Coagulopathies are one of the obstetric complications affecting the period of pregnancy, childbirth, and puerperium. One of the more severe and complex disorders of the haemostatic system is the disseminated intravascular coagulation syndrome (DIC), in which generalised activation of the coagulation system and activation of inflammatory cells occurs. DIC syndrome was observed in patients whose pregnancy was complicated by SARS-CoV-2 infection. Both the course of these cases and literature review indicate that particular notice should be paid to laboratory parameters of the coagulation system, closely monitoring the well-being of the foetus and, in the situation of acute DIC development, it is advised to deliver a baby and initiate intensive therapy.
Objectives: Local and international organizations recommend folic acid (FA) supplementation in the periconceptional period. This study aimed to analyse the prevalence of periconceptional supplementation with FA in women at high risk of fetal anomalies refferred for first trimester screening.Material and methods: Our analysis involved 1,455 women at high risk of fetal anomalies refferred for first trimester screening. FA supplementation was assessed by face-to-face interviews conducted by doctors performing first trimester screening for aneuploidy.Results: FA supplementation before pregnancy was reported by 46.8% of the women and during the first trimester by 57.2% of those studied. Women used FA supplementation more frequently if they had a history of at least one miscarriage (OR 2.2, 95% CI 1.70-2.83; p < 0.001), a history of assissted reproductive techniques (OR 2.25, 95% CI 1.18-4.31; p = 0.014), or were aged between 30 and 34 (OR 2.87, 95% CI 1.47-5.58; p = 0.002). Among 122 women with a history of fetal defects only 50% confirmed FA supplementation before pregnancy and 62.2% during pregnancy (p = 0.488). A similar frequency of FA supplementation was noted among women with epilepsy, diabetes, and hypertension. Less frequent taking of FA was noted among women at least third and subsequent pregnancies (p < 0.001). In the current pregnancy, neural tube defects (NTDs) were less frequent by 86% in the group of women with FA supplementation than in the non-supplementation group (1 case vs 6 cases, respectively) and for other fetal defects by 62.5% (24 vs 40 cases, respectively). Conclusions:We found an unsatisfactory compliance with recommendations for the use of folic acid supplementation during periconceptional period among women at high risk of fetal defects and folate deficiency, that could have negative effects on the health of child and mother. The study results show the need to increase the awareness of FA supplementation during periconceptional period especially in women with high risk of fetal anomalies.
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