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Thromboembolic Disease in Pregnancy

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61. Venous Thromboembolism Risk and Adequacy of Prophylaxis in High Risk Pregnancy in the Arabian Gulf Full Text available with Trip Pro

Venous Thromboembolism Risk and Adequacy of Prophylaxis in High Risk Pregnancy in the Arabian Gulf To estimate the prevalence of venous thromboembolism (VTE) risk factors in pregnancy and the proportion of pregnancies at risk of VTE that received the recommended prophylaxis according to the American College of Chest Physicians (ACCP) 2012 published guidelines in antenatal clinics in the Arabian Gulf.The evaluation of venous thromboembolism (EVE)-Risk project was a non-interventional, cross (...) (6.9%), thrombophilia (2.6%), immobilization (2.0%), sickle cell disease (2.8%) and previous VTE (1.6%). Only 8.3% (n=111) of the high risk patients were on the recommended VTE prophylaxis. Enoxaparin was used in 80% (n=89) of the cases followed by tinzaparin (4%; n=4). Antiplatelet agents were prescribed in 11% (n=149) of pregnant women. Of those on anticoagulants (n=111), 59% (n=66) were also co-prescribed antiplatelet agents. Side effects (mainly local bruising at the injection site) were

2016 Current vascular pharmacology

62. Inhaled iloprost for chronic thromboembolic pulmonary hypertension (CTEPH) during pregnancy: a case report. (Abstract)

Inhaled iloprost for chronic thromboembolic pulmonary hypertension (CTEPH) during pregnancy: a case report. Chronic thromboembolic pulmonary hypertension (CTEPH) is a subset of pulmonary hypertension caused by acute and recurrent pulmonary emboli. Pulmonary thromboendarterectomy is the treatment of choice, but 10-50% of patients are ineligible for this procedure. We describe the case of a 25-year-old, morbidly obese (228-kg, body mass index 83.5 kg/m(2) ) pregnant woman (G3 P2 ) who presented (...) pregnant are limited to phosphodiesterase type 5 inhibitors and prostacyclin analog therapies due to the teratogenicity of the other drug classes used to treat the disorder (endothelin receptor antagonists and soluble guanylate cyclase stimulators). To our knowledge, this is the first case report of inhaled iloprost use in addition to oral sildenafil to improve patient symptomatology and hemodynamics during the peripartum period of a young pregnant patient with inoperable CTEPH. This drug therapy

2016 Pharmacotherapy

63. Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease. Full Text available with Trip Pro

adjustment for patient characteristics, Gini and country-specific birth rate.While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018 (...) Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease. Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal

2017 Heart

64. A case of successfully managed pregnancy in a patient with complex cyanotic congenital heart disease Full Text available with Trip Pro

A case of successfully managed pregnancy in a patient with complex cyanotic congenital heart disease Medical advances have increased survival of patients with congenital heart disease. However, cardiac disease in pregnancy carries significant maternal and fetal risks, posing enormous challenges to obstetricians. Cyanotic congenital heart disease is associated with maternal complications such as arrhythmias, thromboembolic events and death. Fetal complications include small for gestational age (...) , miscarriage and prematurity. Cyanotic congenital heart disease patients who continue their pregnancies require holistic multidisciplinary team care with early and coordinated planning for delivery. Management of such patients include early counseling regarding pregnancy-associated risks, close monitoring of their cardiac function and regular scanning for fetal assessment. Choice of anesthesia for these patients requires meticulous planning to achieve a favorable balance between systemic and pulmonary

2016 Obstetric medicine

65. Cardiac Diseases With Pregnancy in Benisuef Localities

Details Study Description Go to Brief Summary: The aim of this work is to demonstrate the variation of cardiac diseases among pregnant ladies in our localities, detect maternal & fetal complications and to predict the risk factors for poor maternal, fetal & neonatal outcomes Condition or disease Intervention/treatment Heart Disease Structural Disorder Abscess of Cardiac Septum Other: registry Study Design Go to Layout table for study information Study Type : Observational [Patient Registry] Actual (...) at presentation and up till 6 weeks postpartum in comparison to women free from any cardiac diseases. Criteria Inclusion criteria All pregnant ladies with Cardiac diseases, valvular heart disease, congenital heart disease, ischemic heart disease, cardiomyopathy, arrhythmias , big and pulmonary hypertension, presenting with pregnancy regardless age, any concomitant diseases and type of heart disease will be enrolled. A similar number of pregnant females free from previous mentioned cardiac diseases

