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Coagulopathy in Pregnancy

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1. Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy (PubMed)

Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy Intrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Prothrombin Time (PT) of 117.8 seconds, International Normalized Ratio (INR) of 10.34, and elevated (...)  mg of intramuscular vitamin K shortly after delivery but went on to develop bilateral grade III intraventricular hemorrhages by day 5. Intrahepatic cholestasis in pregnancy and nutrition issues were identified as the main risk factors for the severe coagulopathy of this patient. This case underlines the importance of evaluation of possible severe coagulopathy in patients with intrahepatic cholestasis of pregnancy in order to avoid serious maternal or fetal adverse outcomes.

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2017 Case reports in obstetrics and gynecology

2. Coagulopathy in Pregnancy

Coagulopathy in Pregnancy Coagulopathy in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Coagulopathy in Pregnancy (...) Coagulopathy in Pregnancy Aka: Coagulopathy in Pregnancy , Pregnancy Related Coagulopathy II. Labs: Coagulation studies (PT) (PTT) Fibrin split products ( ) Clot Test (4-8 minutes is normal clotting time) III. Management: General Specific underlying cause Replace Fluids Replace Coagulation deficits IV. Management: Fresh Frozen Plasma (1 unit) Indications <100 mg/dl FFP 1 unit increases 10 mg/dl (PTT) >60 >18 (INR >3) Following every 5-6 platelets transfused Following every 4-8 units packed RBCs transfused

2018 FP Notebook

3. Ectopic pregnancy and miscarriage: diagnosis and initial management

-line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if: the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or or she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or or she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable (...) Ectopic pregnancy and miscarriage: diagnosis and initial management Ectopic pregnancy and miscarriage: Ectopic pregnancy and miscarriage: diagnosis and initial management diagnosis and initial management NICE guideline Published: 17 April 2019 nice.org.uk/guidance/ng126 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

4. Incidence of Trauma Induced Coagulopathy in Patients With Prehospital Administration of Fibrinogen

Incidence of Trauma Induced Coagulopathy in Patients With Prehospital Administration of Fibrinogen Incidence of Trauma Induced Coagulopathy in Patients With Prehospital Administration of Fibrinogen - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove (...) one or more studies before adding more. Incidence of Trauma Induced Coagulopathy in Patients With Prehospital Administration of Fibrinogen (TICAF) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03572309 Recruitment

2018 Clinical Trials

5. Intraventricular Hemorrhage Due to Coagulopathy After Vitamin K Administration in a Preterm Infant With Maternal Crohn Disease (PubMed)

Intraventricular Hemorrhage Due to Coagulopathy After Vitamin K Administration in a Preterm Infant With Maternal Crohn Disease Intraventricular hemorrhage (IVH) is a devastating morbidity in preterm infants and can result in poor neurodevelopmental outcomes. Intraventricular hemorrhage usually occurs within 72 hours after birth; post-acute-phase IVH (>1 week after birth) is uncommon. Development of the hemostatic system in fetuses and neonates is an age-dependent evolving process (...) , and the neonatal hemostatic system is characterized by low levels of vitamin K-dependent factors, with further reduction caused by prematurity. Importantly, a severe coagulation deficiency can be a major contributing factor of IVH. Active maternal Crohn disease (CD) during pregnancy causes malnutrition via enteral malabsorption; this may include vitamin K deficiency, resulting in fetal vitamin K deficiency. We herein describe a preterm infant who was born to a mother with CD and developed post-acute-phase IVH

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2017 Japanese clinical medicine

6. Trauma Induced Coagulopathy and Inflammation

Trauma Induced Coagulopathy and Inflammation Trauma Induced Coagulopathy and Inflammation - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Trauma Induced Coagulopathy and Inflammation (TrICI) The safety (...) provided by (Responsible Party): University of Pennsylvania Study Details Study Description Go to Brief Summary: While a number of factors are known to be associated with the development of trauma induced coagulopathy (TIC), inflammation, and multi-organ failure, we currently cannot predict which patients are at risk for developing these life threatening conditions with any certainty. In this prospective observational study, we will investigate the many factors that contribute to the development

