Serial D-Dimer in Pregnancy Women with a History of Fetal Loss Syndrome and Invitro Fertilization

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4366-4366
Author(s):  
Tubagus Djumhana Atmakusuma ◽  
Raden Muharam
Keyword(s):  
Pregnant Women ◽  
Umbilical Artery ◽  
Conflicts Of Interest ◽  
Post Partum ◽  
Fetal Loss ◽  
Assay Method ◽  
Chromogenic Assay ◽  
History Of ◽  
High Level ◽  
D Dimer

Abstract Abstract 4366 Background We have reported in abstract P-Th-374 in a 2011 Kyoto ISTH Congress that an increased level of D-dimer in combination with umbilical artery systolic diastolic (UASD) ratio can be used as a timing to start with prophylactic anticoagulants In women with pregnancy failure, regardles of the antibody antiphospholipids (APAs) level, history of fetal loss syndrome or invitro fertilization (IVF). The question is: Are there any differences of a serial D-dimer level if is compared to the APAs level, history of fetal loss syndrome and IVF?. Methods. A retrospective Cohort study was conducted on a total sampling subjects of pregnancy women who visited two hospitals in Jakarta, Indonesia, at a periode of January 2009 – December 2010. Serial D-dimer using chromogenic assay method (cut off normal level < 500 ng/ml) was tested during antenatal and post partum period. The data were analysed to compare a mean D-dimer with the level of APAs (ACA IgG/IgM, AntiB2GP1 IgG/IgM) tested using ELISA method, a history of fetal loss syndrome and IVF conception Results Of 83 pregnant women,19 women with high level of APAs (subgroup 1) showed a mean D-dimer level as follows: Trimester I: 892.15 ± 785.15 ng/ml, trimester II: 782.59 ± 440.53 ng/ml, trimester III:1282.62 ± 601.22 ng/ml, post partum 1367.45 ± 581.19 ng/ml; 31 women with normal APAs (subgroup 2) showed: Trimester I: 666.23 ± 396.24 ng/ml, trimester II: 896.66 ± 396.24 ng/ml, trimester II: 896.66 ± 496.32 ng/ml, trimester III: 1313.45 ± 850.20 ng/ml, post partum: 1991.75 ± 1388.70 ng/ml; 33 women with no data of APAs (subgroup 3) showed: Trimester I: 568.47 ± 482.70 ng/ml, trimester 2: 797.95 ± 934.59 ng/ml, trimester III: 966.89 ± 862.10 ng/ml, post partum: 1078.50 ± 836.29 ng/ml Of 83 pregnant women, 47 women who have experienced 1 or ≥ 1 abortion or IUFD (subgroup 4) showed D-dimer level as follows: Trimester I:493.09 ± 385.89 ng/ml, trimester II: 740.23 ± 564.99 ng/ml, trimester III: 859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Meanwhile, 36 women who have no history of fetal loss (subgroup 5) showed: Trimester I: 892.17± 593.47 ng/ml, trimester II: 930.57± 807.02 ng/ml, trimester III: 1439.71 ± 932.12 ng/ml, post partum 1695.16 ± 1131.56 ng/ml. Of 83 pregnant women, 10 women who became pregnant after embryo transfer of IVF (subgroup 6) showed: Trimester I: 493.09± 385.895 ng/ml, trimester II: 740.23± 564.99 ng/ml, trimester III:859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Conclusion Either in subgroup 1, 2, 3,4,5 and 6 mean D-dimer tend to increase from trimester I to trimester II and from trimester II to trimester III, except in subgroup 1 from trimester I to trimester II of pregnancy. Meanwhile, all groups showed a higher mean D-dimer post partum compared to antenatal period. Disclosures: No relevant conflicts of interest to declare.

