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Thromboembolic Disease in Pregnancy

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41. Hypertensive disorders of pregnancy

pregnancy on antihypertensive therapy with no secondary cause determined (and with lower sBP and/or dBP) • Secondary Hypertension may be due to: o Chronic kidney disease (e.g. glomerulonephritis, reflux nephropathy and adult polycystic kidney disease) o Renal artery stenosis o Systemic disease with renal involvement (e.g. diabetes mellitus, systemic lupus erythematosus) o Endocrine disorders (e.g. phaeochromocytoma, Cushing’s syndrome and primary hyperaldosteronism, hyper or hypothryroidism (...) stable then every 30 minutes • Respiratory rate and patellar reflexes hourly • Temperature 2nd hourly • Continuous CTG monitoring if > 24 weeks (interpret with caution if : greater than, 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 • Gestational trophoblastic disease • Fetal triploidy Maternal investigations

2016 Queensland Health

42. Nonobstetric Surgery During Pregnancy

of trimester because this can adversely affect the pregnant woman and her fetus. Elective surgery should be postponed until after delivery. Given the potential for preterm delivery with some nonobstetric procedures during pregnancy, corticosteroid administration for fetal benefit should be considered for patients with fetuses at viable premature gestational ages, and patients should be monitored in the perioperative period for signs or symptoms of preterm labor. Pregnant women undergoing nonobstetric (...) Nonobstetric Surgery During Pregnancy Nonobstetric Surgery During Pregnancy - ACOG Menu ▼ Nonobstetric Surgery During Pregnancy Page Navigation ▼ INTERIM UPDATE Number 775 (Replaces Committee Opinion No. 696, April 2017) Committee on Obstetric Practice American Society of Anesthesiologists This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice and the American Society of Anesthesiologists. This document reflects emerging

2019 American College of Obstetricians and Gynecologists

43. Contraception, Venous Thromboembolism, and Inflammatory Bowel Disease: What Clinicians (and Patients) Should Know. (Abstract)

Contraception, Venous Thromboembolism, and Inflammatory Bowel Disease: What Clinicians (and Patients) Should Know. The peak incidence of the inflammatory bowel diseases (IBDs) is between the second and fourth decades of life, which coincides with prime reproductive years. Unplanned or mistimed pregnancies may account for nearly half of all pregnancies and are associated with adverse consequences such as a higher risk of delayed preconceptual care, increased risk of preterm birth, low birth (...) weight, and adverse maternal and neonatal outcomes. Increased IBD activity during pregnancy is also associated with adverse pregnancy-related outcomes, such as miscarriage, intrauterine growth retardation, and preterm birth. Furthermore, the increased risk of venous thromboembolism (VTE) conferred by active IBD may be potentially augmented by hormonal contraceptives. Recent literature suggests that women with IBD seek counseling on contraception from gastroenterologists in preference to their primary

2019 Inflammatory Bowel Diseases

44. Sickle cell disease and venous thromboembolism in pregnancy and the puerperium. (Abstract)

Sickle cell disease and venous thromboembolism in pregnancy and the puerperium. Recent data strongly suggest an increased risk of venous thromboembolism in subjects with sickle cell disease and to a lesser extent, sickle cell trait. However, most studies have been retrospective, case-control or cross-sectional based on data obtained from administrative databases. More data from adequately powered prospective studies that include matched controls are needed to definitely establish the link (...) between venous thromboembolism during pregnancy and sickle hemoglobin disorders. Similarly, there remains a need for properly designed randomized control trials to establish the safety of various hormonal contraceptive methods in women with sickle cell disorders. © 2015 Elsevier Ltd. All rights reserved.

