Does fetal sex influence the risk of venous thrombosis in pregnancy? A cohort study.

BACKGROUND: Venous thromboembolism is a prominent cause of maternal death. OBJECTIVE: As inflammation is a well-known risk factor for venous thromboembolism and several studies have found a higher grade of inflammation in pregnancies bearing a male compared with female fetuses, we investigated the risk of pregnancy-related venous thromboembolism associated with sex of the fetus. METHODS: This cohort study linked data from national registries and compared event rates and hazard ratios of venous thrombosis for pregnancies bearing a male fetus with those bearing a female fetus during pregnancy and in the first 3 months postpartum. National data from 1995 to 2017 were used. All Danish women aged 15 to 49 years with a live or stillbirth were eligible for inclusion; 1 370 583 pregnancies were included. Women with venous thrombosis, ischemic heart disease, cerebrovascular disease, thrombophilia, or cancer before conception were excluded. RESULTS: The event rate for a venous thrombosis was 8.0 per 10.000 pregnancy years with a male fetus compared with 6.8 for a female fetus. The adjusted hazard ratio for venous thrombosis during pregnancies bearing a male was 1.2 (95% CI, 1.1-1.4), whereas in the postpartum period, it was 0.9 (95% CI, 0.7-1.0). The risk was elevated until week 30. CONCLUSION: These findings indicate a slightly greater risk of venous thrombosis during pregnancies bearing a male fetus than during pregnancies bearing a female fetus. There was no increased risk associated with fetal male sex in the postpartum period.

Pregnant womens views on the timing of prophylactic antibiotics during caesarean delivery: A qualitative semi-structured interview study.

OBJECTIVE: To gain insight into pregnant women's preferences if given a choice between getting antibiotic prophylaxis before or after cord clamping during caesarean delivery. STUDY DESIGN: A qualitative semi-structured interview-study. The interviews were conducted at a Danish Hospital, with about 4000 deliveries a year. Fourteen individual semi-structured interviews were conducted with pregnant women, either considering or having a planned caesarean section, or scheduled for induction due to post-term gestational age. A systematic text condensation approach was used to analyze the transcribed interviews. RESULTS: Ten of the fourteen women favored antibiotic administration after cord clamping. Despite any adverse effects to the infant's microbiota and increased risk of long-term health outcomes were only hypothetical and the risk reduction in postpartum infections being well documented, they did not want to expose their offspring to antibiotics. Those who preferred antibiotic prophylaxis before cord clamping were concerned, if they would be able to care for the infant in case of a maternal infection. Three of the women preferring antibiotics after cord clamping said they would potentially change preference, if the maternal risk was higher. Most women preferred to be informed of the use of prophylactic antibiotic and that the timing has consequences for trans-placental exposure to the infant. CONCLUSIONS: With most of the interviewed women preferring antibiotic administration after cord clamping, we suggest patients should be involved in the decision regarding timing of prophylactic antibiotics before caesarean section.

[Duplication cyst as cause of ileus in a 16-year-old girl].

A 16-year-old girl was admitted to hospital with lower abdominal pain. An ultrasound examination suggested an ovarian cyst. A laparoscopic procedure found that a duplication cyst in the patient's ileum had caused mechanical ileus. The cyst was surgically resected through the creation of an end-to-end anastomosis, and pathological examination confirmed it to be a duplication cyst. Duplication cysts are a rare congenital disorder, especially past infancy. They are characterized by an epithelium of gastrointestinal origin and a lining of smooth muscle in their walls. The treatment is surgical resection when possible.

Risk factors for venous thromboembolism in 1.3 million pregnancies: a nationwide prospective cohort.

