Prescription of postnatal thromboprophylaxis has increased with the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence guidance. Our study of postnatal women meeting the criteria for thromboprophylaxis aimed to ascertain compliance with low-molecular-weight heparin and barriers to completion of a full course. Women were recruited from the antenatal clinic or postnatal wards. Those who agreed were contacted by telephone 14 days after delivery and asked about their compliance with and experience of thromboprophylaxis. 111 women were followed up. We found reported compliance with postnatal thromboprophylaxis to be high (83% taking the full course); most women self-injected (54%) but a significant number relied on family members (39%). Most would be prepared to take the course in a future pregnancy (94%); however, some felt that they needed more information. Reported compliance with postnatal thromboprophylaxis is high. This may be down to the motivation of the new mother, appropriate information giving and access to health care professionals for advice.
We present a 25-year-old Caucasian woman in her first pregnancy (conceived on clomiphene) who had an uncomplicated course until 19 weeks of pregnancy. She has given written permission for the case to be reported. Booking blood tests in 2003 showed her to be blood group A positive and negative for hepatitis B virus and HIV. A nuchal translucency scan was low risk and confirmed the gestational age. She had a past history of ileo-caecal resection for Crohn's disease 4 years earlier.Between 19 and 23 weeks of gestation she had recurrent episodes of abdominal pain and vaginal bleeding warranting admission and a 2-unit blood transfusion. At 22 weeks an ultrasound scan showed normal fetal anatomy and a normal posterior, not low, placenta. However, it showed an 8.5-cm complex cystic mass on the anterior uterine wall. This was felt likely to represent a blood clot because it had not been present on the routine anomaly scan at 20 weeks. She remained an inpatient as she continued to have intermittent vaginal bleeding.After 6 days she complained of breathlessness and pleuritic chest pain. An ECG showed sinus tachycardia and a chest X-ray showed multiple rounded opacities throughout both lungs, measuring up to 2 cm in diameter, suggestive of metastases. A subsequent computed tomography pulmonary angiogram showed no evidence of embolic disease but confirmed multiple lesions highly suggestive of metastases. Renal, liver and thyroid function were normal and a quantitative b-human chorionic gonadotrophin (bhCG) measurement was 115 000 IU/l. Clinical examination of the breasts and skin revealed no abnormality and there were no palpable lymph nodes in the neck, groin and axilla.
Arrhythmias are one of the most common forms of cardiac disease presenting in pregnancy. Women with underlying arrhythmias may only present to health care professionals when they are pregnant. The most common type of sustained arrhythmia presenting in pregnancy is a supraventricular tachycardia (SVT). This can be difficult to diagnose, as symptoms such as palpitations, dizziness and shortness of breath are also common symptoms of pregnancy. We present the management of a woman who developed intrapartum SVT. Her case highlights the importance of considering the diagnosis in the antenatal period, the use of antiarrhythmic drugs, as well as the fact that achieving vaginal delivery is possible in correctly selected cases while the mother and baby remain stable.
Background Multiple caesarean sections (C/S) have an impact on maternal morbidity and are ‘resource hungry’. Previous audit data (April 2008–October 2009) in this unit had shown that 44% of elective C/S were performed for ‘maternal request’ after the woman had one previous C/S. Consequently a birth after caesarean (BAC) clinic was set up where the care of women was standardised. This is Consultant led with a specialised midwife and patient information leaflets. Aims To increase the percentage of women opting for Vaginal (V) BAC resulting in an increased percentage of successful VBAC's without increasing the overall complication rate from VBAC. To standardise an induction of labour (IOL) protocol for VBAC's to improve the success rate further. Standards The delivery register was reviewed for 6 months prior to the BAC clinic (November 2009–April 2010): 40% of women with one previous C/S aimed for VBAC with a 64% success rate. Results 93 women have delivered via the BAC clinic between May-December 2010. 73% opted for VBAC of which 68% were successful. 10 women chose IOL and 3 had emergency C/S. One woman had an incidental finding of scar dehiscence in spontaneous labour. Seven babies went to NICU – 6 after emergency C/S and 1 after SVD; 4 of these infants were preterm. Conclusions There was a significant improvement in the percentage of women opting for VBAC. There was a more modest improvement in VBAC success rates which we hope will be sustained as more data becomes available. We will continue monitoring complication rates.
Sixty two (93%) would take thromboprophylaxis if indicated in a future pregnancy. Conclusions Reported patient compliance with 7 days of postnatal thromboprophylaxis is high. Most patients are prepared to selfinject although a substantial number required help to administer the injections. The majority would accept the medication if required in a future pregnancy. Some did not feel they had adequate information and this could be addressed in our unit.
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