2017 Clinical Trials

7. Overview of pregnancy complications

cholestasis of pregnancy (ICP) is a pruritic condition caused by impaired bile flow allowing bile salts to be deposited in the skin and the placenta. Usually presents in the third trimester with pruritus, which is worse at night, starts on the soles of feet and hands, and spares the face. Some women may present with jaundice and significant liver dysfunction, coagulopathy from vitamin K deficiency (rarely), abnormal fetal heart rate, premature labour, or intrauterine fetal demise. Risk factors include (...) Overview of pregnancy complications Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Overview of pregnancy complications Last reviewed: February 2019 Last updated: September 2018 Introduction Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant

2018 BMJ Best Practice

8. Overview of pregnancy complications

cholestasis of pregnancy (ICP) is a pruritic condition caused by impaired bile flow allowing bile salts to be deposited in the skin and the placenta. Usually presents in the third trimester with pruritus, which is worse at night, starts on the soles of feet and hands, and spares the face. Some women may present with jaundice and significant liver dysfunction, coagulopathy from vitamin K deficiency (rarely), abnormal fetal heart rate, premature labour, or intrauterine fetal demise. Risk factors include (...) Overview of pregnancy complications Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Overview of pregnancy complications Last reviewed: February 2019 Last updated: September 2018 Introduction Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant

2018 BMJ Best Practice

9. Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies

is confirmed before 14 weeks and the fetuses appear concordant for growth and anatomy (II-2B). 7. Prior to invasive testing or in the context of twins discordant for an abnormality, selective reduction should be discussed and made available to those requesting the procedure after appropriate counselling (III-B). 8. Monitoring for disseminated intravascular coagulopathy is not indicated in dichorionic twin pregnancies undergoing selective reduction (II-2B). Key Words: , , , , , , Abbreviations (...) Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies - Journal of Obstetrics and Gynaecology Canada Email/Username: Password: Remember me Search Terms Search within Search Volume 39, Issue 9, Pages e347–e361 No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies x François Audibert , MD (Principal Author) Montreal, QC x Alain Gagnon , MD (Principal Author) Vancouver, BC

2017 Society of Obstetricians and Gynaecologists of Canada

10. CRACKCast E177 – Acute Complications of Pregnancy

. The HELLP syndrome is a particularly severe form of preeclampsia characterized by hemolysis, elevated liver enzyme levels (ALT and AST > 70U/L), and low platelet count (<100,000/mL). Amniotic Fluid Embolism Amniotic fluid embolus should be suspected during the second or third trimester of pregnancy, particularly in the setting of uterine manipulation or contraction, when a patient experiences sudden hypotension, hypoxia, and coagulopathy. Treatment of amniotic fluid embolus consists of ACLS care (...) (oxygenation and ventilation, aggressive fluid resuscitation, inotropic cardiovascular support) and anticipation and management of consumptive coagulopathy. Rh Immunization Rh immunization occurs when an Rh-negative woman is exposed to Rh-positive fetal blood. To prevent this, a dose of 50 μg of Rh immune globulin can be used if the patient is at less than 12 weeks of gestation. After 12 weeks, a 300-μg dose should be given. Abdominal Pain in Pregnancy Appendicitis is the most common surgical emergency

2018 CandiEM

11. Amniotic Fluid Embolism with Isolated Coagulopathy: A Report of Two Cases (PubMed)

Amniotic Fluid Embolism with Isolated Coagulopathy: A Report of Two Cases Amniotic Fluid Embolism (AFE) is a catastrophic complication of pregnancy with high mortality rate. The most common clinical presentation is an abrupt onset of cardiopulmonary collapse. Here, we present an uncommon variant involving isolated disseminated intravascular coagulation that developed without antecedent cardiopulmonary disturbances. Both patients developed symptoms soon after delivery. Blood test was sent at 14 (...) minutes postpartum for the second patient due to suspected amniotic fluid embolism. Fetal components were observed in the uterine veins of the lower uterine segments in both cases. Amniotic fluid embolism with disseminated intravascular coagulopathy typically progresses faster than disseminated intravascular coagulopathy associated with other causes and symptoms. It usually develops within two hours of delivery. Prompt recognition and treatment of this entity is crucial to survival.

