vitamin-k-semiquinone-radical and Abortion--Spontaneous

Managing anticoagulation in pregnant women with mechanical heart valves remains challenging. Our aim was to evaluate the effectiveness and safety of 4 regimens in these women.. Relevant studies published before June 2015 were collected in several databases and analyzed with RevMan version 5.3 and SPSS version 19.0. Four regimens were defined as follows: a regimen of a vitamin K antagonist (VKA) throughout pregnancy; a heparin (H)/VKA regimen using VKAs except for unfractionated heparin (UFH) or low molecular weight heparin (LMWH) during 6-12 weeks of pregnancy; a LMWH regimen of adjusted LMWH doses throughout pregnancy; and a UFH regimen of adjusted UFH doses throughout pregnancy. The low warfarin dose in the VKA regimen was defined as 5 mg/d or less.. Fifty-one studies comprising 2113 pregnancies in 1538 women were included. The rate of fetal wastage was significantly higher in the high warfarin dose subgroup than in the low dose one. Compared with the H/VKA regimen, the rate of maternal major thromboembolic event in the low-dose VKA regimen group was significantly lower, although the fetal outcomes were similar. Compared with the H/VKA regimen, the rate of fetal wastage in the LMWH regimen group was significantly lower, and the maternal outcomes were similar. The UFH regimen presented the worst maternal and fetal outcomes.. In the absence of large prospective trials, this meta-analysis showed that the VKA regimen should be best for pregnant women with a low warfarin dose, and the H/VKA regimen might be reasonable for those with a high warfarin dose. The LMWH regimen could be used for those who refuse VKA.

Topics: Abnormalities, Drug-Induced; Abortion, Induced; Abortion, Spontaneous; Anticoagulants; Dose-Response Relationship, Drug; Female; Heart Valve Prosthesis; Heparin; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications, Cardiovascular; Stillbirth; Thromboembolism; Vitamin K

The aim of this observational cohort study was to specify the risk of the vitamin K antagonist (VKA) phenprocoumon during first trimester of pregnancy, in particular to estimate the risk of birth defects and spontaneous fetal loss. Four hundred eight pregnancies with phenprocoumon exposure were compared to 1,642 pregnancies neither exposed to VKA nor to other major teratogens or fetotoxicants. There was no typical warfarin embryopathy in our exposed cohort. However, the overall rate of major birth defects was significantly increased (7.4 % vs 2.3 %; adjusted odds ratio [OR

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Abortion, Therapeutic; Adult; Anticoagulants; Birth Weight; Blood Coagulation; Drug Administration Schedule; Drug Substitution; Female; Humans; Infant, Newborn; Logistic Models; Odds Ratio; Phenprocoumon; Pregnancy; Pregnancy Trimester, First; Premature Birth; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vitamin K; Young Adult

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Adverse Drug Reaction Reporting Systems; Anticoagulants; Coumarins; Female; Humans; Pregnancy; Pregnancy Trimester, First; Proportional Hazards Models; Vitamin K

Vitamin K antagonists (VKA) are known to act as teratogens; however, there is still uncertainty about the relative risk for birth defects and the most sensitive period. In a multi-centre (n = 12), observational, prospective study we compared 666 pregnant women exposed to phenprocoumon (n = 280), acenocoumarol (n = 226), fluindione (n = 99), warfarin (n = 63) and phenindione (n = 2) to a non-exposed control group (n = 1,094). Data were collected by institutes collaborating in the European Network of Teratology Information Services (ENTIS) during individual risk counselling between 1988 and 2004. Main outcome measures were coumarin embryopathy and other birth defects, miscarriage rate, birth-weight, and prematurity. The rate of major birth defects after 1st trimester exposure was significantly increased (OR 3.86, 95% CI 1.86-8.00). However, there were only two coumarin embryopathies (0.6%; both phenprocoumon). Prematurity was more frequent (16.0% vs. 7.6%, OR 2.61, 95% CI 1.76-3.86), mean gestational age at delivery (37.9 vs.39.4, p<0.001), and mean birth weight of term infants (3,166 g vs. 3,411 g; p < 0.001) were lower compared to the controls. Using the methodology of survival analysis, miscarriage rate reached 42% vs. 14% (hazard ratio 3.36; 95% CI 2.28-4.93). In conclusion, use of VKA during pregnancy increases the risk of structural defects and other adverse pregnancy outcomes. The risk for coumarin embryopathy is, however, very small, in particular when therapy during the 1(st) trimester did not take place later than week 8 after the 1(st) day of the last menstrual period. Therefore, elective termination of a wanted pregnancy is not recommended if (inadvertent) exposure took place in early pregnancy. Close follow-up by the obstetrician including level II ultrasound should be recommended in any case of VKA exposure during pregnancy.