2015 Thrombosis research

45. An unusual occurrence: a case of venous thromboembolism in pregnancy associated with heterotaxy syndrome. Full Text available with Trip Pro

An unusual occurrence: a case of venous thromboembolism in pregnancy associated with heterotaxy syndrome. Heterotaxy is a relatively uncommon congenital anomaly that is usually diagnosed incidentally on imaging studies in adults. We present an unusual case of venous thromboembolism in a 26 year old pregnant female with Heterotaxy syndrome.A 26 year-old pregnant female at 13 weeks gestation suffered cardiac arrest with successful cardiac resuscitation and return of spontaneous circulation (...) in pregnancy associated with heterotaxy syndrome. A discussion on pathophysiology of venous thromboembolism in pregnancy and heterotaxy syndrome has been undertaken along with treatment approach in such situations.

2015 BMC Hematology

46. Management of Pregnancy

the past 25 years, maternal pregnancy-related mortality and morbidity have been increasing. Common complications that can occur during pregnancy include maternal obesity or excessive weight gain, mental health conditions (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), hyperemesis gravidarum, anemia, gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (e.g., gestational hypertension, preeclampsia, eclampsia).[ ] 9 Pregnancy-related deaths (approximately 600 (...) schedules. Federal laws addressing breastfeeding in the workplace exist but are relatively new.[ ] 11 In contrast, the infant mortality rate has declined 15% between 2005 and 2015, from 6.86 infant deaths per 1,000 live births to 5.82.[ ] The Centers for Disease Control and Prevention (CDC) indicated the following were the five leading causes of infant death in 2014:[ ] 12 13 • Birth defects • Preterm birth or low birth weight • Maternal complications of pregnancy • Sudden infant death syndrome (SIDS

2018 VA/DoD Clinical Practice Guidelines

47. CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy

for use in patients with severe exacerbations Smooth muscle relaxation – MgSO4 – limited data supports its use Maintenance inhaled steroids and LRTA’s [2] What anti-hypertensives are not safe in pregnancy? How is a hypertensive emergency treated? The increase in blood volume due to pregnancy, along with the increases in preload, cardiac output, and oxygen consumption, can worsen or reveal cardiac disease in pregnant women. Because the signs and symptoms of acute coronary syndromes and heart failure (...) are the most common types of valvular disease (63%), followed by aortic valve disease (23%). The most common valvular complication in pregnancy is heart failure (challenging dx to make in pregnancy!) When it comes to prosthetic valves, these women are at high risk for clotting (hypercoagulable state) as well as thromboembolic phenomenon! Pregnant patients with prosthetic heart valves who are not anticoagulated have a maternal mortality as high as 5%, and thromboembolic events can occur in up to 24

2018 CandiEM

48. CRACKCast E177 – Acute Complications of Pregnancy

in pregnancy. Clinical presentations may be atypical. Cholelithiasis presents with similar symptoms to those in nonpregnant women and is similarly diagnosed through ultrasound. Surgery, if required, is optimally done during the second trimester. Hepatitis is the most common cause of liver disease in pregnancy; Acute fatty liver of pregnancy is a rare disorder of the third trimester that can result in hepatic failure, complicated labor, and fetal mortality. Coagulopathy, jaundice, seizures, DIC, and hepatic (...) encephalopathy may also result. Intrahepatic cholestasis of pregnancy typically presents with generalized pruritus and mild jaundice. Nausea and Vomiting in Pregnancy Hyperemesis gravidarum is defined as nausea and vomiting that cause starvation metabolism, weight loss, dehydration, and prolonged ketonemia and ketonuria. Initial management involves rehydration with IV fluids, antiemetics, and demonstration of ability to take oral hydration. Thromboembolism in Pregnancy Thromboembolic disease accounts

