Objective. To evaluate the course of pregnancy and puerperium in asymptomatic carriers of FV Leiden and FII prothrombin mutation in heterozygous configuration in terms of risk of thrombembolic disease (TED) and late pregnancy complications. To evaluate whether global prophylactic LMWH administration during pregnancy benefits these women. Methods. We monitored the incidence of thrombembolic events and severe late pregnancy complications in 473 asymptomatic carriers of FV Leiden and FII prothrombin mutation in heterozygous configuration. In 253 women, preventive LMWH application was introduced already during pregnancy. In 220 women, the application of LMWH was commenced as late as on the delivery day. In both groups application of LMWH continued during the puerperium. Results. The incidence of TED in the whole group of carriers of thrombophylic mutations accounted for 0.19%. The incidence of severe late pregnancy complications was low -2.5% compared with general population of pregnant women (6.4%). Conclusions. No direct causal relationship was established between asymptomatic carriage of Leiden and prothrombin mutation in heterozygous configuration and the occurrence of severe late pregnancy complications. There was no benefit from general LMWH prophylaxis started as early as pregnancy in these women and thus we consider it unnecessary.
Aim: Evaluation of the effect of substitution therapy on the birth weight of the newborn, its postpartum adaptation and course of the neonatal abstinence syndrome.
Patients and methods:We studied heroin-addicted women and women undergoing methadone and buprenorphine substitution. During the 3 years we concentrated on 47 heroin-addicted women and 60 women under substitution for prenatal screening, labour and delivery.Results: Birth weight of newborns was lowest in the group of heroin-addicted women as compared to the group receiving substitution with buprenorphine p < 0.01 and to the group of methadone-substituted patients p < 0.05. The highest number of changes in the placenta was exhibited by heroin users, both when compared to methadone users (p < 0.01) and buprenorphine users (p < 0.001). The highest statistically significant number of newborns with IUGR symptoms were born to heroin-addicted women. The lowest Apgar score was recorded in all three evaluations in the group of buprenorphine users and the highest in methadone-substituted women.
Conclusions:Substitution therapy provides pregnant women with the possibility of social stabilization and adequate prenatal care. With regard to the fact that methadone substitution protracts the newborn´s abstinence syndrome, attention has been recently focused on substitution with buprenorphine that seems to be from this viewpoint a more considerate option.
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