vitamin-k-semiquinone-radical and Fetal-Death

To review maternal and foetal outcomes in women with mechanical heart valves (MHVs) treated with vitamin-K antagonists (VKAs), first-trimester heparin followed by VKAs (sequential treatment), low molecular weight heparin (LMWH) and unfractionated heparin (UFH) during pregnancy, in order to inform practice.. Medline, Embase and Central were searched from inception until February 2016. Two reviewers independently screened 1786 titles, reviewed 110 full-texts and extracted data and assessed risk-of-bias from 46 articles. Pooled incidence (95% confidence intervals) was calculated for maternal and foetal outcomes. Included studies had a moderate or high risk-of-bias. With VKAs, sequential treatment and LMWH, maternal mortality occurred in 0.9% (0.4-1.4), 2.0% (0.8-3.1) and 2.9% (0.2-5.7), thromboembolic complications in 2.7% (1.4-4.0), 5.8% (3.8-7.7) and 8.7% (3.9-13.4), livebirths in 64.5% (48.8-80.2), 79.9% (74.3-85.6) and 92.0% (86.1-98.0) and anticoagulant-related foetal/neonatal adverse events (embryopathy or foetopathy) in 2.0% (0.3-3.7), 1.4% (0.3-2.5) and 0%, respectively. When UFH is used throughout pregnancy, 11.2% (2.8-19.6) suffered thromboembolic complications. Foetal loss and adverse events occurred with first-trimester warfarin doses ≤ 5 mg/day, although there were more livebirths [83.6% (75.8-91.4) vs. 43.9% (32.8-55.0)] and fewer foetal anomalies [2.3% (0.7-4.0) vs. 12.4% (3.3-21.6)] with lower doses than with warfarin > 5 mg/day.. VKAs are associated with fewest maternal complications but also with fewest livebirths. Sequential treatment does not eliminate anticoagulant-related foetal/neonatal adverse events. LMWH is associated with the highest number of livebirths. The safety of UFH throughout pregnancy and first-trimester warfarin  ≤ 5 mg/day remains unconfirmed.

Topics: Anticoagulants; Female; Fetal Death; Fetal Diseases; Heart Valve Prosthesis; Heparin; Heparin, Low-Molecular-Weight; Humans; Incidence; Maternal Mortality; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy Trimester, First; Thromboembolism; Vitamin K; Warfarin

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease during pregnancy, characterized by otherwise unexplained pruritus in late second and third trimester of pregnancy and elevated bile acids and/or transaminases. ICP is associated with an increased risk of adverse perinatal outcomes for the fetus and the later development of hepatobiliary disease for the mother. Bile acids should be monitored throughout pregnancy since fetal risk is increased at serum bile acids >40 µmol/l. Management of ICP consists of treatment with ursodeoxycholic acid, which reduces pruritus. Early elective delivery is common practice but should be performed on an individualized basis as long as strong evidence supporting this practice is lacking. Mothers should be followed-up for normalization of liver function tests 6-12 weeks after delivery. Future research in large-scale studies is needed to address the impact of ursodeoxycholic acid and early elective delivery on fetal outcome.

Topics: Antifibrinolytic Agents; Bile Acids and Salts; Cholagogues and Choleretics; Cholestasis, Intrahepatic; Female; Fetal Death; Histamine Antagonists; Humans; Labor, Induced; Nucleic Acid Synthesis Inhibitors; Pregnancy; Pregnancy Complications; Premature Birth; Pruritus; Rifampin; Ursodeoxycholic Acid; Vitamin K

Topics: Abruptio Placentae; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelet Disorders; Blood Transfusion; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Factor XIII Deficiency; Female; Fetal Death; Fetal Diseases; Fibrin; Fibrinogen; Fibrinolysis; Hemophilia A; Humans; Liver Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Sepsis; Uterine Hemorrhage; Vitamin K

Topics: Abnormalities, Drug-Induced; Anticonvulsants; Blood Coagulation; Epilepsy; Female; Fetal Death; Fetus; Folic Acid Deficiency; Humans; Infant, Newborn; Maternal-Fetal Exchange; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Vitamin B 12; Vitamin D; Vitamin D Deficiency; Vitamin K

Topics: Fetal Death; Humans; Oxidoreductases; Vitamin K; Vitamin K Epoxide Reductases; 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

Descriptions of salicylate poisoning during pregnancy are rare and unique features of perinatal physiology predict an increased sensitivity of the fetus to aspirin poisoning. A 17-year-old, 37-week pregnant woman presented to the hospital stating that she had ingested 50 aspirin tablets per day for 1 month in an attempt to harm her baby and herself. Ultrasound showed fetal demise. Serum salicylate was 620 mg/L with an anion gap of 22.6 and the following blood gases: pO2 108 mm Hg, pCO2 15mm Hg, pH 7.34, and HCO3 8.8 mmol/L. She was successfully treated with alkaline diuresis followed by hemodialysis. She spontaneously delivered a macerated stillborn 2380-g fetus. Autopsy revealed diffuse petechiae in the lungs, heart, thymus, and kidneys. Salicylic acid was found in the cord blood, but quantification was not possible due to the small volume of the blood sample. Our patient supports the hypothesis that the fetus is at greater risk than the mother in salicylate poisoning during pregnancy. Consideration should be given to emergent delivery of term or near-term, aspirin-poisoned fetuses.