2017 Clinical Trials

66. Complications of pregnancy and labor in women with Klippel-Trenaunay syndrome: a nationwide cross-sectional study. Full Text available with Trip Pro

Complications of pregnancy and labor in women with Klippel-Trenaunay syndrome: a nationwide cross-sectional study. To evaluate complications of pregnancy, including thromboembolism, in women with extensive vascular malformations associated with Klippel-Trénaunay syndrome (KTS).Nationwide cross-sectional study.Two tertiary expert centres and the Dutch Klippel-Trénaunay patient organisation.Adult women with KTS.Patients with KTS were invited to participate in a comprehensive online survey about (...) their obstetric history. Reference data on pregnancy outcomes and complications of non-diseased women were collected from population-based cohorts from the literature.Prevalence of complications, specifically venous thromboembolism and postpartum haemorrhage.Sixty women completed the survey. Seventeen patients did not conceive, of whom three refrained from pregnancy because of KTS. A total of 97 pregnancies and 86 deliveries were reported in 43 patients. KTS-related symptoms were aggravated during pregnancy

2017 BJOG

67. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

published 4 May 2020 Circulation. 2020;141:e884–e903 Abstract Cardio-obstetrics has emerged as an important multidisciplinary field that requires a team approach to the management of cardiovascular disease during pregnancy. Cardiac conditions during pregnancy include hypertensive disorders, hypercholesterolemia, myocardial infarction, cardiomyopathies, arrhythmias, valvular disease, thromboembolic disease, aortic disease, and cerebrovascular diseases. Cardiovascular disease is the primary cause (...) , and significant aortic dilatation with underlying connective tissue disease. Women with these conditions are often advised to avoid pregnancy. However, it is not uncommon for women to present pregnant, and at that point, the high-risk cardio-obstetrics team must work together to come up with the best way to mitigate maternal cardiovascular and obstetric risk and fetal risk moving forward. Medical Conditions During Pregnancy Hypertensive Disorders in Pregnancy Hypertensive disorders of pregnancy (HDP

2020 American Heart Association

68. Maternal Comorbidities and Complications of Delivery in Pregnant Women With Congenital Heart Disease. Full Text available with Trip Pro

Maternal Comorbidities and Complications of Delivery in Pregnant Women With Congenital Heart Disease. Pregnant women with congenital heart defects (CHDs) may be at increased risk for adverse events during delivery.This study sought to compare comorbidities and adverse cardiovascular, obstetric, and fetal events during delivery between pregnant women with and without CHDs in the United States.Comorbidities and adverse delivery events in women with and without CHDs were compared in 22,881,691 (...) to 238.0), congestive heart failure (aOR: 49.1; 95% CI: 37.4 to 64.3), and coronary artery disease (aOR: 31.7; 95% CI: 21.4 to 47.0). Greater odds of adverse events were observed, including heart failure (aOR: 22.6; 95% CI: 20.5 to 37.3), arrhythmias (aOR: 12.4; 95% CI: 11.0 to 14.0), thromboembolic events (aOR: 2.4; 95% CI: 2.0 to 2.9), pre-eclampsia (aOR: 1.5; 95% CI: 1.3 to 1.7), and placenta previa (aOR: 1.5; 95% CI: 1.2 to 1.8). Cesarean section, induction, and operative vaginal delivery were more

2019 Journal of the American College of Cardiology

69. Time of Treatment With LMWH in Cancer Patients With Thromboembolic Disease

used like recurrence predictors after LMWH treatment suspension, but in cancer patients the useful is limited. Phospholipid-dependent microparticles could been used like recurrence predictors in cancer patients and tailored the duration of LMWH treatment for each patient. Condition or disease Venous Thromboembolism Pulmonary Thromboembolisms Cancer Detailed Description: We are carrying out a study in Cancer-associated-thromboembolism patients in order to decide the suitable anticoagulation time (...) Time of Treatment With LMWH in Cancer Patients With Thromboembolic Disease Time of Treatment With LMWH in Cancer Patients With Thromboembolic Disease - 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. Time