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2016 Journal of clinical and diagnostic research : JCDR

12. TEG (Thromboelastography) Based Versus Conventional Coagulation Parameters Based Correction of Coagulopathy in Non Variceal Bleed.

TEG (Thromboelastography) Based Versus Conventional Coagulation Parameters Based Correction of Coagulopathy in Non Variceal Bleed. TEG (Thromboelastography) Based Versus Conventional Coagulation Parameters Based Correction of Coagulopathy in Non Variceal Bleed. - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have (...) reached the maximum number of saved studies (100). Please remove one or more studies before adding more. TEG (Thromboelastography) Based Versus Conventional Coagulation Parameters Based Correction of Coagulopathy in Non Variceal Bleed. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02689232

2016 Clinical Trials

13. Pre-hospital Administration of Lyophilized Plasma for Post-traumatic Coagulopathy Treatment (PREHO-PLYO)

Pre-hospital Administration of Lyophilized Plasma for Post-traumatic Coagulopathy Treatment (PREHO-PLYO) Pre-hospital Administration of Lyophilized Plasma for Post-traumatic Coagulopathy Treatment (PREHO-PLYO) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100 (...) ). Please remove one or more studies before adding more. Pre-hospital Administration of Lyophilized Plasma for Post-traumatic Coagulopathy Treatment (PREHO-PLYO) (PREHO-PLYO) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier

2016 Clinical Trials

14. Early pregnancy loss

intrauterine pregnancy Table 14. Expectant management for stable non-viable IUP Aspect Consideration Indications • Woman’s preference • Most suited to the management of incomplete miscarriage 43 Contraindications • Suspected GTD • Haemodynamically unstable • Intrauterine device (requires removal) • Women at increased risk of haemorrhage (e.g. late in first trimester) 2 or effects of (e.g. unable to have blood transfusion or coagulopathies) 2 • Evidence of infection 2 Risk/benefit • More days of bleeding (...) Early pregnancy loss Maternity and Neonatal C linical G uideline Queensland Health Early pregnancy loss Queensland Clinical Guideline: Early pregnancy loss Document title: Early pregnancy loss Publication date: May 2017 Document number: MN17.29-V5-R22 Document supplement: The document supplement is integral to and should be read in conjunction with this guideline Amendments: Full version history is supplied in the document supplement Amendment date: May 2018 Replaces document: MN17.29-V4-R22

2017 Queensland Health

15. Liver Disease and Pregnancy

Hypoglycaemia 340 µ mol/l Leucocytosis >11×10 6 cells/l Ascites or bright liver on ultrasound scan Elevated transaminases (AST or ALT) >42 IU/l Elevated ammonia >47 µ mol/l Renal impairment; creatinine >150 µ mol/l Coagulopathy; prothrombin time >14 s or APPT>34 s Microvesicular steatosis on liver biopsy ALT, alanine transaminase; APPT, activated partial thromboplastin time; AST, aspartate transaminase. Liver Disease and Pregnancy © 2016 by the American College of Gastroenterology The American Journal (...) Liver Disease and Pregnancy nature publishing group 1 © 2016 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY PRACTICE GUIDELINES To determine the level of evidence, the results from the selected papers with the greatest level of evidence were extrapolated and utilized in the GRADE program ( h t t p://w w w .gradep r o .o r g ). A summary of the recommendations are outlined in Table 1 . EVALUATION OF THE PREGNANT PATIENT WITH ABNORMAL LIVER ENZYMES

