Plasma Angiotensin-(1-7) Is Decreased in Preeclampsia

Hypertension ◽  
2000 ◽  
Vol 36 (suppl_1) ◽  
pp. 696-696
Author(s):  
K. Bridget Brosnihan ◽  
Michael Karoly ◽  
David Merrill
Keyword(s):  
Gestational Age ◽  
Previous History ◽  
Renin Angiotensin System ◽  
Normal Pregnancy ◽  
Ang Ii ◽  
Third Trimester ◽  
Bioactive Component ◽  
Plasma Angiotensin ◽  
History Of ◽  
Group A

P18 Angiotensin-(1-7)[Ang-(1-7)] is a bioactive component of the renin-angiotensin system (RAS), which has depressor, vasodilatory, and antihypertensive actions. In normal pregnancy we questioned whether the known rise in plasma Ang II is counterbalanced by an increase in plasma Ang-(1-7) and whether plasma Ang-(1-7)levels are decreased in preeclampsia and may thus be a factor involved in the development of hypertension. Nulliparous preeclamptic patients (PREE) and third trimester normotensive pregnant contols (NPC)(matched for parity, race, and gestational age) were enrolled (n=15/group). A nonpregnant group (CON)(n=15) was also included for comparison. PREE had no previous history of hypertension. Mean gestational age of preeclamptic subjects was 33.9±1.2 vs 33.7±1.2 weeks for normotensive pregnant subjects (n.s.,p=0.9). PREE subjects had significant hypertension (159±3/98±2 mmHg) and all had ≥3† proteinuria. Plasma Ang I, Ang II, and renin activity (PRA) were significantly elevated in normal pregnancy as compared to nonpregnant CON subjects; plasma Ang-(1-7) was increased by 51%(p<0.05). In PREE subjects all components of the RAS were reduced as compared to NPC; however, plasma Ang II remained elevated as compared to nonpregnant CON subjects. These studies confirm that the RAS is activated in the third trimester of normal pregnancy,including an increase in plasma Ang-(1-7)levels. In preeclampsia, the decreased levels of plasma Ang-(1-7)in the presence of persistent elevated plasma Ang II are consistent with the development of hypertension.

scholarly journals Monitoring Foetus and Neonatal Outcomes in Patients With Current or Previous History of Hyperthyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A942-A942
Author(s):  
Lakshminarayanan Varadhan ◽  
Monzoor Quader ◽  
Ayat Mohamed ◽  
Julia Uffindell ◽  
Sa’adatu Usman ◽  
...  
Keyword(s):  
Gestational Age ◽  
Care Pathway ◽  
Previous History ◽  
Multidisciplinary Care ◽  
Thyroid Function Test ◽  
Large For Gestational Age ◽  
Third Trimester ◽  
Thyroid Status ◽  
Tertiary Referral Centre ◽  
History Of

Abstract Aim: Graves’ hyperthyroidism can be associated with persistent TSH-receptor antibody (TRAB) and need for anti-thyroid drugs (ATD) during pregnancy warranting careful monitoring during pregnancy and the neonatal period. The aim of this retrospective observational study was to assess the outcomes of babies born of women with current or previous history of hyperthyroidism. Method: All women with previous or current hyperthyroidism were reviewed in the joint antenatal-endocrine clinic. Neonatal alert was instituted for all patients with positive TRAB at 20 weeks and/or requiring ATD into third trimester and included serial growth scans in third trimester, fetal medicine(FM) scan, review of neonate by paediatrician, thyroid function test(TFT) for the neonate on day 2(D2) and further tests as needed. Results: Of the 56 patients treated over a 2 year period, 31 qualified for this study. Thyroid statuses of patients were: active hyperthyroidism at conception=20; Post radioactive iodine (RAI)=4; post thyroidectomy =2; hyperthyroidism in remission prenatally=5. 24 patients were TRAB positive at 20 weeks (Strongly positive(&gt;3xnormal) =10) & 7 were TRAB negative. 16 patients required ATD into 3rd trimester, of whom 11 required until delivery. Presence of any TRAB positivity did not statistically predict continuation or withdrawal of treatment. FM scan was normal in all patients (one patient had hydronephrosis which was deemed not related to thyroid status and resolved spontaneously after birth). Growth Scans were normal in 26 patients. One patient had a large for gestational age fetus which was not related to thyroid status (patient in Graves’ remission, TRAB weakly positive, normal FM scan, normal D2 and D14 TSH in the neonate). 4 patients had small for gestational age fetuses -2 had weakly positive and 1 strongly positive TRAB; all had normal FM scans; 1 neonate had high TSH at D2 and others normal; all neonates had normal TFT at D14. None of the neonates had clinical or biochemical hyperthyroidism on D2. 12 had high TSH on D2 - 10 normalized at D14; the other 2 were discussed with tertiary referral centre, no further medical treatment was advised and normalized spontaneously. 22 had high T4 at D2; at D14, 14 normalized, 4 had persistent high T4 but normal TSH (T4 data not available on 4 but all had normal TSH). Neonates born to mothers who were using ATD at time of delivery had higher probability of having high TSH at D2 compared to those who were not (8/11 vs 4/20, p&lt;0.005). This difference was not statistically significant based on use of ATD at onset of pregnancy (10/20 vs 2/11, p=0.08). Conclusion: Our study showed that no neonates developed overt hyperthyroidism. Use of ATD, especially in third trimester, could be associated with risk of transient biochemical hypothyroidism in neonate. A coordinated multidisciplinary care pathway is required to monitor and manage this complex cohort of patients and neonates.

