scholarly journals The use of thrombolytic therapy in pregnancy

2013 ◽  
Vol 6 (3) ◽  
pp. 105-111 ◽  
Author(s):  
Eric J Gartman
Keyword(s):  
Pregnant Women ◽  
Clinical Trial Data ◽  
Mechanical Valve ◽  
Pregnant Patient ◽  
Primary Treatment ◽  
Published Data ◽  
Thrombolytic Agents ◽  
Hemodynamic Compromise ◽  
Increased Risk ◽  
In Pregnancy

The relative hypercoagulable state of pregnancy leads to an increased risk of thrombotic complications, of which some may be life-threatening or medically devastating. In the non-pregnant patient, the current guidelines suggest thrombolysis as the primary treatment in acute ischemic stroke, myocardial infarction when percutaneous intervention is unavailable, certain cases of mechanical valve thrombosis, and pulmonary embolism with hemodynamic compromise or shock. Given that clinical trial data regarding thrombolytic use in pregnant women are absent due to exclusion, the goal of this review is to summarize the available published data regarding the use of thrombolytic agents and subsequent outcomes and complications in pregnant women. Overall, the use of thrombolytic agents in pregnancy is associated with a relatively low reported complication rate, especially given the severe medical conditions for which they are indicated. The data would suggest that thrombolysis should be considered for appropriate indications similar to that of non-pregnant patients. However, caution should be exercised when drawing conclusions regarding maternal and fetal safety, given the lack of controlled clinical trials including pregnant women and the nature of the weak evidence level of the cumulative data presented in this review.

First epidemiological data for venotonics in pregnancy from the EFEMERIS database

2015 ◽  
Vol 31 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Isabelle Lacroix ◽  
Anna-Belle Beau ◽  
Caroline Hurault-Delarue ◽  
Claire Bouilhac ◽  
Dominique Petiot ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Adverse Pregnancy Outcome ◽  
Pregnancy Termination ◽  
Newborn Health ◽  
Control Group ◽  
Published Data ◽  
Intrauterine Death ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
In Pregnancy

Objective There are few published data about possible effects of veinotonics in pregnant women. The present study investigates potential adverse drug reactions of veinotonics in pregnancy. Method EFEMERIS is a database including prescribed and dispensed reimbursed drugs during pregnancy (data from Caisse Primaire d’Assurance Maladie) and outcomes (data from Maternal and Infant Protection Service and Antenatal diagnostic Centre). Women who delivered from 1 July 2004 to December 2007 in Haute-Garonne and were registered in the French Health Insurance Service have been included in the EFEMERIS database. We compared pregnancy outcomes and newborn health between women exposed to veinotonics during pregnancy and unexposed women. Results We found that 8998 women (24%) had received at least one prescription for venotonic agents during their pregnancy, corresponding to the period of organogenesis in 1200 cases. We compared data for these women with those for the 27,963 women for whom these drugs were not prescribed during pregnancy. The most widely used veinotonics were hesperidin, diosmin and troxerutin. Pregnancies led to 98.4% versus 93.6% of live births, 0.2% versus 0.2% of postnatal deaths and 1.6% versus 6.4% of pregnancy termination (miscarriage, ectopic pregnancy, medical termination, intrauterine death) in exposed and non-exposed groups, respectively. The risks of pregnancy termination (HR = 0.71 (0.60–0.84)) and prematurity (HR = 0.82 (0.73–0.93)) remained significantly lower in the women exposed to venotonics than in unexposed women. In the group of newborns whose mother had a prescription of veinotonics during organogenesis, 39 out of 1200 (3.4%) had a malformation versus 789 (3.0%) in the control group (ORa = 1.134 (0.873–1.472)). The risk of neonatal diseases was not increased by exposure to venotonic agents in the third trimester (4.9% versus 6.1% for the controls, ORa = 1.07 (0.95–1.20)). Conclusion We found no increased risk of adverse pregnancy outcome among women exposed to veinotonics compared with unexposed pregnant women.