2016 American College of Gastroenterology

16. Guideline supplement: Hypertensive disorders of pregnancy

Guideline supplement: Hypertensive disorders of pregnancy Maternity and Neonatal C linical G uideline Queensland Health Supplement: Hypertensive disorders of pregnancy Queensland Clinical Guideline Supplement: Hypertensive disorders of pregnancy Refer to online version, destroy printed copies after use Page 2 of 13 Table of Contents 1 Introduction 3 1.1 Funding 3 1.2 Conflict of interest 3 1.3 Guideline review 3 2 Methodology 4 2.1 Topic identification 4 2.2 Scope 4 2.3 Clinical questions 4 2.4 (...) of this licence contact: Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email ip_officer@health.qld.gov.au, phone (07) 3234 1479. Queensland Clinical Guideline Supplement: Hypertensive disorders of pregnancy Refer to online version, destroy printed copies after use Page 3 of 13 1 Introduction This document is a supplement to the Queensland Clinical Guideline Hypertensive disorders of pregnancy. It provides supplementary information regarding guideline development, makes

2016 Queensland Health

17. Flowchart: Management of hypertension in pregnancy

Flowchart: Management of hypertension in pregnancy Queensland Health State of Queensland (Queensland Health) 2016 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Management of hypertension in pregnancy Queensland Clinical Guidelines: Hypertensive disorders in pregnancy. Flowchart version: F15.13-2-V7-R20 Hypertension sBP = 140 mmHg and/or dBP = 90 mmHg Maternal (...) investigations and fetal assessment Birth Inpatient or outpatient care Worsening maternal or fetal condition? Is birth indicated? Yes No No Yes Risk factors for preeclampsia • Previous history of preeclampsia • Family history of preeclampsia • Inter-pregnancy interval > 10 years • Nulliparity • Pre-existing medical conditions o APLS o Pre-existing diabetes o Renal disease o Chronic hypertension o Chronic autoimmune disease • Age > 40 years • BMI > 35 kg/m 2 • Multiple pregnancy • Elevated BP at booking

2016 Queensland Health

18. Hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy Maternity and Neonatal C linical G uideline Queensland Health Hypertensive disorders of pregnancy Queensland Clinical Guideline: Hypertensive disorders of pregnancy Refer to online version, destroy printed copies after use Page 2 of 32 Document title: Hypertensive disorders of pregnancy Publication date: August 2015 Document number: MN15.13-V7-R20 Document supplement: The document supplement is integral to and should be read in conjunction with this guideline (...) . For permissions beyond the scope of this licence contact: Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email ip_officer@health.qld.gov.au, phone (07) 3234 1479. Queensland Clinical Guideline: Hypertensive disorders of pregnancy Refer to online version, destroy printed copies after use Page 3 of 32 Flow Chart: Management of eclampsia Queensland Clinical Guidelines: Hypertensive disorders in pregnancy. Flowchart version: F15.13-1-V7-R20 Control Seizures Control Hypertension

2016 Queensland Health

19. Ectopic pregnancy and miscarriage: diagnosis and initial management

management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if: the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or or she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or or she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have (...) than expectant management if: the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or or she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or or she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have a blood transfusion) or or there is evidence of infection. 1.5.3 Offer medical management to women

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

20. Coagulopathy in Pregnancy

Coagulopathy in Pregnancy Coagulopathy in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Coagulopathy in Pregnancy (...) Coagulopathy in Pregnancy Aka: Coagulopathy in Pregnancy , Pregnancy Related Coagulopathy II. Labs: Coagulation studies (PT) (PTT) Fibrin split products ( ) Clot Test (4-8 minutes is normal clotting time) III. Management: General Specific underlying cause Replace Fluids Replace Coagulation deficits IV. Management: Fresh Frozen Plasma (1 unit) Indications <100 mg/dl FFP 1 unit increases 10 mg/dl (PTT) >60 >18 (INR >3) Following every 5-6 platelets transfused Following every 4-8 units packed RBCs transfused

2015 FP Notebook

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