-risk patients (primary prevention) and preventing recurrent thrombotic complications in patients with a history of thrombosis (secondary prevention). Assessment of thrombotic risk in these patients, balanced against estimated bleeding risks associated with antithrombotic therapy could assist clinicians in determining whether antithrombotic therapy is warranted...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27876004/enoxaparin-for-the-prevention-of-preeclampsia-and-intrauterine-growth-restriction-in-women-with-a-prior-history-an-open-label-randomised-trial-the-eppi-trial-study-protocol
#3
K M Groom, L M McCowan, P R Stone, L C Chamley, C McLintock
BACKGROUND: Preeclampsia and intrauterine fetal growth restriction (IUGR) are two of the most common causes of maternal and perinatal morbidity and mortality. Current methods of predicting those at most risk of these conditions remain relatively poor, and in clinical practice past obstetric history remains the most commonly used tool. Aspirin and, in women at risk of preeclampsia only, calcium have been demonstrated to have a modest effect on risk reduction. Several observational studies and randomised trials suggest that low molecular weight heparin (LMWH) therapy may confer some benefit...
November 22, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27872414/effect-of-low-dose-aspirin-on-midluteal-phase-uterine-artery-blood-flow-in-patients-with-recurrent-pregnancy-loss
#4
Xiaomin Kang, Tongfei Wang, Liyin He, Haijing Xu, Zhilan Liu, Aimin Zhao
OBJECTIVES: The purpose of this study was to evaluate differences in uterine artery blood flow parameters and pregnancy outcomes, if any. An investigation was conducted to determine the effects of low-dose aspirin on uterine artery blood flow indices in patients with recurrent pregnancy loss. METHODS: This observational study included 353 Chinese women with a history of recurrent pregnancy loss and 85 women without a history of recurrent pregnancy loss (control group) from Ren Ji Hospital...
December 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/27816920/preconception-use-of-pain-relievers-and-time-to-pregnancy-a-prospective-cohort-study
#5
Kathryn A McInerney, Elizabeth E Hatch, Amelia K Wesselink, Kenneth J Rothman, Ellen M Mikkelsen, Lauren A Wise
STUDY QUESTION: To what extent is preconception use of pain-relieving medication associated with female fecundability? SUMMARY ANSWER: Women who used naproxen or opioids had slightly lower fecundability than women who did not use any pain-relieving medications; use of acetaminophen, aspirin and ibuprofen was not appreciably associated with fecundability. WHAT IS KNOWN ALREADY: Over-the-counter pain-relieving medications are commonly used by women of reproductive age in the USA...
November 5, 2016: Human Reproduction
https://www.readbyqxmd.com/read/27807890/impact-of-aspirin-on-trophoblastic-invasion-in-women-with-abnormal-uterine-artery-doppler-at-11%C3%A2-%C3%A2-14-weeks-a-randomized-controlled-study-asap
#6
Elena Scazzocchio, Dani Oros, Daysi Diaz, Juan C Ramirez, Marta Ricart, Eva Meler, Rafael González de Agüero, Eduard Gratacos, Francesc Figueras
BACKGROUND: Defective trophoblastic invasion is a key feature in many of cases of preeclampsia. Uterine artery Doppler is a validated non-invasive surrogate of this trophoblastic invasion. OBJECTIVE: To explore whether low-dose aspirin administered from the first trimester improves trophoblastic invasion, evaluated by uterine Doppler, during the second and third trimesters in women defined as high-risk by abnormal uterine artery Doppler at first trimester. METHODS: This randomized Phase II study had a triple-blind, parallel-arm, controlled design...
November 3, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27807847/aspirin-for-in-vitro-fertilisation
#7
REVIEW
Charalampos S Siristatidis, George Basios, Vasilios Pergialiotis, Paraskevi Vogiatzi
BACKGROUND: Aspirin is used with the aim of optimising the chance of live birth in women undergoing assisted reproductive technology (ART), despite inconsistent evidence of its efficacy and safety (in terms of intraoperative bleeding during oocyte retrieval and risk of miscarriage). The most appropriate time to commence aspirin therapy and the length of treatment required are also still to be determined. This is the second update of the review first published in 2007. OBJECTIVES: To evaluate the effectiveness and safety of aspirin in women undergoing ART...
November 3, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27807733/aspirin-use-in-women-current-perspectives-and-future-directions
#8
REVIEW
Amy Sarma, Nandita S Scott
PURPOSE OF REVIEW: This review examines the recent literature on the use of low-dose aspirin (LDA) for primary and secondary prevention of cardiovascular disease in women, use of LDA for pre-eclampsia prevention in pregnancy, and the underutilization of aspirin therapy in women as compared to men. RECENT FINDINGS: While men and women should not differ with respect to aspirin use for secondary prevention, its role in primary prevention remains unclear for both sexes, with particular uncertainty in women...