scholarly journals Can Co-enzyme Q10 improve the chances of conception after the age of 35?

2017 ◽  
Vol 6 (7) ◽  
pp. 2729
Author(s):  
Eman Ali Abd El Fattah
Keyword(s):  
Chromosomal Abnormalities ◽  
Normal Pregnancy ◽  
Metabolic Energy ◽  
Secondary Outcome ◽  
Slowing Down ◽  
Ovulation Stimulation ◽  
Before And After ◽  
History Of ◽  
Group A ◽  
Group B

Background: ovarian follicular quality diminishes with age, Free radicals and oxidative stress begin to accumulate in cells, aging or slowing down the metabolic energy production centers in the cell- the mitochondria. When the mitochondria cannot generate a certain amount of energy, it slows growth and proper development of the follicle making it more prone to DNA damage, including chromosomal abnormalities resulting in poor fertilization patterns, and early miscarriage. Co-enzyme Q10 (CoQ10) is a major cellular antioxidant. its tissue levels gradually decrease with age. We attempt to evaluate its protective effect on ROS-induced ovarian damage, which is one of the most important and widely accepted patho- mechanisms underlying cell ageing.Methods: 40 Participants   from El Shatby hospital infertility clinic 35 to 38 years old, with history of bad response to ovulation stimulation, were divided into two equal groups (group A given (CoQ10) 3mg|kg body weight for three cycles prior to stimulation Serum anti- mullarian hormone level was measured before and after CoQ10 administration, group B= twenty cases as control). Participants were given gonadotrophins (150 IU to 375 IU). Follicular growth was monitored by trans- vaginal ultra- sonography and serum estradiol level (E2). Ovulation trigger was achieved using 10,000 IU of human chorionic gonadotrophin.Results: The primary outcome was occurrence of normal pregnancy; secondary outcome was good response to stimulation (at least one mature follicle 18-22mm).Conclusions: CoQ10 has no significant effect on response to ovulation stimulation or on pregnancy rates.

Child Abuse and Attempted Suicide

1980 ◽  
Vol 137 (4) ◽  
pp. 319-323 ◽  
Author(s):  
Jacquie Roberts ◽  
Keith Hawton
Keyword(s):  
Child Abuse ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Previous History ◽  
Psychiatric Disturbance ◽  
At Risk Children ◽  
History Of ◽  
Group A ◽  
Marital Breakdown ◽  
The Relationship

SummaryOf a sample of families containing abused and at risk children, in 29 per cent one or both parents had attempted suicide. The rate at which the suicide attempts were repeated within a year was higher than that expected for other attempters of the same age group. A previous history of psychiatric disturbance and marital breakdown was strongly associated with the combination of child abuse and suicidal behaviour. The relationship between child abuse and attempted suicide did not appear in most cases to have been a direct one; often both forms of behaviour seemed to reflect marital difficulties.

scholarly journals Deliberate Self-Harm and the Elderly: A Volatile Combination—An Overview from the Plastic Surgery Perspective

