BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial ...BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial effect in the improvement of microcirculation,prophylactic application of LMWH in patients with preeclampsia became a trend.However,the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated.This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy.All the cases experienced catastrophic hemorrhagic events.After reviewing the twenty-one meta-analyses,the bleeding risk related with LMWH seems ignorable.Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH.Other studies reported minor bleeding risks,none of these were serious enough to stop LMWH treatment.Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored.Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.展开更多
BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigat...BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigate the clinical characteristics,prognosis,and therapy of HHD in pregnant women.METHODS We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu,China,following the approval by the Ethics Committee.We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD.The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system.All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.RESULTS A total of 155 patients were diagnosed with thyrotoxicosis,of whom six were diagnosed with HHD.Three of them had regular antenatal care.Two patients were complicated with acute heart failure attacks,and one of them had a stillbirth.Both of these patients had a long history of Graves’disease with poor treatment compliance.Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis.Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications.Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage.Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.CONCLUSION The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD.Improvement in patients’awareness of thyrotoxicosis is needed.展开更多
基金Supported by National Natural Science Foundation of China,No.82301924.
文摘BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial effect in the improvement of microcirculation,prophylactic application of LMWH in patients with preeclampsia became a trend.However,the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated.This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy.All the cases experienced catastrophic hemorrhagic events.After reviewing the twenty-one meta-analyses,the bleeding risk related with LMWH seems ignorable.Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH.Other studies reported minor bleeding risks,none of these were serious enough to stop LMWH treatment.Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored.Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.
基金Supported by Science and Technology Department of Sichuan Province,No.2019YJ0086Clinical Research Fund of West China Second University Hospital of Sichuan University,No.KL024
文摘BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigate the clinical characteristics,prognosis,and therapy of HHD in pregnant women.METHODS We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu,China,following the approval by the Ethics Committee.We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD.The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system.All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.RESULTS A total of 155 patients were diagnosed with thyrotoxicosis,of whom six were diagnosed with HHD.Three of them had regular antenatal care.Two patients were complicated with acute heart failure attacks,and one of them had a stillbirth.Both of these patients had a long history of Graves’disease with poor treatment compliance.Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis.Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications.Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage.Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.CONCLUSION The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD.Improvement in patients’awareness of thyrotoxicosis is needed.
