Induction or spontaneous labor for pregnant patients on anticoagulants?

Mauny, Lea; Peyronnet, Violaine; Peynaud-Debayle, Edith; Picone, Olivier; Nebout, Sophie; Mandelbrot, Laurent

doi:10.1016/j.jogoh.2023.102623

Cited by 1 publication

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“…Another important aspect concerns the management of labor in patients with hereditary thrombophilia. Controversies persist regarding the choice between inducing labor and awaiting spontaneous labor, as a long interval without anticoagulation is a thrombosis risk factor, while a short interval increases the risks of delivering without epidural analgesia or postpartum hemorrhage [50]. On the other hand, premature induction or induction without proper cervical ripening can lead to an increased rate of induction failure, number of misoprostol doses, longer time of induction, and higher cesarean section and episiotomy rate, as in obese and older women [51,52].…”

Section: Discussionmentioning

confidence: 99%

Impact of Thrombophilic Polymorphisms in Antenatal Women on Perinatal Health: A Single-Center Prospective Study

Sokol Karadjole,

D’Amato,

Milošević

et al. 2024

JPM

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Background: Despite pregnancy’s hypercoagulable state, the correlation between inherited thrombophilia and thrombotic adverse pregnancy outcomes remains uncertain. The objective of this study was to determine the prevalence of inherited thrombophilic polymorphisms among asymptomatic pregnant individuals and to examine their potential correlation with adverse perinatal outcomes. Methods: in this single-center prospective study, 105 healthy pregnant women were included. Genotyping was conducted for factor V Leiden (FVL), prothrombin gene mutation, methylenetetrahydrofolate reductase enzyme (MTHFR) C677T, MTHFR A1298C, and plasminogen activator inhibitor-1 (PAI-1), alongside the assessment of protein C (PC), protein S (PS), and antithrombin (AT) levels. The study analyzed the association between inherited thrombophilic polymorphisms and pregnancy complications linked to placental insufficiency, such as gestational hypertension (GH), preeclampsia (PE), intrauterine death (IUD), fetal growth restriction (FGR), and placental abruption. Results: The prevalence of identifiable thrombophilic polymorphism mutations was 61.9% (95% confidence interval - CI 52.4–70.8%), with the most common single mutation being PAI-1 4G/5G (12/105, 11.4%, 95% CI 6.4–18.5). The most frequent combined mutation was heterozygosity for MTHFR C677T and PAI-1 (12/105, 11.4%, 95% CI 6.4–18.5). Notably, no FVL homozygous carriers or single homozygous and heterozygous carriers for prothrombin polymorphisms were found. Additionally, no deficiencies in PC and AT were detected among participants. Except for homozygosity for PAI-1, none of the studied polymorphisms demonstrated a significant association with pregnancy complications linked to placental insufficiency. Conclusions: The asymptomatic carriers of inherited thrombophilic polymorphisms do not have an increased risk of adverse perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%