ABSTRACT
Certain pregnant populations are at high risk of developing venous thromboembolism (VTE) during pregnancy. Patients at particularly high risk of VTE are those with a history of VTE, thrombophilia or adverse pregnancy outcomes or with mechanical heart valves. In these high-risk patients, evidence-based guidelines recommend the use of thromboprophylaxis. Low-molecular-weight heparin (LMWH) is a safe and effective thromboprophylaxis option in these patients and has a number of administrative and pharmacokinetic advantages over unfractionated heparin. Furthermore, LMWH has also been shown to be a safe and effective treatment for confirmed deep vein thrombosis in pregnant women.
Subject(s)
Anticoagulants/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Pregnancy Complications, Hematologic/prevention & control , Pregnancy, High-Risk , Venous Thromboembolism/prevention & control , Clinical Trials as Topic , Female , Humans , PregnancyABSTRACT
Venous thromboembolism and adverse pregnancy outcomes are potential complications of pregnancy. Numerous studies have evaluated both the risk factors for and the prevention and management of these outcomes in pregnant patients. This consensus group was convened to provide concise recommendations, based on the currently available literature, regarding the use of antithrombotic therapy in pregnant patients at risk for venous thromboembolic events and adverse pregnancy outcomes.
Subject(s)
Anticoagulants/therapeutic use , Pregnancy Complications, Hematologic/therapy , Pregnancy Outcome , Venous Thromboembolism/therapy , Adult , Anesthesia, Conduction , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Antithrombin III/analysis , Antithrombin III/therapeutic use , Antithrombins/analysis , Cesarean Section , Delivery, Obstetric , Female , Fetus/drug effects , Heparin/administration & dosage , Heparin/adverse effects , Heparin, Low-Molecular-Weight/administration & dosage , Humans , Obesity/epidemiology , Obesity/physiopathology , Odds Ratio , Postpartum Period , Pregnancy , Pregnancy Complications, Hematologic/epidemiology , Pregnancy Complications, Hematologic/physiopathology , Pregnancy Complications, Hematologic/prevention & control , Risk Assessment , Risk Factors , Thrombocytopenia/chemically induced , Thrombocytopenia/therapy , Thrombolytic Therapy , Thrombophilia , Venous Thromboembolism/epidemiology , Venous Thromboembolism/physiopathology , Venous Thromboembolism/prevention & control , Warfarin/adverse effectsABSTRACT
BACKGROUND: Methotrexate has multiple therapeutic uses in women of reproductive age including treatment for ectopic pregnancy, neoplastic disease, autoimmune disorders, and inflammatory conditions. More frequent use of methotrexate may result in an increased number of exposures in pregnant women and their fetuses. CASE: A 16-year-old gravida 1, para 0 used oral methotrexate treatment of 7.5 mg per day for psoriasis for 2 days at 3.5 weeks postconception. Multiple anomalies were noted on an 18-week ultrasound. Fetopsy revealed craniofacial, axial skeletal, cardiopulmonary, and gastrointestinal abnormalities. CONCLUSION: A minimal, low-dose, brief exposure to methotrexate in the first trimester resulted in a fetus with multiple internal and external malformations. Some of the anomalies (craniofacial and skeletal) have been previously reported with first- trimester methotrexate exposure. This case depicts the association of cardiopulmonary and gastrointestinal abnormalities with methotrexate exposure.