Serial D-dimer in Pregnant Women Compared to Antiphospholipid-antibodies Level, a History of Fetal Loss Syndrome and Invitro Fertilization

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4364-4364
Author(s):  
Tubagus Djumhana Atmakusuma
Keyword(s):  
Pregnant Women ◽  
Conflicts Of Interest ◽  
Post Partum ◽  
Fetal Loss ◽  
Assay Method ◽  
Chromogenic Assay ◽  
Group 2 ◽  
High Level ◽  
D Dimer ◽  
Group 1

Abstract 4364 Background We have reported in abstract P-Th-374 in a 2011 Kyoto ISTH Congress that an increased level of D-dimer in combination with umbilical artery systolic diastolic (UASD) ratio can be used as a timing to start with prophylactic anticoagulants In women with pregnancy failure, regardles of the antibody antiphospholipids (APAs) level. The question is: Are there any differences of a serial D-dimer level if is compared to the APAs level?. Methods. A retrospective Cohort study was conducted on a total sampling subjects of pregnancy women who visited two hospitals in Jakarta, Indonesia, at a periode of January 2009 – December 2010. Serial D-dimer using chromogenic assay method (cut off normal level < 500 ng/ml) was tested during antenatal and post partum period. The data were analysed to compare a mean D-dimer with the level of APAs (ACA IgG/IgM, AntiB2GP1 IgG/IgM) tested using ELISA method Results Of 83 pregnant women,19 women with high level of APAs (group 1) showed a mean D-dimer level as follows: Trimester I: 892.15 ± 785.15 ng/ml, trimester II: 782.59 ± 440.53 ng/ml, trimester III:1282.62 ± 601.22 ng/ml, post partum 1367.45 ± 581.19 ng/ml; 31 women with normal APAs (group 2) showed: Trimester I: 666.23 ± 396.24 ng/ml, trimester II: 896.66 ± 396.24 ng/ml, trimester II: 896.66 ± 496.32 ng/ml, trimester III: 1313.45 ± 850.20 ng/ml, post partum: 1991.75 ± 1388.70 ng/ml; 33 women with no data of APAs (group 3) showed: Trimester I: 568.47 ± 482.70 ng/ml, trimester 2: 797.95 ± 934.59 ng/ml, trimester III: 966.89 ± 862.10 ng/ml, post partum: 1078.50 ± 836.29 ng/ml Conclusion Either in group 1, 2, and 3 mean D-dimer tend to increase from trimester I to trimester II and from trimester II to trimester III, except in group 1 from trimester I to trimester II of pregnancy. Meanwhile, all groups showed a higher mean D-dimer post partum compared to antenatal period. Disclosures: No relevant conflicts of interest to declare.

Features of psychoemotional condition and stress-assosiatate hormons bioproduction in pregnant women after application of assisted reproductive technologies

2018 ◽  
pp. 118-121
Author(s):  
L.M. Vygivska ◽  
◽  
I.A. Usevych ◽  
I.V. Maidannyk ◽  
V.F. Oleshko ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Emotional State ◽  
Assisted Reproductive Technologies ◽  
Past History ◽  
Reproductive Technologies ◽  
Main Group ◽  
Psychological Status ◽  
Perinatal Complications ◽  
History Of ◽  
High Level

The article represents the results of a prospective clinical and paraclinical examination of women with a history of infertility, pregnancy in which occurred as a result of the assisted reproductive technologies application. The objective: was to study the dynamics of pregnancy features of the psycho - emotional state and the concentration of stress-associated hormones in the serum of pregnant women after the application of assisted reproductive technologies in order to improve the tactics of antenatal care and prevention of obstetric and perinatal complications. Materials and methods. The main group consisted of 80 pregnant women with endocrine infertility, in which pregnancy occurred as a result of therapeutic cycles of ART, control – 50 first-pregnant women with spontaneous fertilization, taken in an arbitrary order of clinical, statistical and laboratory and instrumental studies. In pregnant women of the study groups, in order to determine the psycho emotional state in the screening mode, a clinical interview was conducted by filling out questionnaires that contained the Spilberger test questions in modification of Y.L. Hanina and «Test of relationof pregnant» by the method of I.V. Dobryakova. In the dynamics of pregnancy, the concentration of prolactin (PRL) and cortisol (K) was determined by the enzyme immunoassay on the Reader-MSR-1000 apparatus using test systems manufactured by Hema-Medicament (Russia). Results. Pregnant women with infertility in past history were characterized by a state of chronic stress. According to the results of the Spielberger test in modification Y .L. Hanina every second pregnant of main group had a high level of reactive and every fourth personal anxiety. Almost 90.0% of pregnant women after art are characterized by the presence of pathological PKGD, among which an alarming and depressive type was registered in every sixth and twelfth pregnant woman, respectively. The obtained data are confirmed by the results of the study of the level of K and PRL. For women with a history of infertility and pregnancy, which is the result of therapeutic cycles of ART, inherent in increasing concentrations of stress-associated hormones – cortisol and prolactin, which is one of the reasons for the complicated course of pregnancy and requires reasonable pathogenetic correction. Conclusion. For women who are pregnant as a result of the use of therapeutic cycles of art characterized by a high level of personal and reactive anxiety and PKGD, which confirm the presence of neuropsychiatric and afferent disorders. Increasing the concentration of stress-associated hormones is one of the causes of complicated pregnancy and requires a reasonable pathogenetic correction. Key words: pregnancy, infertility, assisted reproductive technologies, psychological status, cortisol, prolactin.