Topics: Abnormalities, Drug-Induced; Abortion, Induced; Abortion, Spontaneous; Acenocoumarol; Adverse Drug Reaction Reporting Systems; Anticoagulants; Birth Weight; Female; Fetal Diseases; Gestational Age; Humans; Phenindione; Phenprocoumon; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Premature Birth; Prospective Studies; Vitamin K; Warfarin

This study was undertaken to evaluate the risks and pregnancy outcome in women with prosthetic heart valves on different anticoagulent regimens.. A retrospective chart review of 82 pregnancies in 33 women with mechanical valve prostheses at a tertiary referral center from 1987 to 2002. The main outcome measures were major maternal complications and perinatal outcome.. The valve replaced was mitral (60.6%), aortic (18.2%), and both (21.2%). Fifty-four pregnancies (65.9%) resulted in live births, 9 (11.0%) had stillbirths (all on warfarin), and 12 (14.6%) had spontaneous and 7 (8.5%) therapeutic abortions (all on warfarin). The rate of spontaneous abortion was highest in women on warfarin throughout pregnancy (P < .01). The live birth rate was higher in women on heparin compared with those on warfarin (P < .01), and in those on heparin/warfarin compared with warfarin alone (P < .01). There were no maternal deaths; however, 3 patients had mitral valve thrombosis (2 on heparin and 1 on warfarin) necessitating surgery in 1 patient and medical thrombolysis in 2 patients. Hemorrhagic complications occurred in 5 patients, 4 of whom required transfusion.. No single anticoagulant regimen confers complete protection from thromboembolic phenomena in pregnancy. Despite a high maternal morbidity rate, the perinatal outcome is acceptable when pregnancy progresses beyond the first trimester.

Topics: Abortion, Spontaneous; Abortion, Therapeutic; Birth Weight; Delivery, Obstetric; Female; Fetal Death; Fetal Growth Retardation; Gestational Age; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies; Thrombosis; Vitamin K; Warfarin

To assess past care practices of neurologists and obstetricians to identify areas in which practice patterns differ from currently accepted optimal care.. Retrospective chart review of 155 women identified as having a diagnosis of epilepsy (or seizure disorder) who had been pregnant any time between January 1988 and December 1995 and were admitted to Stanford University Hospital for delivery. A total of 161 pregnancies (132 women) were selected for study.. An obstetrician was seen at some point during the pregnancy in 99% of the pregnancies, whereas a neurologist was seen at least once in only 64% of the pregnancies. In the 3 months before conception, an obstetrician was seen in 5% of the pregnancies and a neurologist was seen in 15%. Seventy-five percent of the patients taking antiepileptic medication and 65% of the untreated patients had documentation of folate supplementation at any time during pregnancy. Vitamin K supplementation in the final month of pregnancy was documented for only 41% of those receiving antiepileptic drugs. In over one-third of the pregnancies the mother did not have a maternal serum alpha-fetoprotein measure documented and a similar percentage did not receive genetic counseling. Monitoring of the maternal serum concentration of the non-protein-bound fraction of the prescribed antiepileptic drugs was not documented.. We identified specific omissions of appropriate vitamin supplementation, genetic counseling, and drug level monitoring. Educational efforts should be targeted to improve the management of pregnancy in women with epilepsy.

Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Anticonvulsants; Epilepsy, Generalized; Female; Folic Acid; Hematinics; Humans; Pregnancy; Pregnancy Outcome; Prenatal Care; Retrospective Studies; Risk Factors; Vitamin K

Topics: Abortion, Spontaneous; Aminocaproates; Ascorbic Acid; Extraembryonic Membranes; Female; Genitalia, Female; Humans; Labor, Obstetric; Oxytocin; Placenta Previa; Pregnancy; Pyridoxine; Uterine Cervical Neoplasms; Uterine Hemorrhage; Uterine Rupture; Vitamin K

Topics: Abortion, Spontaneous; Adult; Dicumarol; Disseminated Intravascular Coagulation; Female; Hemorrhage; Humans; Personality Disorders; Pregnancy; Prothrombin Time; Spectrophotometry; Substance-Related Disorders; Vitamin K

Topics: Abortion, Spontaneous; Adult; Aminobenzoates; Echinococcosis; Factor V Deficiency; Female; Humans; Hypoprothrombinemias; Obstetric Labor Complications; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Uterine Hemorrhage; Vitamin K

Topics: Abortion, Spontaneous; Anemia, Hemolytic, Congenital; Animals; Ascorbic Acid; Ergocalciferols; Female; Humans; Hydrocephalus; Infant, Newborn; Infant, Newborn, Diseases; Jaundice, Neonatal; Maternal-Fetal Exchange; Osteomalacia; Pregnancy; Pregnancy, Prolonged; Pyridoxine; Rats; Scurvy; Seizures; Skull; Vitamin A; Vitamin B 12; Vitamin E; Vitamin K; Vitamins

Topics: Abortion, Induced; Abortion, Spontaneous; Estrogens; Female; Humans; Pregnancy; Vitamin A; Vitamin K; Vitamins