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
J. Packer ◽  
M. A. Hussain ◽  
S. H. A. Shah ◽  
J. R. Srinivasan
Keyword(s):  
Plastic Surgery ◽  
Protective Factor ◽  
Previous History ◽  
Later Life ◽  
The Elderly ◽  
Elderly Group ◽  
History Of ◽  
Group A ◽  
Almost All ◽  
Surgery Department

Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80%) of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90%) were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life.

scholarly journals Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

2012 ◽  
Vol 8 (3) ◽  
pp. 321-324
Author(s):  
S R Tamrakur ◽  
C D Chawla
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Previous History ◽  
Cervical Length ◽  
University Teaching ◽  
Third Trimester ◽  
Cervical Cerclage ◽  
Trimester Abortion ◽  
Cervical Incompetence ◽  
History Of

Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district.  All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation.  33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-trimester abortion, of having a high suspicion of cervical incompetence after mid-trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases.  All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6222 Kathmandu Univ Med J 2010;8(3):321-24 

scholarly journals Predictive factors for developing acute cholangitis and cholecystitis in patients undergoing delayed cholecystectomy: a retrospective study

2019 ◽  
Author(s):  
Takashi Miyata ◽  
Daisuke Matsui ◽  
Yuta Fujiwara ◽  
Hiroto Saito ◽  
Yoshinao Ohbatake ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Outcomes ◽  
Intraoperative Complications ◽  
Acute Cholangitis ◽  
Previous History ◽  
Cell Counts ◽  
Number Of Patients ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background We evaluated the risk of acute cholangitis and cholecystitis while waiting for cholecystectomy for gallstones. Methods We retrospectively enrolled 168 patients who underwent cholecystectomy for gallstones after a waiting period and conservative therapy between April 2014 and March 2018 at our hospital. We compared the clinical data from 20 patients who developed acute cholangitis and cholecystitis while waiting for cholecystectomy (group A) with data from 148 patients who did not develop cholangitis and cholecystitis (group B). The risk factors for developing acute cholangitis and cholecystitis and all patients' surgical outcomes were investigated. Results Preoperatively, significant differences in age (68.6 years vs 60.7 years; p= 0.004) and the number of patients with a previous history of acute grade II or III cholecystitis (55.0% vs 10.8%; p< 0.001) and biliary drainage (20.0% vs 2.0%; p= 0.004) were observed between group A and group B, respectively. Preoperative white blood cell counts (13500/µL vs 8155/µL; p< 0.001) and serum C-reactive protein levels (12.6 mg/dL vs 5.1 mg/dL; p< 0.001) were significantly increased, and serum albumin levels (3.2 g/dL vs 4.0 g/dL; p< 0.001) were significantly decreased in group A vs group B, respectively. Gallbladder wall thickening (≥ 5 mm) (45.0% vs 18.9%; p= 0.018), incarcerated gallbladder neck stones (55.0% vs 22.3%; p= 0.005), and abscess around the gallbladder (20.0% vs 1.4%; p= 0.002) were seen significantly more frequently during imaging in group A vs group B, respectively. Furthermore, investigating patients' surgical outcomes revealed a higher conversion rate to open surgery (20.0% vs 2.0%; p= 0.004), longer operation time (137 min vs 102 min; p< 0.001), and a higher incidence of intraoperative complications (10.0% vs 0%; p= 0.014) in group A vs group B, respectively. Conclusions Our results suggest that a history of severe cholecystitis is a risk factor for developing acute cholangitis and cholecystitis in patients waiting for surgery, and a risk factor for increased surgical difficulty.

scholarly journals EFFECTS OF ORAL FLUIDS AND INTRAVENOUS FLUIDS IN THE IMPROVEMENT OF AMNIOTIC FLUID INDEX DURING THIRD TRIMESTER OF PREGNANCY

2021 ◽  
Vol 71 (1) ◽  
pp. 179-83
Author(s):  
Mehwish Malik ◽  
Samina Irshaad ◽  
Nadia Ahmed Bokhari ◽  
Wardah Ajaz Qazi ◽  
Asia Raza ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Sampling Technique ◽  
Intravenous Fluids ◽  
Third Trimester ◽  
Amniotic Fluid Index ◽  
Singleton Pregnancy ◽  
Oral Fluids ◽  
Group A ◽  
Group B