The Influence of Antiphospholipid Antibodies on the Pregnancy Outcome of Patients With Recurrent Spontaneous Abortion

2001 ◽  
Vol 7 (4) ◽  
pp. 281-285 ◽  
Author(s):  
L. Heilmann ◽  
G.-F. v. Tempelhoff ◽  
S. Kuse
Keyword(s):  
Pregnant Women ◽  
Intravenous Immunoglobulin ◽  
Spontaneous Abortion ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Standard Therapy ◽  
Loss Rate ◽  
Fetal Loss ◽  
Negative Group ◽  
History Of

Several therapeutic regimens have been proposed for women with recurrent spontaneous abortion (RSA) and antiphospholipid antibodies (APA). Conflicting results have been reported about women with history of RSA, positive APA, and failure of standard therapy. To evaluate the use of intravenous immunoglobulin in RSA patients with APA and history of treatment failure, we initiated a study with standard therapy (aspirin and low-molecular- weight heparin) and intravenous immunoglobulin. We used an enzyme-linked immunosorbent assay (ELISA)test to screen IgG and IgM anticardiolipin antibodies, and a diluted Russel viper venom time assay for the lupus anticoagulant activity. Altogether. 66 pregnant women with positive APAs at the first visit could be included. Patients with hereditable thrainbaghilic factors were excluded. After confirmation of the pregnancy, women received a basis immunization of 0.3 g/kg immunoglobulin in a 4-week cycle until the 28th to 32nd week of gestation. All patients received 100 mg/d aspirin and 3,000 anti-Xa U/d certoparin. Among the 66 pregnant women, 17 were persistently autoantibody positive (25.8%), of whom 11 (16.7%) were ACA positive alone, 2 (3%) were lupus anticoagulant positive, and 4 (6.4%) had both antibody types. A total of 49 patients had positive APAs at the initial test, but were negative for ACA and lupus anticoagulant at the second test administered approximately 5 weeks after the start of therapy. We described this group in our following observation as "antibody negative." Sixteen of the 17 autoantibody-positive patients (94.1 %) were delivered of live infants compared with 40 patients (81.6%) in the antibody-negative group (odds ratio [OR]: 1.2; 95% CI: 0.98 to 1.4). The overall miscarriage rate was 12.1% and the fetal loss rate was 15.2%. Four patients (25%) in the antibody-positive group developed symptoms of preeclampsia and fetal growth retardation compared with four patients (9.8%) in the antibody-negative group. In conclusion. we see a reduction of the fetal loss rate in patients with RSA and positive APA (5.8%) compared with APAnegative (18.4%) women with the same therapy (OR: 0.3; 95% CI: 0.04 to 2.3).

scholarly journals Peculiarities of pregnansy and childbirth in patients with a burdened gynecological anamnesis

2020 ◽  
Vol 5 ◽  
pp. 5-10
Author(s):  
T. P. Andriichuk ◽  
A. Ya. Senchuk ◽  
V. I. Chermak
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Control Group ◽  
Careful Monitoring ◽  
Pregnancy And Childbirth ◽  
History Of ◽  
High Level ◽  
Adaptive Reactions