2017 Clinical Trials

70. Pregnancy: Diagnosis of DVT and PE

discomfort and dyspnea are common in normal pregnancy. Therefore, the majority of pregnant women investigated for VTE (>90%) will not have VTE. However, in patients with unilateral leg swelling, particularly of the left leg, previous history of VTE, family history of VTE, increased BMI, age > 40, bedrest for 7 days or medical illness, the suspicion of VTE must be increased. Since the consequences of failing to diagnose VTE in pregnancy are significant, the threshold for investigating pregnant women (...) Pregnancy: Diagnosis of DVT and PE © 2016 Thrombosis Canada Page 1 of 4 PREGNANCY: DIAGNOSIS OF DVT AND PE OBJECTIVE: To provide a diagnostic approach to the evaluation of pregnant patients with a clinical suspicion of deep vein thrombosis (DVT) or pulmonary embolism (PE). BACKGROUND: Pregnancy is a well established risk factor for VTE. DVT complicates 1-2 per 1,000 pregnancies and PE complicates 0.5 per 1,000 pregnancies. VTE occurs in all trimesters of pregnancy and the post-partum period

2016 Thrombosis Interest Group of Canada

71. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum

settings. It gives advice for multidisciplinary professionals involved in the care of women with these conditions, including how to counsel and support women before, during and after their pregnancies. 2. Introduction and background epidemiology NVP affects up to 80% of pregnant women 1 and is one of the most common indications for hospital admission among pregnant women, with typical stays of between 3 and 4 days. 2–4 For this guideline, NVP is defined as the symptom of nausea and/or vomiting during (...) . 10,11 They are primarily thought to be associated with rising levels of beta human chorionic gonadotrophin (hCG) hormone, and conditions with higher hCG levels, such as trophoblastic disease and multiple pregnancy, have been associated with increased severity of NVP . 12,13 3. Identification and assessment of evidence This guideline was developed in accordance with standard methodology for producing Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guidelines. Databases searched

2016 Royal College of Obstetricians and Gynaecologists

72. Ectopic pregnancy and miscarriage: diagnosis and initial management

of 39they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and and the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests. Using ultrasound for diagnosis Offer women who attend an early pregnancy assessment service (or out (...) there is no evidence exploring the psychological impact of the different treatments for ectopic pregnancy. However, the emotional impact of the condition can be significant, in some circumstances leading to post-traumatic stress disorder. A qualitative comparative study should be carried out to assess how this impact can be reduced. This would help to maximise women's emotional recovery in the short and long term, enable women and clinicians to decide the optimum Ectopic pregnancy and miscarriage: diagnosis

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

73. Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. Full Text available with Trip Pro

/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity (...) Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. Weight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance.Direction, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between

2017 PLoS ONE

74. Antenatal care - uncomplicated pregnancy

are unsure about the safety of a medication during pregnancy, contact the on 0344 892 0909 for a patient-specific risk assessment. Assess and document the risk factors for venous thromboembolism including: History of thromboembolism. Thrombophilia (such as Factor V Leiden deficiency, Antiphospholipid syndrome, Prothrombin 20210, Protein C, protein S or antithrombin deficiencies). Other medical conditions (such as heart disease, sickle cell disease, systemic lupus erythematosus, obesity, anaemia, diabetes (...) disease, including hypertension. Renal disease. Hepatic disease. Endocrine disorders or diabetes mellitus. Psychiatric disorders (requiring medication) or a history of psychiatric disorders. Haematological disorders, including sickle cell disease, thalassaemia, or thromboembolic disease. Autoimmune disorders, such as antiphospholipid syndrome. Epilepsy requiring anticonvulsant drugs. Cancer. Severe asthma (for example requiring hospital admission or frequent courses of oral corticosteroids). HIV

2019 NICE Clinical Knowledge Summaries

75. The Acute Management of Thrombosis and Embolism during Pregnancy and the Puerperium

The Acute Management of Thrombosis and Embolism during Pregnancy and the Puerperium Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management Green-top Guideline No. 37b April 2015RCOG Green-top Guideline No. 37b © Royal College of Obstetricians and Gynaecologists 2 of 32 Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management This is the third edition of this guideline. The first edition was published in April 2001 under the same title (numbered Green-top (...) ) is particularly unreliable in pregnancy and only a minority of women with clinically suspected VTE have the diagnosis confirmed when objective testing is employed; the prevalence of ultimately diagnosed PE in pregnant women with suspected PE is 2–6%. 3–5 The risk of antenatal VTE is four- to five-fold higher in pregnant women than in nonpregnant women of the same age, 6,7 although the absolute risk remains low at around 1 in 1000 pregnancies. 8 Venous thromboembolism can occur at any stage of pregnancy

