Fetal warfarin syndrome.

A case of a baby born preterm with an antenatal diagnosis of aortic coarctation for which prostin was electively started at birth. The baby was found to be profoundly anaemic with no clear obstetric cause. Features consistent with antenatal intracerebral haemorrhage were noted on cranial ultrasonography in the context of severe coagulopathy, prompting investigations which confirmed fetal-maternal haemorrhage. It transpired that, following aortic and mitral valve replacements, the mother was anticoagulated with warfarin at conception, having misunderstood her cardiologist's advice that: 'you cannot get pregnant whilst on warfarin'. Following conversion to low molecular weight heparin, she suffered a stroke, thus warfarin was restarted, with an international normalised ratio of 3-4.7 during pregnancy. Following transfer to the paediatric intensive care unit, fetal warfarin syndrome was diagnosed. The coagulopathy and anaemia were corrected and aortic coarctation was excluded. The baby returned to the neonatal intensive care unit for ongoing care and was discharged home in good condition around his due date. At the present time, there is no clinically overt neurological deficit.

Estimating sediment quality thresholds to prevent restrictions on fish consumption: Application to polychlorinated biphenyls and dioxins-furans in the Canadian Great Lakes.

Sediment quality thresholds (SQTs) are used by a variety of agencies to assess the potential for adverse impact of sediment-associated contaminants on aquatic biota, typically benthic invertebrates. However, sedimentary contaminants can also result in elevated fish contaminant levels, triggering consumption advisories that are protective of humans. As such, SQTs that would result in fish concentrations below consumption advisory levels should also be considered. To illustrate how this can be addressed, we first calculate biota sediment accumulation factors (BSAFs) for polychlorinated biphenyls (total PCB) and polychlorinated dioxins-furans (PCDD/Fs) in the Canadian Great Lakes using measured lake sediment and fish tissue concentrations in 4 fish species, namely, lake trout, whitefish, rainbow trout, and channel catfish. Using these BSAFs and tissue residue values for fish consumption advisories employed by the Ontario Ministry of the Environment (OMOE, Canada), we derive fish consumption advisory-based SQTs (fca-SQTs) that are likely to result in fish tissue residues that are safe to eat without restriction. The PCDD/Fs fca-SQTs ranged from 6 to 128 pg toxic equivalents (TEQ)/g dry weight (dw) and were above the Canadian Council of the Ministers of the Environment (CCME) threshold effect level (TEL) of 0.85 pg TEQ/g dw. In contrast, the total PCB fca-SQTs ranged from 1 to 60 ng/g dw and were generally below the CCME's TEL of 34.1 ng/g and OMOE's lowest effect level (LEL) of 70 ng/g; however, they were consistent with the OMOE's no effect level (NEL) of 10 ng/g. The fca-SQTs derived using the BSAF as well as food chain multiplier (FCM) approach for a smaller scale system (Hamilton Harbour in Lake Ontario) corresponded well with average lakewide Lake Ontario fca-SQTs. This analysis provides approximate sediment concentrations necessary for reducing fish consumption advisories for each of the Canadian Great Lakes and emphasizes the impacts of historical lake sediment contamination on fish advisories. We believe that this approach merits consideration in sediment guideline development.