The objective: to study the features of pregnancy, childbirth, postpartum period, fetal status and newborns in patients with a history of chronic salpingo-оophoritis.Materials and methods. Conducted a retrospective study of 150 birth histories and neonatal development maps. All patients were divided into two groups. The main group includes 100 patients with chronic salpingo-оophoritis, for which they received anti-inflammatory treatment from 1 to 3 times before pregnancy. The control group included 50 pregnant women who did not suffer from chronic salpingo-оophoritis.Results. Our analysis of pregnancy, childbirth, fetal and neonatal status in women with chronic salpingo-оophoritis indicates that such patients have a complicated obstetric and gynecological and somatic history, which forms an unfavorable basic condition of organs and systems, imperfect adaptation to pregnancy, high risk of failure of adaptive reactions. The result is a violation of the formation and development of the mother-placenta-fetus system and, as a consequence, a high level of complications during pregnancy, childbirth and perinatal pathology.Conclusion. Patients suffering from chronic salpingo-oophoritis should be considered at high risk of possible complications during pregnancy and childbirth. This category of women needs quality preconception training and careful monitoring during pregnancy.

History of Health Technology Assessment in Iran

2020 ◽  
Vol 36 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Morteza Arab-Zozani ◽  
Mobin Sokhanvar ◽  
Edris Kakemam ◽  
Tahereh Didehban ◽  
Soheil Hassanipour
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
New Technologies ◽  
Conflicts Of Interest ◽  
Health Technology ◽  
Lessons Learned ◽  
Policy Makers ◽  
History Of ◽  
Systematic Structure ◽  
High Level

This article describes the characteristics of the health system and reviews the history of health technology assessment (HTA) in Iran, including its inception, processes, challenges, and lessons learned. This study was conducted by analyzing existing documents, reports, and guidelines related to HTA and published articles in the field. HTA in Iran has been established since the late 2000s and was first introduced as a secretariat by the Deputy of Health at the Ministry of Health and Medical Education. The mission of the HTA office is to systematically assess technologies to improve evidence-informed decision making. Despite its 10 years of existence, HTA in Iran still faces some challenges. The most pressing problems currently facing HTA in Iran include conflicts of interest among researchers performing the HTAs, the absence of a systematic structure for identifying and introducing new technologies, the lack of interest in HTA results among high-level policy makers, and the lack of external oversight for HTA projects.

Outcomes in Pregnant Women Exposed to Low Molecular Weight Heparin.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4168-4168
Author(s):  
Maria Teresa De Sancho ◽  
Sana Khalid
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Dose Adjustment ◽  
Congenital Heart ◽  
Post Partum ◽  
Low Molecular Weight ◽  
Live Births ◽  
History Of ◽  
Transient Visual Loss ◽  
Fluid Leak

Abstract Abstract 4168 Objective To evaluate the efficacy of low molecular weight heparin (LMWH) in a heterogeneous population of pregnant women. Methods Using hospital databases, we retrospectively evaluated the records of all women who were managed with LMWH during pregnancy and referred to our hematology clinic at a tertiary center between January 2001 and August 2009. Data collected included age, rate of live births, indications for using LMWH, type of thrombophilia, need to adjust LMWH dose, incidence of adverse outcomes of pregnancy (AOP), maternal complications, and complications related to use of LMWH. Results There were a total of 64 pregnancies in 57 women whose mean age was 25 years (range, 23 to 48). The rate of live births was 97%. Indications for LMWH included: deep venous thrombosis (DVT) (n=11), pulmonary embolism (PE) (n=10), combined DVT and PE (n=5), cerebrovascular accident (n=7), prosthetic mechanical heart valves (n=1), and upper extremity arterial thrombosis (n=1). Of the 57 women, 7 had a history of intrauterine growth restriction (IUGR), 6 had a history of preeclampsia, 3 had a history of HELLP syndrome and 1 had a history of placental abruption. In 31 of the pregnancies women had a prior history of spontaneous pregnancy loss (23 recurrent first trimester losses, 5 second trimester and 3 stillborn). There were 7 women with history of unexplained infertility. Seventeen women had factor V Leiden, 15 had prothrombin G20210 mutation, 11 had antiphospholipid antibodies IgG isotype, 8 had IgM isotype, 5 had lupus anticoagulant (LAC), 3 had hereditary antithrombin (AT) deficiency, and 1 protein S deficiency. Twenty women had less important thrombophilias. 14 pregnancies (22%) were managed with treatment doses of LMWH while 50 pregnancies (78%) were managed with preventive doses. LMWH dose adjustment was required in 11 pregnancies on treatment doses and in 23 pregnancies on preventive doses. Six pregnancies were complicated with IUGR and 3 with other complications (diaphragmatic hernia, congenital heart defect and death). Six women had documented bone loss and 1 had an allergic reaction. 15 had other complications (4 hypertension, 2 anemia, 1 subchorionic hematoma, 1 preterm labor, 1 proteinuria, 1 preeclampsia, 1 cholecystitis, 1 transient visual loss, 1 headaches 1 was diagnosed of breast cancer after completion of the post-partum period and 1 had amniotic fluid leak after amniocentesis. 14 pregnancies (22%) were managed with treatment doses of LMWH while 50 pregnancies (78%) were managed with preventive doses. LMWH dose adjustment was required in 11 pregnancies on treatment doses and in 23 pregnancies on preventive doses. Six pregnancies were complicated with IUGR and 3 with other complications (diaphragmatic hernia, congenital heart defect and death). Six women had documented bone loss and 1 had an allergic reaction. 15 had other complications (4 hypertension, 2 anemia, 1 subchorionic hematoma, 1 preterm labor, 1 proteinuria, 1 preeclampsia, 1 cholecystitis, 1 transient visual loss, 1 headaches 1 was diagnosed of breast cancer after completion of the post-partum period and 1 had amniotic fluid leak after amniocentesis. Conclusion Almost all pregnant women exposed to LMWH in our series had live births. Dose adjustments in LMWH were required for both treatment and prophylactic dosages. Complications related to use of LMWH were minimal. Disclosures: No relevant conflicts of interest to declare.

