Obstetric outcome with low molecular weight heparin therapy during pregnancy
Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles St, Dublin 2.Irish medical journal (Impact Factor: 0.51). 01/2012; 105(1):27-9.
This was a prospective study of women attending a combined haematology/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.
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ABSTRACT: Venous thromboembolism (VTE) is one of the most relevant causes of maternal death in industrialized countries. Low molecular weight heparin (LMWH), continued throughout the entire pregnancy and puerperium, is currently the preferred treatment for patients with acute VTE occurred during pregnancy. However, evidences on the efficacy and safety of anticoagulant drugs in this setting are extremely limited. We carried out a systematic review and a meta-analysis of the literature to provide an estimate of the risk of bleeding complications and VTE recurrence in patients with acute VTE during pregnancy treated with antithrombotic therapy. Weight mean incidence (WMI) of bleeding and thromboembolic events and the corresponding 95% confidence interval (CI) were calculated. Eighteen studies for a total of 981 pregnant patients with acute VTE were included. LMWH was prescribed to 822 patients, the remaining were treated with unfractionated heparin. Anticoagulant therapy was associated with a WMI of major bleeding of 1.41 % (95% CI:0.60-2.41;I) antenatally and of 1.90% (95% CI:0.80-3.60%;) during the first 24 hours after delivery. The estimated WMI of recurrent VTE during pregnancy was 1.97% (95% CI:0.88-3.49% I(2) : 39.5%). Anticoagulant therapy appears to be safe and effective for the treatment of pregnancy related VTE, but the optimal dosing regimens remain uncertain. © 2012 International Society on Thrombosis and Haemostasis.Journal of Thrombosis and Haemostasis 12/2012; 11(2). DOI:10.1111/jth.12085 · 5.72 Impact Factor
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ABSTRACT: Unfractionated heparin has largely been replaced by low molecular weight heparin in the treatment and prevention of thrombosis and recurrent miscarriage in pregnancy. There is little information, however, about the efficacy and safety of tinzaparin, which has the advantage of being administered as a single daily dose. To evaluate the safety and efficacy of tinzaparin use in pregnancy. We retrospectively reviewed the medical records of women who were prescribed tinzaparin during pregnancy and the puerperium in our hospitals from January 2000 to December 2008. Tinzaparin was given as a single daily prophylactic dose for women with a history of venous thromboembolism (VTE) or recurrent miscarriage and as a single daily therapeutic dose for women diagnosed with VTE. The primary outcomes recorded were thrombosis, bleeding, allergy and thrombocytopenia. One hundred and forty-nine women aged between 17 and 44 years received tinzaparin in pregnancy and the puerperium over the study period. The dose administered was therapeutic in 21 (14 %) cases and prophylactic in all others. VTE recurred in three women who had a history of VTE (3.6 %). Antepartum and postpartum haemorrhage occurred in 9.7 and 5 % of cases, respectively and two women developed thrombocytopenia but their platelets remained above 100,000/ml. Fifty-seven women (38 %) had regional anaesthesia without complication. Our study demonstrates a safety profile for tinzaparin in pregnancy that is equivalent to other low molecular weight heparins with the advantage of single daily dosing.Irish Journal of Medical Science 08/2013; 183(2). DOI:10.1007/s11845-013-0998-7 · 0.83 Impact Factor