Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual-fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1-week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus.
In this review, we aimed to understand the relationship between SARS-CoV-2 infection and preeclampsia severity in infected pregnant women. Pregnant women with SARS- CoV-2 infection have been shown to have a significantly increased risk of maternal death, ICU admission, preterm delivery, and stillbirth compared with those without infection. The risk of preeclampsia also increases in pregnant women infected with SARS-CoV-2, particularly in those with severe symptoms. We emphasize the im-portance of specialized clinical management to prevent poor pregnancy outcomes in this situation. The association between COVID-19 and preeclampsia (PE) is likely due to multiple mechanisms, including the direct effects of the virus on trophoblast function and the arterial wall, acute atherosis, local inflammation leading to pla-cental ischemia, exaggerated inflammatory responses in pregnant women, SARS-CoV-2-related myocardial injury, cytokine storm, and thrombotic microan-giopathy. Emphasis has been placed on the potential impact of COVID-19 on pregnant women, specifically in relation to thrombotic complications, placental dysfunction, and cardiovascular dysfunction. Undoubtedly, one of the diagnostic tools to differentiate between COVID-19-induced preeclampsia-like syndrome and true preeclampsia is the use of biomarkers, such as the sFlt-1/PlGF ratio. We wish to highlight the potential for COVID-19-induced myocardial injury in pregnant women and the associated in-crease in maternal mortality rate. Vaccination against COVID-19 in the general population and in pregnant women in particular, drastically reduced the severity of the disease. There is an urgent need to continue the follow-up of these women and their children to detect the appearance of sequelae of the disease or peristent COVID 19
Background Essential thrombocythaemia (ET) is an uncommon myeloproliferative disorder with an elevated platelet count. ET occurring in pregnancy has been reported to be mainly associated with first trimester abortion, preterm delivery, intrauterine growth retardation, placental abruption and preeclampsia. Purpose To describe the case of a pregnant patient diagnosed with essential thrombocythaemia who could not remain untreated due to complications of the disease. Materials and methods 35-year-old female patient diagnosed with essential thrombocythaemia untreated for months so she could try for a baby reached platelet counts of 1,118,000/mL. In the first month of pregnancy this could not be left untreated because complications can arise as such microthrombosis in blood vessels, leading to a high incidence of abortions in these patients. The treatment requested from pharmacy services for this case was interferon alpha-2 beta (IFN α-2b) which has shown no teratogenicity compared to other alternatives such as hydroxyurea or anagrelide. Low-dose acetylsalicylic acid is contraindicated in patients with platelet counts of more than a million/mL, due to the possibility of acquired Von Willebrand syndrome. Interferon alfa has not been approved for the indication of essential thrombocythaemia so its off-label use required approval by the hospital management. 3 MUI of IFN α-2b were administered twice weekly IV during gestation. Results Platelet counts decreased gradually from the beginning of treatment passing from 1,118,000/mL to 680,000/mL in two weeks, then 602,000/mL in the third month, in the fourth month 530,000/mL, 487,000/mL in the fifth month, in the sixth month 462,000/mL and in the seventh month 328,000/mL. During week 29 + 2 gave birth by emergency Caesarean section because of severe preeclampsia. Despite the complications, mother and child progressed favourably. Conclusions Essential thrombocythaemia is a difficult to treat disease in pregnancy. Sometimes you have to use drugs off-label. In this case, the IFN α-2b successfully reduced the platelet count during pregnancy. No conflict of interest.
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