Objective: To assess the effects of oral fluids and intravenous fluids in terms of frequency of improving Amniotic Fluid Index during third trimester of pregnancy having oligohydramnios.Study Design: Comparative prospective survey. Place and Duration of Study: Obstetrics and Gynaecological Department of Fauji Foundation HospitalRawalpindi, from Apr 2018 to Oct 2018. Methodology: A total of 100 patients with singleton pregnancy (50 in each group) at gestational age of 28-37weeks and AFI of 5cm or less than 5cm were included. Non probability consecutive sampling technique wasused. Ethics approval from hospital ethical committee and research board was taken. Patients were randomizedinto 2 groups (50 patients each) by lottery method. Group A was instructed to drink 2 liters of water per day fora time period of seven days and patients in group B was given 2 liters of 5% D/W which was in addition to theirnormal fluids intake. Amniotic fluid index was measured pre hydration and post hydration in both groups. Datawas analyzed using SPSS-21. Results: Mean age of the patients was 33.62 ± 5.45 years and 34.70 ± 4.76 years for groups A and B respectively.In group A and group B mean gestational age was 34.28 ± 1.85 weeks vs 34.32 ± 1.82 weeks. In group A, 44 (88%)..............

Upregulation of renin-angiotensin system and downregulation of kallikrein in obstructive nephropathy

1993 ◽  
Vol 264 (5) ◽  
pp. F874-F881 ◽  
Author(s):  
S. S. el-Dahr ◽  
J. Gee ◽  
S. Dipp ◽  
B. G. Hanss ◽  
R. C. Vari ◽  
...  
Keyword(s):  
Renin Angiotensin System ◽  
Plasma Renin ◽  
Obstructive Nephropathy ◽  
Mrna Levels ◽  
Ang Ii ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Kininase Ii ◽  
Plasma Angiotensin ◽  
Renin Mrna

The purpose of this study was to delineate the effects of prolonged (1 and 5 wk) unilateral ureteral obstruction (UUO) on the intrarenal renin-angiotensin and kallikrein-kinin systems in the rat. Systolic blood pressure (SBP) and plasma angiotensin (ANG) II levels were significantly higher at 1 and 5 wk of obstruction than in sham-operated groups. Also, plasma renin activity and ANG I levels were elevated at 1 wk (P < 0.05), and plasma angiotensin-converting enzyme (ACE)-kininase II activity was elevated at 5 wk (P < 0.05). Blockade of ANG II receptors with losartan (Dup 753) prevented the rise in SBP after UUO and normalized SBP in chronically hypertensive UUO rats. Renin mRNA levels and ANG II content were elevated in the obstructed kidneys at 1 and 5 wk compared with sham-operated kidneys (P < 0.05). ACE-kininase II activity was elevated in both the obstructed and contralateral kidneys at 5 wk compared with sham-operated kidneys (P < 0.05). In marked contrast to renin, total immunoreactive kallikrein contents and tissue kallikrein mRNA levels in the obstructed kidneys were reduced to 25% of sham-operated kidneys both at 1 and 5 wk (P < 0.001). The results indicate that urinary obstruction activates renin and suppresses kallikrein gene expression. Activation of ACE-kininase II by UUO also serves to enhance intrarenal ANG II generation and kinin degradation. The results implicate ANG II overproduction and kinin deficiency in the pathogenesis of UUO-induced hypertension and intrarenal vasoconstriction.

Abstract 548: Reduced Urinary Angiotensinogen Excretion in Preeclampsia

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Mohammad N Uddin ◽  
Darijana Horvat ◽  
Steven R Allen ◽  
Richard O Jones ◽  
Thomas J Kuehl
Keyword(s):  
Urinary Excretion ◽  
Rat Model ◽  
Renin Angiotensin System ◽  
Normal Pregnancy ◽  
Systemic Hypertension ◽  
Hypertensive Disorder ◽  
Ang Ii ◽  
Urinary Angiotensinogen ◽  
Desoxycorticosterone Acetate ◽  
Student’S T