Retrospective Comparison of Recombinant Thrombomodulin and Conventional Drugs in a Treatment of DIC Caused by Acute Leukemia

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1220-1220
Author(s):  
Hisayuki Yokoyama ◽  
Toshihiro Itoh ◽  
Hideo Harigae
Keyword(s):  
Acute Leukemia ◽  
Conflicts Of Interest ◽  
Patient Characteristics ◽  
Achievement Rate ◽  
Retrospective Comparison ◽  
Cumulative Rate ◽  
Cumulative Curve ◽  
Recombinant Thrombomodulin ◽  
High Level ◽  
D Dimer

Abstract Abstract 1220 Acute leukemia (AL) is often complicated with DIC, and its control is important for preventing severe adverse events. Here, we evaluated the efficacy of rTM compared to conventional drugs, such as Nafamostat, Gabexate and Dalteparin, in the treatment of DIC caused by AL. Between 2006 and 2011, 27 cases of AL were complicated with DIC. Eleven cases were APL and 16 were other leukemia. Among APL, 5 cases were treated with rTM and 6 were treated with conventional drugs. Patient characteristics were similar except the high level of FDP (149 vs 27.4 ng/ml, p=0.028), and D-dimer (DD) (102 vs 26.6ng/ml, p=0.032) in rTM group. To evaluate the efficacy of drugs, we investigated the number of days to reach less than 20ng/ml of FDP, or 10ng/ml of DD. Median days to reach the level (12 vs 11 days) and cumulative curve of achievement rate (HR 1.0, 95%CI 0.2–5.2) was similar. Considering the high level of FDP and DD in rTM group at the beginning of treatment, rTM might quickly improve DIC compared to conventional drugs. Next, we also evaluated the efficacy in AL other than APL. 8 out were treated with rTM and 8 were treated with conventional drugs. Patient characteristics were similar in each group. As for DIC improvement, median days of achievement was significantly short in rTM group (7 vs 13days, p=0.02). Cumulative rate also showed fast improvement of DIC in rTM group (HR 5.4, 95%CI 1.3–22.4) (figure). These results suggest that rTM could rapidly improve DIC complicated with AL compared to conventional drugs, and thus might have a benefit to prevent further severe complications. In addition high cost is a drawback of this drug, and hence appropriate use should be considered. Disclosures: No relevant conflicts of interest to declare.