2015 Royal College of Obstetricians and Gynaecologists

76. Reducing the Risk - Thrombosis and Embolism during Pregnancy and the Puerperium

in pregnancy. Risk scoring methodologies A formal VTE risk assessment with numerical scoring for all pregnant and postpartum women is recommended (see Appendix III). [New 2015] B P P D P P D D D P DRCOG Green-top Guideline No. 37a © Royal College of Obstetricians and Gynaecologists 9 of 40 1. Purpose and scope The aim of this guideline is to provide advice, based on clinical evidence where available, regarding the prevention of venous thromboembolism (VTE) during pregnancy, birth and following delivery (...) titre anticardiolipin antibodies and/or ß 2 -glycoprotein 1 antibodies Medical comorbidities e.g. cancer; heart failure; active SLE, inflammatory polyarthropathy or IBD; nephrotic syndrome; type I diabetes mellitus with nephropathy; sickle cell disease; 49 current intravenous drug user Age > 35 years Obesity (BMI = 30 kg/m 2 ) either prepregnancy or in early pregnancy Parity = 3 (a woman becomes para 3 after her third delivery) Smoking Gross varicose veins (symptomatic or above knee

2015 Royal College of Obstetricians and Gynaecologists

77. Thrombophilia Testing for Early Pregnancy Loss

not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions. TITLE: Thrombophilia Testing for Early Pregnancy Loss: Clinical Effectiveness (...) Thrombophilia Testing for Early Pregnancy Loss Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

78. Venous Thromboembolism: Duration of Treatment

THROMBOSIS CANADA CLINICAL GUIDES: ? Cancer and Thrombosis ? Deep Vein Thrombosis (DVT): Treatment ? Pediatric Thrombosis ? Pregnancy: Venous Thromboembolism Treatment ? Pulmonary Embolism (PE): Treatment © 2015 Thrombosis Canada Page 5 of 5 REFERENCES: Kearon C, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e419S-494S. Kearon C, Akl EA (...) Venous Thromboembolism: Duration of Treatment © 2015 Thrombosis Canada Page 1 of 5 VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT OBJECTIVE: To provide guidance on the recommended duration of anticoagulant therapy for venous thromboembolism (VTE). BACKGROUND: Recurrent episodes of VTE appear to fall into two categories: 1) Recurrences may be due to reactivation and extension of the original thrombosis. This risk is very high when patients first present with acute thrombosis; the risk decreases

2015 Thrombosis Interest Group of Canada

79. Diagnosis of Pulmonary Embolism During Pregnancy: A Multicenter Prospective Management Outcome Study. (Abstract)

Diagnosis of Pulmonary Embolism During Pregnancy: A Multicenter Prospective Management Outcome Study. Data on the optimal diagnostic management of pregnant women with suspected pulmonary embolism (PE) are limited, and guidelines provide inconsistent recommendations on use of diagnostic tests.To prospectively validate a diagnostic strategy in pregnant women with suspected PE.Multicenter, multinational, prospective diagnostic management outcome study involving pretest clinical probability (...) and, if results were negative, CTPA. A ventilation-perfusion (V/Q) scan was done if CTPA results were inconclusive. Pulmonary embolism was excluded if results of the diagnostic work-up were negative, and untreated pregnant women had clinical follow-up at 3 months.The primary outcome was the rate of adjudicated venous thromboembolic events during the 3-month follow-up.441 women were assessed for eligibility, and 395 were included in the study. Among these, PE was diagnosed in 28 (7.1%) (proximal deep venous

2018 Annals of Internal Medicine

80. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. (Abstract)

and 44 non-academic hospitals in the Netherlands. Women with non-severe hypertensive disorders of pregnancy between 34 and 37 weeks of gestation were randomly allocated to either induction of labour or caesarean section within 24 h (immediate delivery) or a strategy aimed at prolonging pregnancy until 37 weeks of gestation (expectant monitoring). The primary outcomes were a composite of adverse maternal outcomes (thromboembolic disease, pulmonary oedema, eclampsia, HELLP syndrome, placental abruption (...) Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy. We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women.We did an open-label, randomised controlled trial, in seven academic hospitals

2015 Lancet Controlled trial quality: predicted high

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