OBJECTIVE: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period. DESIGN: In a nationwide prospective cohort study we followed pregnant and puerperal women in Denmark from 1995 to 2009 for venous thromboembolism. Information on risk factors and confounders was retrieved from national registries. The diagnosis of venous thromboembolism was confirmed through medical charts. We calculated adjusted incidence rates per 10,000 women years and used Poisson regression to estimate effects during pregnancy and the puerperal period. RESULTS: We studied 1,297,037 pregnancies and related puerperal periods, during which there were 748 venous thromboembolisms. The incidence rate for venous thromboembolism during a pregnancy with and without hospitalization for hyperemesis was 15.2/10,000 yr and 6.3/10,000 yr, respectively, (adjusted rate ratio: 2.5 (95%-confidence interval; 1.4-4.5)). The incidence rate among women with multiple pregnancies was 18.2/10,000 yr and 6.3/10,000 yr in singletons (adjusted rate ratio: 2.8 (1.9-4.2)). Increased risk was found with hospitalization during pregnancy or the puerperal period with incidence rates of 42.1/10.000 and 54.7/10.000, respectively, (rate ratios: 12.2 (8.7-17) and 5.9 (4.0-8.8)). Women hospitalized with infections during pregnancy had incidence rates of 25.9/10,000 yr and 29.3/10,000 yr during pregnancy and the puerperal period, respectively, and of 62.7/10,000 yr if hospitalized with infection in the puerperal period. Puerperal venous thromboembolism was associated with hospitalization for preeclampsia and intrauterine growth restriction/fetal death with incidence rates of 45.8/10,000 yr and 18.3/10,000 yr, respectively (rate ratio: 5.0 (3.1-7.8) and 1.9 (0.9-4.4)). Additionally puerperal venous thromboembolism was associated with obesity, elective and acute caesarean sections and major postpartum bleeding with incidence rates of 25.5/10,000 yr, 23.2/10,000 yr, 34.0/10,000 yr and 20.3/10,000 yr, respectively (rate ratios 1.7 (1.1-2.7), 2.1 (1.4-3.1), 3.0 (2.3-4.0) and 1.4 (1.0-2.1)). CONCLUSIONS: Important risk factors for venous thromboembolism during pregnancy or the puerperal period were hospitalization, infection, hyperemesis, multiple pregnancies, preeclampsia, obesity, caesarean section, major postpartum bleeding, and intrauterine growth restriction or fetal death.

Venous thromboembolism in pregnancy and the puerperal period: a study of 1210 events.

OBJECTIVE: The aim of this study was to describe venous thromboembolism (VTE) in pregnancy and the puerperal period, and to validate diagnoses of VTE. DESIGN: Historical cohort study. POPULATION: All pregnancies in Denmark from 1995 to 2009. METHODS: VTE diagnoses were retrieved from national registries. MAIN OUTCOME MEASURES: Positive predictive value of a VTE diagnoses diagnosed during pregnancy or the puerperal period. Location of VTE. Incidence rate of confirmed, validated diagnoses of VTE and on all retrieved diagnoses of VTE. RESULTS: In 1 297 037 pregnancies, 1436 women had a first-ever VTE diagnosis. Hospital records were retrieved for 1210 women (84.3%). Almost all women had relevant clinical symptoms and in 796 (65.8%), the diagnosis were confirmed by a positive diagnostic test or by instituted anticoagulation treatment. In all, 72.6, 53.7, 58.5 and 79.1% of the diagnoses were confirmed in the first, second, third trimester and the puerperal period, respectively. The 796 cases of VTE included 624 women with deep venous thrombosis only and 133 with pulmonary embolisms. Deep venous thrombosis was located in the left lower limb in 83.8% in pregnancy, compared with 67.9% in the puerperal period. CONCLUSIONS: The vast majority of women with a registered diagnosis of VTE had relevant symptoms. Diagnoses of VTE were confirmed in the medical records in two of three women. VTE diagnoses were most often confirmed when made in the first trimester and in the puerperal period. Left-sided deep venous thrombosis was the predominant type of VTE in pregnancy and the puerperal period.

Venous thromboembolism in pregnant and puerperal women in Denmark 1995-2005. A national cohort study.

Venous thromboembolism (VTE) is the leading cause of maternal death in the Western world, and the risk increases during pregnancy and puerperal period. It was the objective of the present study to estimate the absolute and the relative risk of VTE at different weeks of gestation and in the postnatal period as compared to non-pregnant women. This was a historical controlled national cohort study. The National Registry of Patients identified relevant diagnoses. These data were linked to The National Registry of Medical Products Statistics for information about current use of oral contraceptives. Danish women 15 to 49 years old during the period January 1995 through December 2005 were included in the study. In total 819,751 pregnant women were identified of whom 727 had a diagnosis of VTE. The absolute risk of VTE per 10,000 pregnancy-years increased from 4.1 (95% CI, 3.2 to 5.2) during week 1-11 up to 59.0 (95% CI: 46.1 to 76.4) in week 40 and decreased in the puerperal period from 60.0 (95% CI:47.2-76.4) during the first week after birth to 2.1 (95% CI:1.1 to 4.2) during week 9-12 after birth. Compared with non-pregnant women, the incidence rate ratio rose from 1.5 (95% CI:1.1 to 1.9) in week 1-11, to 21.0 (95%CI16.7 to 27.4) in week 40 and 21.5 (95% CI:16.8 to 27.6) in the first week after delivery, declining to 3.8 (95% CI:2.5 to 5.8) 5-6 weeks after delivery. In conclusion, the risk of VTE increases almost exponentially through pregnancy and reaches maximum just after delivery and is no longer significantly increased six weeks after delivery.