Management Of Pregnancy In Patients With Antithrombin Deficiency

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 216-216
Author(s):  
Mario von Depka ◽  
Stefanie Döpke ◽  
Anja Henkel-Klene ◽  
Cornelia Wermes ◽  
Mahnaz Ekhlasi-Hundrieser ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Loss ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
History Of ◽  
At Deficiency ◽  
The Mean

Abstract Introduction During pregnancy women have a four- to five-fold increased risk of thromboembolism (TE) compared to women who are not pregnant. Among the most important risk factors for TE in pregnancy is the presence of thrombophilia. Multiple reports have described an association between antithrombin (AT) deficiency and an increased rate of thromboembolic events especially during pregnancy. As the placental development depends on well-balanced pro- and anticoagulant mechanisms, thrombophilia, e.g. AT deficiency may be associated with poor pregnancy outcome. Despite anticoagulation with low molecular weight heparin (LMH) during pregnancy and the postpartum period alone, women with AT deficiency are still at a high risk to develop TE, especially perinatal and during puerperium because of withheld anticoagulation to prevent bleeding complications. Therefore, several guidelines recommend the administration of antithrombin concentrates during high risk situations as pregnancy. Here, we present the results of our study on the usage of AT concentrates in pregnant women with AT deficiency who either suffered from fetal loss or thromboembolism prior inclusion. Methods In total, 22 pregnancies in 19 patients (age: 31.9±4.7; 22-41) with AT deficiency were included in this open-label, single-center study. Ten patients (53%) had a history of fetal loss, 9/19 (47%) patients hat a history of thromboembolism. During all pregnancies AT concentrate (AT-C) was administered, in 18/22 (81.8%) pregnancies LMH was given in addition. Prior pregnancy losses (21/30, 70%) occurred in all trimester (t1: n=11, t2: n=5, and in t3: n=5). Historical live birth rate (LBR) was 30%. Blood samples were collected in all trimesters and postpartum to analyze AT activity and antigen, endogenous thrombin potential (ETP), thrombin-antithrombin-complex (TAT), Fragment 1+2 (F1+2) and c-reactive protein test (CRP). A total of 114 uneventful pregnancies of 113 healthy women served as controls. Furthermore, the mean doses of AT concentrates/kg BW and the mean total number of infusions were calculated. Results In total, 21 pregnancies (95.5%) were successful. Mean total requirement of AT concentrate per pregnancy was 79.454 IU (range: 3.000-272.000 IU) during 27.8 treatment days per pregnancy (range: 1-88). Our data show an increase of F1+2 in the course of pregnancy. Mean levels of F1+2 at t1, t2 and t3 (t1= 255.9 ± 107.6, t2= 360.9 ± 117.4, t3= 545.3 ± 220.3 pmol/L) were significantly higher than in controls (t1= 82.2 ± 43, t2= 140 ± 100.2, t3= 183.5 ± 103.1, p<.001). Mean level of TAT was higher (3.1 ± 1.4 ng/mL) than in controls (1.7 ± 1.6 ng/mL, p=.001) in t1, whereas mean TAT in t2 and t3 was lower than in controls (3.8 ± 1.3 vs. 4.8 ± 1.9, p=.03; 5.0 ± 1.4 vs. 6.1 ± 3.0 ng/mL, n.s., resp.). No thromboembolic events occurred. In patients receiving AT-C, LBR increased from 30% to 95.5% (p<0.001) with a relative risk of 49.0 to develop pregnancy loss without anticoagulant treatment (5.7 – 421.8; 95% CI). Conclusion In patients with AT deficiency receiving AT concentrate and LMH we could demonstrate a significant increase of LBR from 30% to 95.5%. Furthermore, no thromboembolic events occurred, though almost half of the patients had a history of thromboembolism. There was no clear evidence of increased hypercoagulability. We conclude that combined AT concentrate and LMH are safe and efficacious for mother and child in preventing thromboembolism and pregnancy loss. Further studies to evaluate the exact mode of anticoagulation and benefit of combining AT concentrate and LMH are warranted. Disclosures: No relevant conflicts of interest to declare.