2018 CandiEM

49. Maternal, pregnancy and neonatal outcomes following IVF pregnancies

an underlying genetic condition associated with both male infertility (which requires ICSI treatment) and also the development of certain congenital abnormalities. 79,81 MATERNAL, PREGNANCY AND NEONATAL OUTCOMES FOLLOWING IVF: A RAPID REVIEW | SAX INSTITUTE 20 3. What is the evidence regarding the effect of ART on maternal outcomes and the maternal or treatment factors that may alter this effect? 3.1. Thromboembolic disease 3.1.1. Is the incidence of thromboembolic disease different in ART pregnancies (...) compared to naturally conceived pregnancies? The incidence of thromboembolic disease (including pulmonary embolism) seems to be significantly increased in IVF pregnancies compared to pregnancies after a spontaneous conception. 52,82–84 This risk seems to be especially pronounced (~ sevenfold) during the first trimester after IVF (Table 19). The supraphysiological oestrogen levels after ovarian stimulation, ovarian hyperstimulation syndrome, relative immobility and pelvic haemorrhage after the oocyte

2015 Sax Institute Evidence Check

50. Antiphospholipid syndrome: An update on risk factors for pregnancy outcome. (Abstract)

and/or other autoimmune diseases are well known history-based predictive factors for obstetrical complications, such as miscarriage, maternal venous thromboembolism, intrauterine foetal demise, preeclampsia, and neonatal death. Moreover, laboratory findings associated with poor pregnancy outcome are:triple antiphospholipid antibodies aPL positivity, double aPL positivity, single aPL positivity, false-positive IgM for CMV, and hypocomplementemia. Triple positivity is confirmed as the most significant risk (...) Antiphospholipid syndrome: An update on risk factors for pregnancy outcome. The optimal treatment of women with primary antiphospholipid syndrome (APS) is still debated. About 20-30% of women with APS remain unable to give birth to healthy neonates despite conventional treatment, consisting of prophylactic-dose heparin and low-dose aspirin. These cases are defined "refractory obstetric APS". The early identification of risk factors associated with poor pregnancy outcome could be the optimal

2018 Autoimmunity reviews

51. Clinical Report of Probable Catastrophic Antiphospholipid Syndrome in Pregnancy Full Text available with Trip Pro

Clinical Report of Probable Catastrophic Antiphospholipid Syndrome in Pregnancy Catastrophic APS (CAPS) is a rare but life-threatening form of APS defined as multiorgan thrombosis affecting a minimum of three organs with confirmation by histopathology of small vessel occlusions in at least one organ or tissue. The development of CAPS in pregnancy poses many diagnostic challenges as a result of its broad range of clinical presentations and its overlap with other obstetric complications (...) and microangiopathic diseases. Because of the high associated mortality rate, prompt recognition and treatment are paramount.A twenty-five-year-old G3P0111 with a history of multiple thromboembolisms presented at 21 weeks and 3 days of gestation with complaints of right upper quadrant pain, visual disturbances, headache, and syncopal episodes. Laboratory evaluation demonstrated microangiopathic disease with hemolysis (confirmed on peripheral smear), elevated liver enzymes, and abnormal 24-hour urine protein

2018 Case reports in obstetrics and gynecology

52. An Analysis Into the Cause and Preventional Method of Thromboembolic Disease in Gynecological Surgery

Status : Not yet recruiting First Posted : August 24, 2018 Last Update Posted : August 24, 2018 See Sponsor: Second Affiliated Hospital of Wenzhou Medical University Information provided by (Responsible Party): Second Affiliated Hospital of Wenzhou Medical University Study Details Study Description Go to Brief Summary: The aim of this cross-sectional study is to describe the specific sutuations of thromboembolic disease in gynecological surgery and identify the risk factors of it. Condition (...) An Analysis Into the Cause and Preventional Method of Thromboembolic Disease in Gynecological Surgery An Analysis Into the Cause and Preventional Method of Thromboembolic Disease in Gynecological Surgery - 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