Objective: Preeclampsia (preE) is a hypertensive disorder of pregnancy. We reported the suppression of circulatory renin-angiotensin system (RAS) in a rat model of preE. Urinary angiotensinogen has been considered as an indicator of intrarenal angiotensin status in hypertension. Little is known about the urinary angiotensinogen in preE. This study evaluates the level of urinary excretion of angiotensinogen in preE to assess the RAS status. Methods: Normal pregnant (n=57) and preE (n=32) patients were recruited from Scott & White Hospital and had their blood drawn between 21 to 40 weeks of pregnancy. Criteria for diagnosis of preE included blood pressure >140/90 mm Hg and proteinuria >300 mg of protein/24h. Two groups of rats were used: normal pregnant (n=10) and preE rats (n=10) which were given weekly injections of desoxycorticosterone acetate and 0.9% saline to drink. Urinary angiotensinogen levels and the plasma AngII levels were assayed by ELISA. The kidney expression of (pro)renin receptor, AT 1 receptor, AT 2 receptor, and renin for the two groups of rats was measured by western blot. Results are expressed as means with SD and comparisons made using Student’s t test with p<0.05 considered significant. Results: In preE patients, the mean urinary excretion of angiotensinogen (2.0 ± 1.1 ng/mg creatinine) differed (p<0.05) from that in patients with normal pregnancy (2.7 ± 1.5 ng/mg creatinine). The urinary excretion of angiotensinogen (PreE: 1.5 ± 0.3, NP: 2. 3 ± 0.4 nmol/day) also differed (p<0.05) in preE rats compared to NP. The plasma concentration of Ang II for preE rats (25 ± 3 fmol/ml) differed (p<0.05) compared to NP rats (39 ± 5 fmol/ml). The kidney expression of (pro)renin receptor was downregulated (p=0.008), while the AT 1 receptor was upregulated (p=0.01) in preE rats compared to NP. However, the kidney expression of AT 2 receptor (1.0 vs 1.1) and renin (1.0 vs 1.4) were similar in NP and PDS rats (p=0.63 and p=0.12, respectively). Conclusions: We demonstrated that urinary excretion of angiotensinogen is reduced in both patients with preE and in a rat model of preE. The kidney expression of RAS components was either downregulated or remained unchanged in preE rats. This finding indicates that preE is an Ang-II independent form of systemic hypertension.

Elevated Prothrombin Fragment F1+2 Levels during Pregnancy in Women with Previous Venous Thromboembolism.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1055-1055
Author(s):  
Rainer B. Zotz ◽  
Andrea Gerhardt ◽  
Steffi Marzotko ◽  
Karl J. Wagner ◽  
Hans G. Bender ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Mixed Model ◽  
Previous History ◽  
Normal Pregnancy ◽  
Prothrombin Fragment ◽  
History Of ◽  
Additional Approach ◽  
A Prospective Study ◽  
Over Time

Abstract Changes in blood coagulation and fibrinolysis during pregnancy create a state of hypercoagulability. This phenomenon predisposes to venous thromboembolism. Indicators of hypercoagulation in normal pregnancy are circulating thrombin-antithrombin complexes and increased levels of prothrombin fragment 1+2. A significant positive correlation between gestational age and elevated prothrombin fragment 1+2 has been shown. We hypothesized that women with previous venous thromboembolism are at a higher hypercoagulable state during subsequent pregnancies than women without prior thrombotic complications. In a prospective study, we determined prothrombin fragment F1+2 over pregnancy among 109 women (175 measurements) with previous venous thromboembolism, and among 75 pregnant women (75 measurements) without previous venous thromboembolism. The prothrombin fragment F1+2 levels were statistically analyzed over time using a Mixed Model. This model allows a longitudinal analysis of the influence of a between-subjects factor (e.g. history of thrombosis) on prothrombin fragment F1+2 levels, the influence of a within-subjects factor (weeks of gestation) on prothrombin fragment F1+2 levels, and the interaction of the history of thrombosis and weeks of gestation representing a change of risk factor-dependent differences over time (weeks of gestation). Among women with a previous history of venous thrombosis, prothrombin fragment F1+2 values were significantly higher during the course of pregnancy than among pregnant women without venous thromboembolism (p=0.0014). The results were adjusted for the physiological increase of prothrombin fragment F1+2 over pregnancy and were independent of heparin prophylaxis. Thus, determination of indicators of hypercoagulation like prothrombin fragment F1+2 represent an additional approach independent of known and unknown risk determinants of thrombosis to identify women at risk for venous thromboembolism during pregnancy.

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