Primary Thrombophilia in Mexico XII: Miscarriages Are More Frequent in Persons with the Sticky Platelet Syndrome (SPS)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4937-4937
Author(s):  
Guillermo J Ruiz-Delgado ◽  
Yahveth Cantero-Fortiz ◽  
Mariana Méndez-Huerta ◽  
Mónica León-González ◽  
Andrés A. León-Peña ◽  
...  
Keyword(s):  
General Population ◽  
Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Obstetric Complications ◽  
Obstetric Outcomes ◽  
Single Institution ◽  
Clinical Marker ◽  
Female Patients ◽  
History Of

Abstract Background: The sticky platelet syndrome (SPS) is an inherited condition which leads into arterial and venous thrombosis. There is scant information about the association between the SPS and obstetric complications. Objective: To assess the relationship of the SPS and fetal loss in a single institution. Material and methods: The obstetric history of all the consecutive female patients prospectively studied along a 324 month period, in a single institution with a history of thrombosis and a clinical marker of primary thrombophilia was reviewed. Results: Between 1989 and 2016, 268 consecutive patients with a clinical marker of primary thrombophilia and a history of arterial or venous thrombosis were studied; of these, 108 were female patients. Within this subset, 77 (71%) had been pregnant at some moment. Twenty eight of these 77 patients (37%) had had an abortion and 24 out of these (86%) were found to have the SPS. On the other hand, in a subset of 73 female patients with the SPS who had been pregnant, 32% had miscarriages (14 had one abortion, 5 two abortions and 4 three or more abortions). These figures are significantly higher than the prevalence of abortions in the Mexican general population of pregnant women, which is 12-13% (chi square = 7.47; p = 0.0063). Accordingly, the relative risk of having a miscarriage is 2.66 times higher in female patients with the SPS than in the general population (p = 0.0014 ). Conclusion: In México, female patients with the SPS experience significantly more miscarriages than the general population. Since the treatment of the SPS is simple and effective and could in turn prevent adverse obstetric outcomes, its investigation in women studied because obstetric complications may be useful and deserves further research. Disclosures No relevant conflicts of interest to declare.

scholarly journals Evaluation of Anticoagulant Use during Pregnancy in Mothers with Antiphospholipid Syndrome: An Observational Cross-Sectional Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5062-5062 ◽  
Author(s):  
Inolyn Pandjaitan ◽  
Karmel L Tambunan ◽  
Tubagus Djumhana Atmakusuma
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Antiphospholipid Syndrome ◽  
Conflicts Of Interest ◽  
Adverse Pregnancy Outcome ◽  
Antiplatelet Agent ◽  
Elevated Concentration ◽  
Antiphospholipid Antibody ◽  
Reduced Rate ◽  
D Dimer

Abstract Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity with persistent elevated concentration of antiphospholipid antibody. The use of anticoagulant in pregnant women with APS has reduced implantation failure, reduced rate of placental insufficiency, increased rate of delivery of live infant, and reduced rate of abortion. However, compared to its beneficial effects, anticoagulant therapy during pregnancy can be challenging because of the burden of the treatment (self-injecting anticoagulant for 9 months, cost of the treatment) and potential anticoagulant side effects. The purpose of this study was to evaluate the outcome of pregnant women with APS with anticoagulant. Method: We searched through medical records of pregnant women who visited hematology oncology clinic of Cikini CCI Hospital from year 2000 to 2017. Pregnant women with positive antiphospholipid antibodies who were treated with anticoagulant and followed up until presence of outcome were included in the study. Main outcome was any delivery of live infant above 22 weeks gestational age. Activated partial thromboplastin time (aPTT), d dimer level, birth weight and length were also documented. Results: We identified 92 pregnancies in 88 mothers diagnosed with antiphospholipid syndrome who were prescribed anticoagulant. From 92 pregnancies, 67 (73%) and 25 (27%) patients were prescribed low molecular weight heparin (LMWH) and unfractionated heparin (UFH), respectively, with combination of low dose antiplatelet agent. APTT and d dimer level of every patients were monitored monthly. 80% of the pregnancies successfully resulted in live births. The proportion of successful delivery of healthy infant in patients treated with UFH (21 out of 25; 84%) was greater than LMWH (53 out of 67; 79%) but not statistically different (p = 0,708) (Figure 1). Birth weight and length between groups were similar. Conclusion: UFH may be used as safe and cost-effective alternative treatment to LMWH in pregnant women with APS. Despite the use of anticoagulant and antiplatelet agents, 20% of patients still had adverse pregnancy outcome. Disclosures No relevant conflicts of interest to declare.

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