2018 Clinical Trials

53. A Study to Find Out if Selexipag is Effective and Safe in Patients With Chronic Thromboembolic Pulmonary Hypertension When the Disease is Inoperable or Persistent/Recurrent After Surgery

countries for the treatment of pulmonary arterial hypertension (PAH). Due to the similarities between PAH and chronic thromboembolic pulmonary hypertension (CTEPH) and the observed efficacy of other PAH medicines in CTEPH, it is believed that selexipag could benefit to patients with CTEPH. This study aims to assess the efficacy and safety of selexipag in subjects with inoperable or persistent/recurrent CTEPH. Condition or disease Intervention/treatment Phase Chronic Thromboembolic Pulmonary Hypertension (...) A Study to Find Out if Selexipag is Effective and Safe in Patients With Chronic Thromboembolic Pulmonary Hypertension When the Disease is Inoperable or Persistent/Recurrent After Surgery A Study to Find Out if Selexipag is Effective and Safe in Patients With Chronic Thromboembolic Pulmonary Hypertension When the Disease is Inoperable or Persistent/Recurrent After Surgery - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration

2018 Clinical Trials

54. Symptom-driven Referral for Evaluation of Chronic Thromboembolic Disease or Pulmonary Hypertension in Patients With Previous Acute Pulmonary Embolism

they will be referred to a scintigraphy. If CTED is suspected from the scintigraphy, the patient will be referred for full CTED work-up. The investigators expect to screen 300 patients for persistent symptoms with an expected study time of 3 years. Condition or disease Intervention/treatment Phase Chronic Thromboembolic Pulmonary Disease Diagnostic Test: CTEPH/CTED work-up Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 100 (...) Symptom-driven Referral for Evaluation of Chronic Thromboembolic Disease or Pulmonary Hypertension in Patients With Previous Acute Pulmonary Embolism Symptom-driven Referral for Evaluation of Chronic Thromboembolic Disease or Pulmonary Hypertension in Patients With Previous Acute Pulmonary Embolism - 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

2018 Clinical Trials

55. Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis Full Text available with Trip Pro

Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis Globally, sickle cell disease (SCD) is one of the most common haemoglobinopathy. Considered a public health problem, it leads to vessel occlusion, blood stasis and chronic activation of the coagulation system responsible for vaso-occlussive crises and venous thromboembolism (VTE) which may be fatal. Although contemporary observational studies suggest a relationship between SCD (...) -adults. A higher risk of VTE (OR 33.2, 95% CI 9.7-113.4, p < 0.001) and DVT (OR 30.7, 95% CI 1.6-578.2, p = 0.02) was found in pregnant or postpartum women with SCD as compared to their counterparts without SCD. Compared to adults with SCT, the risk of VTE was higher in adults with SCD (pooled OR 3.1, 95% CI 1.8-5.3, p < 0.001), and specifically in SCD pregnant or postpartum women (OR 20.3, 95% CI 4.1-102, p = 0.0003). The risk of PE was also higher in adults with SCD (OR 3.1, 95% CCI 1.7-5.9, p

2018 Thrombosis journal

56. Genital Haemorrhage in Woman of Childbearing Age Treated for Venous Thromboembolism Disease : Comparison According to Oral Anticoagulant and Impact on Quality of Life

of childbearing age in PACA region is not known. Condition or disease Genital Haemorrhage Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 575 participants Observational Model: Cohort Time Perspective: Prospective Official Title: Genital Haemorrhage in Woman of Childbearing Age Treated for Venous Thromboembolism Disease : Comparison According to Oral Anticoagulant and Impact on Quality of Life. Estimated Study Start Date : January 15, 2019 Estimated (...) Genital Haemorrhage in Woman of Childbearing Age Treated for Venous Thromboembolism Disease : Comparison According to Oral Anticoagulant and Impact on Quality of Life Genital Haemorrhage in Woman of Childbearing Age Treated for Venous Thromboembolism Disease : Comparison According to Oral Anticoagulant and Impact on Quality of Life - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms

2018 Clinical Trials

57. Quality measures in high-risk pregnancies: Executive summary of a cooperative workshop of SMFM, NICHD, and ACOG Full Text available with Trip Pro

majorityofwomenwithpreeclampsiawithseverefeatures. Low-dose aspirin. Prevention of hypertensive disease of pregnancy is the preferred approach and has been the subject of multiple trials with low-dose aspirin. The United States Preventive Services Task Force has released guidelines for use of low-dose aspirin to prevent pre- eclampsia,whichincreaseuseofthistherapybyexpansion of the patients whose condition is categorized at elevated risk for the development of this disorder. 49 In contrast, ACOG endorses a more restrained approach by recom (...) trials: re: prevention in pregnancy. Unclear International population- based cohort studies demonstrate improved maternal outcomes (decreased mortality rate). Yes Current infrastructure for risk assessment and monitoring has been implemented widely in hospitals for nonpregnant medical and surgical populations. Yes All pregnant women should undergo venous thromboembolism risk assessment and receive treatment if at increased risk; recommend tracking of prophylaxis rates, harms (wound infection, heparin

2017 Society for Maternal-Fetal Medicine

58. Obesity in pregnancy

. In choosing the cut-offs, resources were taken into consideration, as the prevalence is high in the lower BMI-groups. For most complications, there is a linear association between BMI and risk, and the risk increases from BMI = 25 kg/m 2 . Every individual case must therefore be assessed by the healthcare professional, giving recommendations based on an overall assessment. BMI in a pregnant woman is calculated from the weight just before pregnancy, or the first measured weight in pregnancy, and BMI (...) Women with BMI = 30 kg/m 2 , are advised to take the same vitamin supplementation as recommended for all pregnant women, before and during pregnancy. Due to an increased risk of fetal congenital malformations, consumption of 400 micrograms folic acid, one month before planned pregnancy and continuing during first trimester is particularly important. A Vitamin pills recommended for daily ingestion during pregnancy (Gravitamin®) contains 10 micrograms vitamin D, and there is no evidence for advising

2017 Nordic Federation of Societies of Obstetrics and Gynecology

59. Guidelines for the Use of Laparoscopy during Pregnancy

cholelithiasis, adrenal tumors, splenic disorders, symptomatic hernias, complications of inflammatory bowel diseases, and other rare conditions Over two decades ago, some argued that laparoscopy was contraindicated during pregnancy due to concerns for uterine injury from trocar placement and fetal malperfusion due to pneumoperitoneum. As surgeons gained more experience and documented their outcomes, laparoscopy has become the preferred treatment modality for many surgical diseases in the gravid patient [5, 6 (...) outcomes. When available resources preclude prompt imaging for diagnosis, or imaging is inconclusive, diagnostic laparoscopy may be considered. The risks of delayed diagnosis should be weighed against the risk of possible negative laparoscopy. The surgeon should be prepared to treat conditions diagnosed at laparoscopy. III. Patient Selection Pre-operative Decision Making Guideline 8: Laparoscopic treatment of acute abdominal disease offers similar benefits to pregnant and non-pregnant patients compared

2017 Society of American Gastrointestinal and Endoscopic Surgeons

60. Prevention of Peri-operative Venous Thromboembolism in Paedatric Patients

in approximately 10% Drugs Chemotherapy e.g. aspariginase Contraceptive pill (3 fold increase risk) Parenteral nutrition (may be line related) Immobility 25% cases with prolonged bed rest Pregnancy (2) 2 fold increase Congenital thrombophilia (3/4) Factor V Leiden Antithrombin III deficiency Protein C / S deficiency Increased F VIII Acquired Thrombophilia (3/4) Nephrotic syndrome Antiphospholipid syndrome Connective tissue disease Obesity (2) Increased incidence of VTE cardiac disease Congenital disease (...) mobility for 3 days or more Active cancer or cancer treatment Severe Trauma with ISS score >9 Dehydration Spinal cord injury with paralysis Known thrombophilias Total anaesthetic + surgical time > 90 minutes Obesity (BMI> 30kg/m2) Acute severe sepsis One or more significant medical comorbidities (e.g. congenital or low output heart disease, sickle cell dis- ease, metabolic or inflammatory conditions) Surgery involving pelvis or lower limb with a total anaes- thetic + surgical time > 60 minutes Personal

2017 Association of Paediatric Anaesthetists of Great Britain and Ireland

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