December 2016: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/27799851/low-molecular-weight-heparin-can-benefit-women-with-recurrent-pregnancy-loss-and-sole-protein-s-deficiency-a-historical-control-cohort-study-from-taiwan
#9
Ming-Ching Shen, Wan-Ju Wu, Po-Jen Cheng, Gwo-Chin Ma, Wen-Chu Li, Jui-Der Liou, Cheng-Shyong Chang, Wen-Hsiang Lin, Ming Chen
BACKGROUND: Heritable thrombophilias are assumed important etiologies for recurrent pregnancy loss. Unlike in the Caucasian populations, protein S and protein C deficiencies, instead of Factor V Lieden and Prothrombin mutations, are relatively common in the Han Chinese population. In this study we aimed to investigate the therapeutic effect of low molecular weight heparin upon women with recurrent pregnancy loss and documented protein S deficiency. METHODS: During 2011-2016, 68 women with recurrent pregnancy loss (RPL) and protein S deficiency (both the free antigen and function of protein S were reduced) were initially enrolled...
2016: Thrombosis Journal
https://www.readbyqxmd.com/read/27799457/the-prevalence-of-thrombophilia-in-women-with-recurrent-fetal-loss-and-outcome-of-anticoagulation-therapy-for-the-prevention-of-miscarriages
#10
Rawan Nahas, Walid Saliba, Adi Elias, Mazen Elias
OBJECTIVE: To estimate the prevalence of thrombophilia in women with recurrent miscarriages and to assess the effect of antithrombotic therapy. DESIGN: A retrospective cohort study between the years 2004 and 2010. SETTING: A hypercoagulation community clinic in northern Israel. PATIENTS: Four hundred ninety pregnant women referred for thrombophilia screening. MAIN OUTCOME MEASURES: Screening results for thrombophilia and antithrombotic treatment with enoxaparin, aspirin, or both and pregnancy outcomes...
October 30, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27787594/the-long-term-management-of-children-and-adults-with-a-fontan-circulation-a-systematic-review-and-survey-of-current-practice-in-australia-and-new-zealand
#11
Ganesh K Gnanappa, David S Celermajer, Gary F Sholler, Tom Gentles, David Winlaw, Yves d'Udekem, Julian Ayer
Although long-term survival is now the norm, Fontan patients face significant morbidity and premature mortality. Wide variation exists in long-term Fontan management. With an aim of improving their long-term management, we conducted a systematic review to identify best available evidence and gaps in knowledge for future research focus. We also surveyed cardiologists in Australia and New Zealand managing Fontan patients, to determine the alignment of current local practice with best available evidence. A systematic review was conducted using strict search criteria (PRISMA guidelines), pertaining to long-term Fontan management...
October 27, 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27776934/the-antiphospholipid-syndrome-in-patients-with-systemic-lupus-erythematosus
#12
Guillermo J Pons-Estel, Laura Andreoli, Francesco Scanzi, Ricard Cervera, Angela Tincani
The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the occurrence of venous and/or arterial thrombosis and pregnancy morbidity in the presence of pathogenic autoantibodies known as antiphospholipid antibodies (aPL). APS may be associated with other diseases, mainly systemic lupus erythematosus (SLE). The presence or absence of SLE might modify the clinical or serological expression of APS. Apart from the classical manifestations, APS patients with associated SLE more frequently display a clinical profile with arthralgias, arthritis, autoimmune hemolytic anemia, livedo reticularis, epilepsy, glomerular thrombosis, and myocardial infarction...
October 21, 2016: Journal of Autoimmunity
https://www.readbyqxmd.com/read/27754808/low-dose-aspirin-and-sporadic-anovulation-in-the-eager-randomized-trial
#13
Rose G Radin, Lindsey A Sjaarda, Neil J Perkins, Robert M Silver, Zhen Chen, Laurie L Lesher, Noya Galai, Jean Wactawski-Wende, Sunni L Mumford, Enrique F Schisterman
CONTEXT: Among women with a single, recent pregnancy loss, daily preconception low-dose aspirin (LDA) increased the live birth rate with no effect on pregnancy loss. The mechanism underlying this effect is unclear, but it may work through ovulation. OBJECTIVE: We estimated the effect of LDA on the per-cycle risk of anovulation among eumenorrheic women. DESIGN: The Effects of Aspirin in Gestation and Reproduction trial, a multi-center, randomized, double-blind, placebo-controlled trial of daily LDA on reproductive outcomes...