scholarly journals Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study

2021 ◽  
pp. 1753495X2110125
Author(s):  
Jonathan S Zipursky ◽  
Deva Thiruchelvam ◽  
Donald A Redelmeier
Keyword(s):  
Cohort Study ◽  
Postpartum Depression ◽  
Pregnant Women ◽  
Odds Ratio ◽  
Population Based ◽  
Relative Increase ◽  
Organic Disease ◽  
Increased Risk ◽  
Clinical Clue ◽  
In Pregnancy

Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress. We examined whether electrocardiogram testing in pregnant women is associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered in Ontario, Canada comparing women who received a prenatal ECG to women who did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom 157,352 (5%) received an electrocardiogram during prenatal care. Receiving an electrocardiogram test was associated with a one-third relative increase in the odds of postpartum depression (odds ratio 1.34; 95% confidence interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum depression suggests a possible link of organic disease with mental illness, and emphasizes that cardiovascular symptoms may be a clinical clue to the presence of an underlying mood disorder.

scholarly journals Thyroid disorders in subfertility and early pregnancy

2020 ◽  
Vol 11 ◽  
pp. 204201882094585
Author(s):  
Samantha Anandappa ◽  
Mamta Joshi ◽  
Lukasz Polanski ◽  
Paul V. Carroll
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Current Knowledge ◽  
Thyroid Autoimmunity ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Increased Risk ◽  
Hormone Use ◽  
Current Knowledge Base ◽  
In Pregnancy

Disorders of thyroid function are common in pregnancy and have implications for foetal and maternal health. Thyroid autoimmunity, as evidenced by the presence of elevated levels of anti-thyroid antibodies (anti-TPO and anti-Tg antibodies) is associated with an increased risk of miscarriage, though the mechanism remains poorly understood. There has been considerable focus on the implications and optimal management of pregnant women with thyroid disease, especially those undergoing assisted reproduction. Pregnancy results in significant changes in thyroid physiology and these need to be understood by clinicians involved in the care of pregnant women. Guidelines for the use of thyroxine and target thyroid function tests have been produced by international bodies but it is recognised that these predominantly reflect expert opinion rather than established evidence-based practice. Importantly a number of key clinical trials have been performed to aid understanding, particularly of the consequences of hypothyroidism for mother and baby, and the effectiveness of thyroid hormone use in autoimmune and subclinical hypothyroidism. This review summarises the current knowledge base and guidance for practice relating to thyroid disorders in pregnancy and subfertility.

scholarly journals Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting

2020 ◽  
Vol 17 (6) ◽  
pp. 2034 ◽  
Author(s):  
Gillian S. Gould ◽  
Alys Havard ◽  
Ling Li Lim ◽  
Ratika Kumar ◽  
Keyword(s):  
Smoking Cessation ◽  
Health Outcomes ◽  
Pregnant Women ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Systematic Reviews ◽  
Nicotine Replacement ◽  
Increased Risk ◽  
Pertinent Data ◽  
In Pregnancy

The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother’s and child’s health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.

scholarly journals Anticoagulation for the Pregnant Patient with a Mechanical Heart Valve, No Perfect Therapy: Review of Guidelines for Anticoagulation in the Pregnant Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Aaron Richardson ◽  
Stuart Shah ◽  
Ciel Harris ◽  
Garry McCulloch ◽  
Patrick Antoun
Keyword(s):  
Heart Valve ◽  
Thrombotic Event ◽  
Alternative Therapy ◽  
Mechanical Heart Valve ◽  
Mechanical Valve ◽  
Pregnant Patient ◽  
First Trimester ◽  
Subsequent Pregnancy ◽  
Mechanical Valves ◽  
Increased Risk