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Blood Gas Analysis; Blood Glucose; Diuresis; Female; Fetal Blood; Fetal Death; Fetus; Humans; Male; Pregnancy; Renal Dialysis; Vitamin K

Placental transport of dioxins and furans from mother to fetus takes place. It is probably related to the fatty acid transport. Between 10 and 20% of fatty acids in a full-term baby are of maternal origin. In adipose tissue of children that died in the early neonatal period concentrations of +/- 25% were found of three dioxin and furan congeners 12378 P5CDD, 123678 H6CDD, and 23478 P5CDF in relation to a mean concentration of these congeners in the fat of 14 breastmilk samples. Data of concentrations are given as measured in liver and adipose tissue. In the placenta of a Dutch woman an accumulation of dioxins and furans is found in relation to blood. Animal studies support the hypothesis that polychlorobifenyls play a role in the cause of the late hemorrhagic disease in the newborn, in particular the 2, 4, 5, 2, 4, 5-hexachlorobifenyl that is present in relatively high concentrations in breastmilk.

Topics: Dioxins; Fatty Acids; Female; Fetal Death; Furans; Humans; Infant; Infant, Newborn; Liver; Maternal-Fetal Exchange; Milk, Human; Placenta; Polychlorinated Biphenyls; Pregnancy; Vitamin K

Sixteen pregnancies were followed up in 13 patients with prosthetic heart valves: 8 pregnancies went to term under oral anticoagulation, 4 under heparin and 4 without anticoagulation. 9 healthy normal children were delivered; there were 2 still births and 5 abortions. On the maternal side 3 haemorrhages and thromboembolic episodes which involved 2 patients on heparin, one of whom died, were observed. The following points are apparent from our observations and a review of the existing medical literature: --the risk of thromboembolism is not increased. The marked clotting tendency of maternal blood post-partum contraindicates the withdrawal of anticoagulants during this critical period; --haemorrhagic complications are common with anticoagulants; --foetal loss is greatly increased; --the teratogenecity of vitamin-K antagonists is certain, but the risk is small. The problems of anticoagulation are discussed; theoretically heparin should be given during the 1st trimestre and from the 38th week to the second post-partum week. The patients should be closely supervised by both obstetrician and cardiologist and hospitalisation is advised for the last month of pregnancy. Normal vaginal delivery is usually possible.

Topics: Abnormalities, Drug-Induced; Abortion, Induced; Adult; Anticoagulants; Female; Fetal Death; Heart Valve Prosthesis; Hemorrhage; Heparin; Humans; Labor, Obstetric; Pregnancy; Pregnancy Complications, Cardiovascular; Thromboembolism; Vitamin K

Topics: Acetates; Animals; Female; Fetal Death; Hemorrhage; Hydroquinones; Infertility, Female; Male; Pregnancy; Pregnancy Complications; Rats; Vitamin E; Vitamin E Deficiency; Vitamin K; Vitamin K Deficiency

Topics: Abnormalities, Drug-Induced; Animals; Bone and Bones; Cleft Lip; Cleft Palate; Dose-Response Relationship, Drug; Embryo Implantation; Embryo, Mammalian; Female; Fetal Death; Hemorrhage; Mice; Mice, Inbred Strains; Placenta Diseases; Pregnancy; Prothrombin Time; Sodium Chloride; Time Factors; Vitamin K; Vitamin K 1; Warfarin

Topics: Animals; Body Weight; Bone Development; Embryo Implantation; Female; Fetal Death; Fetus; Maternal-Fetal Exchange; Osteogenesis; Pregnancy; Rats; Time Factors; Vitamin K

Topics: Adult; Anticoagulants; Female; Femoral Vein; Fetal Death; Heparin; Humans; Leg; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombophlebitis; Vitamin K; Warfarin

Topics: Animals; Animals, Newborn; Avitaminosis; Central Nervous System; Fetal Death; Growth Substances; Muscles; Nervous System; Rats; Research; Vitamin A; Vitamin K; Vitamins

Topics: Female; Fetal Death; Fetal Diseases; Fetus; Humans; Natural Childbirth; Pregnancy; Pregnancy Complications; Prenatal Care; Referral and Consultation; Republic of Belarus; Toxicology; Vitamin K