Background Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. Methods We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or extracorporeal membrane oxygenation (ECMO), occurring during pregnancy or within 6 weeks of delivery. Main outcomes were maternal survival and major bleeding, premature delivery, and fetal survival and bleeding. Results We found 127 cases of severe PE (at least 83% massive; 23% with cardiac arrest) treated with at least one modality. Among 83 women with thrombolysis, survival was 94% (95% CI, 86-98). The risk of major bleeding was 17.5% during pregnancy and 58.3% in the postpartum period, mainly because of severe postpartum hemorrhages. Fetal deaths possibly related to PE or its treatment occurred in 12.0% of cases treated during pregnancy. Among 36 women with surgical thrombectomy, maternal survival and risk of major bleeding were 86.1% (95% CI, 71-95) and 20.0%, with fetal deaths possibly related to surgery in 20.0%. About half of severe postpartum PEs occurred within 24 h of delivery. Conclusions Published cases of thrombolysis for massive PE during pregnancy and the postpartum period suggest a high maternal and fetal survival (94% and 88%). In the postpartum period, given the high risk of major bleeding with thrombolysis, other therapeutic options (catheter [or surgical] thrombectomy, ECMO) may be considered if available.
Introduction: The objective of the study was to establish the predictive value of prenatal ultrasound markers for complex gastroschisis (GS) in the first 10 days of life. Material and Methods: In this retrospective cohort study over 11 years (2000-2011) of 117 GS cases, the following prenatal ultrasound signs were analyzed at the last second- and third-trimester ultrasounds: intrauterine growth restriction, intra-abdominal bowel dilatation (IABD) adjusted for gestational age, extra-abdominal bowel dilatation (EABD) ≥25 mm, stomach dilatation, stomach herniation, perturbed mesenteric circulation, absence of bowel lumen and echogenic dilated bowel loops (EDBL). Results: Among 114 live births, 16 newborns had complex GS (14.0%). Death was seen in 16 cases (13.7%): 3 intrauterine fetal deaths, 9 complex GS and 4 simple GS. Second-trimester markers had limited predictive value. Third-trimester IABD, EABD, EDBL, absence of intestinal lumen and perturbed mesenteric circulation were statistically associated with complex GS and death. IABD was able to predict complex GS with a sensitivity of 50%, a specificity of 91%, a positive predictive value of 47% and a negative predictive value of 92%. Discussion: Third-trimester IABD adjusted for gestational age appears to be the prenatal ultrasound marker most strongly associated with adverse outcome in GS.
C ardiovascular diseases are the leading cause of death in women, and hypertension is one of the most important risk factor for their development.1 Coronary heart disease mortality is higher in women compared with men, 2 and heart disease death rates now seem to be increasing in women 3 as does the prevalence of hypertension. 4 Case-control and cohort studies consistently report that preeclampsia, a pregnancy-specific disorder, is predictive of future cardiovascular, cerebrovascular, and end-stage renal diseases. 5,6 Women with early onset or severe preeclampsia and preterm delivery are at particularly high risk of cardiovascular disease later in life, including during the premenopausal period.7 A history of preeclampsia should, therefore, be considered when evaluating the risk of cardiovascular disease in women.It is still uncertain whether the association between preeclampsia and cardiovascular disease is explained by adverse effects of preeclampsia itself on target organs or by underlying risk factors that predispose women to both preeclampsia and later cardiovascular and renal diseases. Blood pressure (BP) response to variations in salt intake, known as salt sensitivity, is considered as an independent marker for increased cardiovascular risk. [8][9][10] Salt sensitivity is traditionally defined as an increase in office BP of 5% to 10% or an increase in mean ambulatory BP (ABP) of ≥4 mm Hg with an increase in sodium intake.11 Several factors contribute to the development of salt sensitivity in humans, including aging and changes in renal function, and also hormonal and genetic factors. [12][13][14] The profile of sex hormones has also been shown to affect the salt sensitivity of BP. 15,16 In previous studies, we have shown that women are salt resistant before menopause or when receiving oral contraceptives, 17 but they become salt sensitive after menopause. 18 That observation might be explained by the aging effect but also by the change in hormonal profile as salt sensitivity also develops in younger women with surgical menopause. 19 In the present study, we hypothesized that part of the elevated risk of cardiovascular disease in women with a history of severe preeclampsia may be related to salt sensitivity of BP. To this purpose, we assessed the salt sensitivity of BP in women with a history of severe or early onset preeclampsia Abstract-Cardiovascular diseases are the principal cause of death in women in developed countries and are importantly promoted by hypertension. The salt sensitivity of blood pressure (BP) is considered as an important cardiovascular risk factor at any BP level. Preeclampsia is a hypertensive disorder of pregnancy that arises as a risk factor for cardiovascular diseases. This study measured the salt sensitivity of BP in women with a severe preeclampsia compared with women with no pregnancy hypertensive complications. Forty premenopausal women were recruited 10 years after delivery in a case-control study. Salt sensitivity was defined as an increase of >4 mm Hg in 24-hour ambulatory ...
The use of misoprotol in preeclamptic women appears to be safe and is not associated with a higher risk of placental abruption when compared with other prostaglandins. Concerns about the use of misoprostol in the case of preeclampsia are not justified.
Introduction: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare condition that may lead to intracerebral haemorrhage (ICH) in the fetus or neonate. Platelet alloimmunisation causing FNAIT has been described in association with fetal cerebral ventriculomegaly (VM), presumably due to subclinical ICH. The objective of this study was to assess the association between fetal VM and platelet alloimmunisation. Methods: This is a case series of pregnancies with fetal VM screened for platelet alloantibodies from 2003 to 2012. Cases of multiple pregnancies, structural anomalies, aneuploidies, or congenital infection were excluded. Results: Of 45 pregnancies with fetal VM that were screened for platelet alloantibodies, 5 (11%) were positive. There was only one antenatal ICH, with confirmed fetal severe thrombocytopenia before termination of pregnancy. The other cases were treated with intravenous immunoglobulins without prior fetal blood sampling. No other case of neonatal thrombocytopenia was confirmed. Conclusions: The prevalence of platelet alloimmunisation was high in this series of fetal VM. Prospective large studies are needed to confirm the role of platelet alloimmunisation in fetal VM.
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