Heart valve replacement with a mechanical valve requires lifelong anticoagulation. Guidelines currently recommend using a vitamin K antagonist (VKA) such as warfarin. Given the teratogenic effects of VKAs, it is often favorable to switch to heparin-derived therapies in pregnant patients since they do not cross the placenta. However, these therapies are known to be less effective anticoagulants subjecting the pregnant patient to a higher chance of a thrombotic event. Guidelines currently recommend pregnant women requiring more than 5 mg a day of warfarin be switched to alternative therapy during the first trimester. This case report highlights a patient who was switched to alternative therapy during her first pregnancy and suffered a devastating cerebrovascular accident (CVA). Further complicating her situation was during a subsequent pregnancy; this patient continued warfarin use during the first trimester and experienced multiple transient ischemic attacks (TIAs). This case highlights the increased risk of thrombotic events in pregnant patients with mechanical valves. It also highlights the difficulty of providing appropriate anticoagulation for the pregnant patient who has experienced thrombotic events on multiple anticoagulants.

scholarly journals COVID-19 OUTCOMES IN PREGNANCY: A REVIEW OF 275 SCREENED STUDIES

2021 ◽  
Author(s):  
Rupalakshmi Vijayan ◽  
Hanna Moon ◽  
Jasmine Joseph ◽  
Madiha Zaidi ◽  
Chhaya Kamwal ◽  
...  
Keyword(s):  
Literature Review ◽  
Pregnant Women ◽  
Direct Evidence ◽  
Case Series ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
World Health ◽  
Increased Risk ◽  
Immunological Changes ◽  
In Pregnancy

In December 2019, a novel strain of severe acute respiratory syndrome (SARS-CoV-2), was declared as a cause of respiratory illness, called coronavirus 2019 (COVID-19), characterized by fever and cough. In diagnostic imaging, the afflicted population showed pathognomonic findings of pneumonia. What started out as an epidemic in China, rapidly spread across geographical locations with a significant daily increase in the number of affected cases. According to the World Health Organization (WHO) reports, the range of worldwide mortality is 3 to 4%. Maternal adaptations and immunological changes predispose pregnant women to a prolonged and severe form of pneumonia, which results in higher rates of maternal, fetal, and neonatal morbidity and mortality. There is limited data about the consequences of COVID-19 in pregnancy, thereby limiting the prevention, counseling, and management of these patients. The objective of this literature review is to explore pregnancy and perinatal outcomes of COVID-19, complications, morbidity, and mortality in this sub-population. We conducted a literature review pertaining to COVID-19 and pregnancy in databases such as: PubMed, Google Scholar, and Science Direct. The studies we chose to focus on were systematic reviews, meta-analysis, case series, and case reports. Twenty four articles were reviewed regarding COVID-19 and pregnancy, complications and their outcomes. Due to immunological changes during pregnancy as evidenced by the flaring of auto-immune diseases; pregnant women may be at an increased risk for infection. Women (19.7%) who had underlying comorbidities such as gestational DM, HTN, hypothyroidism, and autoimmune disease, COPD, or HBV infection were considered high risk. The most common maternal outcomes were premature rupture of membranes (PROM) and pre-eclampsia. Asthma was the most common comorbidity associated with maternal mortality. The most common neonatal complications were fetal distress leading to NICU admissions and preterm birth <37 weeks. The most common laboratory changes were elevated CRP and lymphocytopenia. Most patients underwent C-section due to their underlying comorbidities. Pregnant and lactating women did not shed viral particles through their vaginal mucus and milk, as evidenced by negative nucleic-acid tests of these secretions. Neonatal infections as demonstrated by positive RT-PCR were rare, but direct evidence supporting intrauterine transmission was not confirmed. Direct evidence indicating vertical transmission of COVID-19 is not available, but risk for transmission cannot be ruled out. Pregnant women should be closely monitored due to increased risk of adverse outcomes.

scholarly journals Prevalence of asymptomatic Plasmodium falciparuminfection, anaemia and use of ITNs among pregnant women yet to receive IPTp in parts of southern Ghana

2020 ◽  
pp. 36-42
Author(s):  
Leslie L Afutu ◽  
Johnson N Boampong ◽  
Neils B Quashie
Keyword(s):  
Pregnant Women ◽  
Parasite Density ◽  
Intermittent Preventive Treatment ◽  
Malaria In Pregnancy ◽  
Asymptomatic Malaria ◽  
Nested Polymerase Chain Reaction ◽  
Increased Risk ◽  
The Mean ◽  
To Receive ◽  
In Pregnancy

