A pregnancy producing a boy with congeital adrenocortical hypoplasia is described. Consistently low oestrogen excretion, less than 10 umol/24 h, was not associated with any anatomical abnormality or diminished growth of the fetus as judged by ultrasound examination. Fetoplacental steroid sulphatase definciency was excluded by finding normal maternal excretion of oestrogen precursors, the 3Beta-hydroxy-5-ene steroid sulphates. Generalized adrenocortical hypoplasia was proven in the baby boy by analysis of steroid netabolites excreted in his urine. He suffered from salt loss and progressive jaundice. Both were responsive to gluco- and mineralo-corticoid replacement therapy. It is suggested that amniocentesis may be required for the antenatal diagnosis of congenital adrenocortical hypoplasia.
Key content
The diagnosis of venous thromboembolism requires objective testing, which can be done safely throughout pregnancy.
Low molecular weight heparin is the most suitable agent for both prophylaxis and treatment of venous thromboembolism in pregnancy.
Once labour has commenced, heparin should not be administered.
It is recommended that anticoagulants be resumed 4–6 hours after vaginal delivery and 6–12 hours after caesarean delivery.
Learning objectives
To be able to choose the most appropriate diagnostic tests for venous thromboembolism in pregnancy.
To be able to prescribe the most appropriate anticoagulants.
To be able to manage women on anticoagulants appropriately during the different stages of pregnancy.
Ethical issues
The risks to the fetus of anticoagulant therapy are outweighed by the health benefits to the mother.
Women of reproductive age on oral anticoagulants should know about warfarin embryopathy.
Please cite this article as: Asghar F, Bowman P. A clinical approach to the management of thrombosis in obstetrics. Part 2: diagnosis and treatment of venous thromboembolism. The Obstetrician & Gynaecologist 2007;9:3–8.
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