October 18, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27741174/enoxaparin-and-aspirin-compared-with-aspirin-alone-to-prevent-placenta-mediated-pregnancy-complications-a-randomized-controlled-trial
#14
Bassam Haddad, Norbert Winer, Yvon Chitrit, Véronique Houfflin-Debarge, Céline Chauleur, Karine Bages, Vassilis Tsatsaris, Alexandra Benachi, Florence Bretelle, Jean-Christophe Gris, Sylvie Bastuji-Garin
OBJECTIVE: To evaluate whether daily enoxaparin, added to low-dose aspirin, started before 14 weeks of gestation reduces placenta-mediated complications in pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation. METHODS: In this open-label multicenter randomized trial, we enrolled consenting pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation, gestational age at randomization of 7-13 weeks, singleton pregnancy, and no plan for anticoagulation...
November 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27708976/the-clinical-significance-of-antiphospholipid-antibodies-in-systemic-lupus-erythematosus
#15
Ozan Ünlü, Stephane Zuily, Doruk Erkan
Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of systemic lupus erythematosus (SLE) patients are tested positive for aPL, which may have an impact on the SLE presentation, management, and prognosis. Compared with SLE patients without aPL, those with aPL have a higher prevalence of thrombosis, pregnancy morbidity, valve disease, pulmonary hypertension, livedo reticularis, thrombocytopenia, hemolytic anemia, acute/chronic renal vascular lesions, and moderate/severe cognitive impairment; worse quality of life; and higher risk of organ damage...
June 2016: Eur J Rheumatol
https://www.readbyqxmd.com/read/27704679/vitamin-d-pre-eclampsia-and-preterm-birth-among-pregnancies-at-high-risk-for-pre-eclampsia-an-analysis-of-data-from-a-low-dose-aspirin-trial
#16
A D Gernand, H N Simhan, K M Baca, S Caritis, L M Bodnar
OBJECTIVE: To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. DESIGN: Analysis of prospectively collected data and blood samples from a trial of prenatal low-dose aspirin. SETTING: Thirteen sites across the USA. POPULATION: Women at high risk for pre-eclampsia. METHODS: We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12-26 weeks' gestation (n = 822)...
October 5, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/27703566/early-prognostic-factors-for-the-progress-of-preeclampsia-our-experience-in-the-period-2010-2011
#17
Mariya Angelova, Ivan Todorov, Emil Kovachev
AIM: To determine the prognostic value of the low Pregnancy-associated plasma protein A (PAPP-A) levels in the early stages of pregnancy (11-13 weeks GA) independently and in combination with a Doppler test of the uterine arteries during the second half of pregnancy (22-23 weeks GA). MATERIAL AND METHODS: The study covered the period 2010-2011 and included 106 pregnant women, aged 35-40, with a single child pregnancy. The research excluded pregnant women with anomalies of the fetus, smokers and women taking prophylactically low doses of aspirin...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/27669539/association-of-nausea-and-vomiting-during-pregnancy-with-pregnancy-loss-a-secondary-analysis-of-a-randomized-clinical-trial
#18
Stefanie N Hinkle, Sunni L Mumford, Katherine L Grantz, Robert M Silver, Emily M Mitchell, Lindsey A Sjaarda, Rose G Radin, Neil J Perkins, Noya Galai, Enrique F Schisterman
Importance: Nausea and vomiting during pregnancy have been associated with a reduced risk for pregnancy loss. However, most prior studies enrolled women with clinically recognized pregnancies, thereby missing early losses. Objective: To examine the association of nausea and vomiting during pregnancy with pregnancy loss. Design, Setting, and Participants: A randomized clinical trial, Effects of Aspirin in Gestation and Reproduction, enrolled women with 1 or 2 prior pregnancy losses at 4 US clinical centers from June 15, 2007, to July 15, 2011...
September 26, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27640943/the-role-of-aspirin-dose-on-the-prevention-of-preeclampsia-and-fetal-growth-restriction-systematic-review-and-meta-analysis
#19
REVIEW
Stéphanie Roberge, Kypros Nicolaides, Suzanne Demers, Jon Hyett, Nils Chaillet, Emmanuel Bujold
BACKGROUND: Preeclampsia and fetal growth restriction are major causes of perinatal death and handicap in survivors. Randomized clinical trials have reported that the risk of preeclampsia, severe preeclampsia, and fetal growth restriction can be reduced by the prophylactic use of aspirin in high-risk women, but the appropriate dose of the drug to achieve this objective is not certain. OBJECTIVE: We sought to estimate the impact of aspirin dosage on the prevention of preeclampsia, severe preeclampsia, and fetal growth restriction...
September 15, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27630745/first-trimester-screening-for-pre-eclampsia
#20
REVIEW
Stefan C Kane
The commercial availability of tests in the first trimester of pregnancy that predict the later development of pre-eclampsia has prompted considerable debate regarding their clinical utility and the degree to which they fulfil the longstanding principles of screening. Such tests have been shown to achieve detection rates for early pre-eclampsia (requiring delivery prior to 34 weeks) of over 90%, for a false positive rate of 10%. However, their capacity to predict later onset pre-eclampsia, which accounts for the bulk of the disease burden, is much more limited...
September 2016: Obstetric Medicine
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