Background: Asymptomatic malaria in pregnancy evades most fever-based surveillance systems yet causes significant morbidities such as anaemia in the pregnant woman and low birth weight in the neonate. Objective:This study determined the prevalence of asymptomatic malaria and its association with anaemia among pregnant women who are yet to receive their first dose of Sulphadoxine-Pyrimethamine (SP) as intermittent preventive treatment of malaria in pregnancy (IPTp). Information on the use of insecticide treated nets(ITNs)as vector control by the pregnant women was also sought. Methods: This is a cross-sectional hospital-based study conducted in the Western Region of Ghana. Pregnant women at gestational ages, 16-26 wkwere included. A structured questionnaire was used to collect vital information from the participants. Plasmodiumparasitaemia was determined by rapid diagnostic test (MRDT), microscopy and species-specific nested polymerase chain reaction (PCR). Anaemia was classified using the level of haemoglobin. Results: A total of 413 antenatal clinic attendants were recruited. Prevalence of asymptomatic Plasmodium falciparuminfection was 13.1% by MRDT, 10.1% by microscopy and 13.8% by PCR. The mean haemoglobin was 10.73g/dL. Prevalence of anaemia was 40.49% and the mean parasite density was 149.6 parasite/μL. Pregnant women with asymptomatic malaria were 4 times more at risk of being anaemic (adjusted odds ratio with 95% confidence interval: 4.42, 1.82 -10.70)than those who did not have malaria. There was statistically significant negative correlation between parasite density and anaemia (r=0.0028, p=0.02). Conclusion: Asymptomatic P. falciparuminfection was found among some of the pregnant women and the presence of the parasites make them 4 times at increased risk of developing anaemia. Anaemia when occurring amongst such women was significantly worsened by increasing parasitaemia.

scholarly journals Planning for a cohort study to investigate the impact and management of influenza in pregnancy in a future pandemic

2015 ◽  
Vol 3 (6) ◽  
pp. 1-48 ◽  
Author(s):  
Marian Knight ◽  
Peter Brocklehurst ◽  
Pat O’Brien ◽  
Maria A Quigley ◽  
Jennifer J Kurinczuk
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Influenza Pandemic ◽  
Influenza Infection ◽  
H1n1 Influenza ◽  
Steering Committee ◽  
Pandemic Strain ◽  
Increased Risk ◽  
The Impact ◽  
In Pregnancy

BackgroundEvidence from the 2009 A/H1N1 influenza pandemic demonstrated that pregnant women are particularly vulnerable to infection and at an increased risk of death. Active data collection through the UK Obstetric Surveillance System (UKOSS) about women admitted to hospital during the 2009 A/H1N1 pandemic was used to inform ongoing clinical guidance regarding the use of antiviral treatment for pregnant women and demonstrated that, in addition to an increased risk of maternal morbidity, influenza infection in pregnancy is associated with poor perinatal outcomes, including an increased risk of stillbirth and preterm birth. This evidence influenced the decision to offer routine influenza immunisation to pregnant women. Even in a non-epidemic period, pregnant women continue to die from influenza.ObjectiveTo establish, and then to put into hibernation, the study mechanisms needed to mount a rapid investigation of the impact of pandemic influenza in pregnancy in the event of a newly emerging pandemic strain.DesignA new UKOSS cohort study was designed, based on the 2009–10 study, and following consultation with the Pandemic Flu Planning Group at the Royal College of Obstetricians and Gynaecologists and the UKOSS Steering Committee, to identify potential previously unanswered questions.SettingUK maternity units.ParticipantsAll pregnant women admitted to hospital with influenza in a future pandemic.Main outcome measuresManagement of pregnant women with influenza infection, intervention rates, treatment and pregnancy outcome for both the mother and fetus.ResultsThe study was designed and approved by the UKOSS Steering Committee and then placed into hibernation for activation in the event of an influenza pandemic.ConclusionsPregnant women, as a result of their changed immunological status, appear to be particularly susceptible to infection, including from influenza. The existence of the UKOSS enabled us to rapidly mount a study of pregnant women who were hospitalised with 2009 A/H1N1 influenza. Minor modifications to incorporate previously unanswered questions and our previous study enabled us to design, and then put into hibernation, a new study ready to investigate the impact and management of influenza in pregnancy, which is poised for activation in the event of a newly emerging pandemic strain. This will enable real-time data to be available on which to base rapid changes in clinical management as the as-yet-unforeseen pandemic unfolds. In the event of an influenza pandemic the study will be available to be immediately activated following expedited regulatory approvals.Trial registrationCurrent Controlled Trials ISRCTN44137563.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Insulin-stimulated adiponectin secretion in pregnancy is mediated by inhibition of adiponectin ubiquitination and degradation and is impaired in obesity

