ABSTRACT
Pregnancy and puerperium increase the risk of venous thromboembolic disease. As it is potentially life-threatening, all patients with the suspicion of pulmonary embolism require proper diagnosis and, possibly treatment. Venous ultrasonography is usually applied. However; in most cases the examinations with the use of ionized radiation--computer tomography or scintigraphy--are indispensable. In treatment of pulmonary embolism, low molecular weight heparins play the key role. However; in case of dramatic pulmonary embolism with shock and hypotension, thrombolytic therapy may be necessary. Low molecular weight heparins as well as oral anticoagulants can be used after the delivery.
Subject(s)
Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/therapy , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Venous Thromboembolism/diagnosis , Venous Thromboembolism/therapy , Evidence-Based Medicine , Female , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Maternal Welfare , Practice Guidelines as Topic , Pregnancy , Puerperal Disorders/diagnosis , Puerperal Disorders/therapy , Risk Assessment , Thrombolytic Therapy/methodsABSTRACT
Pulmonary embolism is the main cause of death of pregnant women in developed countries. An increased prothrombotic activity is observed during pregnancy. Moreover, the risk of venous thromboembolic disease can be elevated in cases of inherited thrombophilia, antiphospholipid syndrome or previous venous thromboembolic events. According to presented guidelines of The Royal College of Obstetricians and Gynecologists and The American College of Chest Physicians, the risk stratification of venous thromboembolic disease during pregnancy and puerperium is a vital condition and proper antithrombotic prophylaxis should be implemented.
Subject(s)
Pregnancy Complications, Cardiovascular/prevention & control , Puerperal Disorders/prevention & control , Pulmonary Embolism/prevention & control , Venous Thromboembolism/prevention & control , Evidence-Based Medicine , Female , Fibrinolytic Agents/therapeutic use , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Puerperal Disorders/diagnosis , Pulmonary Embolism/diagnosis , Risk Assessment , Risk FactorsABSTRACT
UNLABELLED: The objective of the study was to determine changeableness of blood cells count, hemoglobin (HGB) and hematocrit (HCT) within the peripheral blood of patients who received betamethasone during treatment of threatened preterm delivery. 65 patients at increased risk of preterm delivery received intramuscular injections of betamethasone 3 x 4 mg/day for fetal lung maturity and to decrease the risk of CNS trauma in newborns. RBC, HGB, HCT, WBC, neutrophils count and CRP level were measured before treatment and on the 1th, 2nd and 7th days after first dose of betamethasone. The steroid administration caused a significant decrease in RBC, HGB and HCT: The lowest levels were noticed on 2nd day. Statistically significant changes were observed between before and 1st day (p < 0.0001), before and 2nd day (p < 0.0001), before and Ist week (p < 0.05), 1st day and 1st week (p < 0.006), 2nd day and Ist week (p < 0.005). The level of WBC and neutrophils were increased. Their peak levels were noticed on 1st day. Statistically significant changes were observed between before and 1st day (p < 0.0001), before and 1st week (p < 0.0003), 1st day and 1st week (p < 0.0001), 2nd day and 1st week (p< 0.001). After 3 days there was a significant decrease of WBC and neutrophils count. CONCLUSIONS: Intramuscular administration of 12 mg betamethasone per day caused decrease of the RBC, HGB and HCT account and elevation of the WBC and neutrophil count. All these parameters normalized after about 7 days.
Subject(s)
Betamethasone/pharmacology , Blood Cell Count , Blood Cells/drug effects , C-Reactive Protein/drug effects , Glucocorticoids/pharmacology , Obstetric Labor, Premature/blood , Betamethasone/administration & dosage , Erythrocyte Count , Erythrocytes/drug effects , Female , Glucocorticoids/administration & dosage , Hematocrit , Hemoglobins/drug effects , Humans , Injections, Intramuscular , Leukocyte Count , Leukocytes/drug effects , Neutrophils/drug effects , PregnancyABSTRACT
OBJECTIVE: Assessment of relationship between homocysteine (Hcy) and noradrenaline (NA), adrenaline (A) concentration and left ventricular mass index (LVMI) in patients with essential hypertension (EH). DESIGN AND METHODS: Samples obtained from 37 patients (14 female, 23 male) with mild EH (according to WHO criteria) (mean age 43.6 +/- 13.2 years) and 37 healthy volunteers (18 female, 19 male; mean age 38.2 +/- 10.6 years) were evaluated for Hcy (ELISA), NA and A (HPLC). Each patient underwent echocardiographic investigation with LVMI measurement (Penn convention). The examinations were performed in the outpatient clinic. RESULTS: Hcy was significantly higher in patients with EH (8.7 +/- 2.4 vs 6.6 +/- 1.3 micromol/l; p < 0.01). NA and A levels were significantly elevated in the EH group (A: 43.9 +/- 26.4 vs 36.9 +/- 29.4 pg/ml; NA: 428.5 +/- 148.8 pg/ml vs 314.6 +/- 103.4 pg/ml; both p < 0.05). LVMI was also significantly higher in EH group (96.6 +/- 19.5 vs 83.4 +/- 16.0 g/m2; p < 0.01). There was no significant correlation between Hcy and other analysed parameters in the studied groups. CONCLUSION: High levels of Hcy appear together with increased left ventricular mass and augmented adrenergic activity in patients with EH. Coexistence of high Hcy concentration, left ventricular hypertrophy and increased adrenergic activity increases the risk of atherosclerosis and cardiovascular disease in patients with EH.