2021 ◽  
Author(s):  
Irving L. M. H. Aye ◽  
Fredrick J. Rosario ◽  
Anita Kramer ◽  
Oddrun Kristiansen ◽  
Trond M. Michelsen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Gestational Diabetes ◽  
Er Stress ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Molecular Mechanisms ◽  
Placental Function ◽  
Increased Risk ◽  
In Pregnancy

ABSTRACTIn pregnancy, adiponectin serves as an endocrine link between maternal adipose tissue, placental function and fetal growth, with low adiponectin promoting placental function and fetal growth. Circulating adiponectin levels are decreased in obese pregnant women and in gestational diabetes, which is believed to contribute to the insulin resistance and increased risk of fetal overgrowth associated with these conditions. However, the molecular mechanisms governing adiponectin secretion from maternal adipose tissues in pregnancy are poorly understood. Using visceral adipose tissue from lean and obese pregnant mice, we show that obesity in pregnancy is associated with adipose tissue inflammation, ER stress, insulin resistance, increased adiponectin ubiquitination and decreased total abundance of adiponectin. Moreover, adiponectin ubiquitination was increased in visceral fat of obese pregnant women as compared to lean pregnant women. We further observed that insulin prevents, whereas ER stress and inflammation promote, adiponectin ubiquitination and degradation in differentiated 3T3-L1 adipocytes. We have identified key molecular pathways regulating adiponectin secretion in pregnancy. This information will help us better understand the mechanisms controlling maternal insulin resistance and fetal growth in pregnancy and may provide a foundation for the development of strategies aimed at improving adiponectin production in pregnant women with obesity or gestational diabetes.

scholarly journals Perinatal outcome in hypertensive disorder of pregnancy in a rural community of Haryana

2019 ◽  
Vol 6 (10) ◽  
pp. 4267
Author(s):  
Bharti . ◽  
Sumit Chawla
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Perinatal Outcome ◽  
Statistical Tests ◽  
Mode Of Delivery ◽  
Hypertensive Disorder ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
In Pregnancy

Background: Pregnancy in hypertension may complicate pregnancies with variable incidence among different settings. Pregnancies complicated with hypertensive disorders are associated with increased risk of adverse fetal, neonatal and maternal outcome including preterm birth, intrauterine growth retardation (IUGR), perinatal death etc. The present study was undertaken to study the perinatal outcome of hypertension in pregnancy in a rural block of Haryana.Methods: This cross-sectional study was carried out in the all the 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Pregnancy outcome was followed-up by contacting the health worker of respective sub-center or mother. Information regarding stillbirth, abortion, maturity, birth weight, mode of delivery and early neonatal death was collected. Appropriate statistical tests were used for analysis.Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Hypertension in pregnancy is significantly associated with premature births still births (6.7% vs 1.4%; p=0.003), low birth weight (26.7% vs 4.9%; p=0.000) and early neonatal deaths (8.3% vs 2.8%; p=0.017).Conclusions: Perinatal mortality is significantly high in mothers with hypertensive disorders. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

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