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Re: low molecular weight heparinFrom: Roberta Speyer (roberta.speyer@elecomm.com)Fri Sep 27 03:12:42 1996
At 03:28 PM 9/23/96 -0500, you wrote: >I have looked without success - is there any published literature on low >molecular weight heparin in pregnancy? Any personal experience? There are about 30 other articles listed if you search Medline in http://www.obgyn.net using: low molecular weight heparin in pregnancy as the key words Here are the first two. I hope they help. Roberta Article Title: Low-molecular-weight heparin during pregnancy and delivery: preliminary experience with 41 pregnancies. Article Source: Obstet Gynecol 1996 Mar;87(3):380-3 Author(s): Dulitzki M; Pauzner R; Langevitz P; Pras M; Many A; Schiff E Abstract: OBJECTIVE: To describe experience with 41 pregnancies treated with the low-molecular-weight heparin enoxaparin. METHODS: The medical charts of 34 women (a total of 41 pregnancies) treated between January 1992 and March 1995 with the low-molecular-weight heparin enoxaparin were reviewed. Most patients (87.5%) received one daily 40-mg injection. In all cases, treatment was continued throughout labor, delivery, and the immediate postpartum period. RESULTS: Therapy was administered for 5-280 days (median 91). One case of a thromboembolic event was recorded during treatment. No systemic or local side effects were reported. During pregnancy, only one patient had mild vaginal bleeding, which resolved spontaneously while therapy was continued. There was no excessive intrapartum bleeding in any of these patients, whether delivered vaginally or abdominally. During treatment, 19 of the 34 patients underwent 24 surgical procedures, including 13 cesarean deliveries, without excessive bleeding. Epidural anesthesia was used during labor in nine of the patients, with no specific complications. The corrected perinatal mortality rate, (ie, the rate of fetal death after 24 weeks' gestation plus neonatal death, excluding a neonate with multiple anomalies) for those neonates delivered after 24 weeks' gestation was 2.7%. There were no cases of intraventricular hemorrhage in any of the neonates. CONCLUSION: This preliminary series, the largest reported to date, demonstrates the relative safety and efficacy of low-molecular-weight heparin therapy in pregnancy and delivery. Author's Address: Division of Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Israel. Article Title: Thrombocytopenia, antithrombin deficiency and extensive thromboembolism in pregnancy: treatment with low-molecular-weight heparin. Article Source: Blood Coagul Fibrinolysis 1995 Oct;6(7):672-5 Author(s): Macklon NS; Greer IA; Reid AW; Walker ID Abstract: Pregnancy limits the therapeutic options for managing thrombocytopenia which occurs in 5% of patients on heparin. We describe a case of extensive thromboembolism associated with antithrombin (AT) deficiency complicated by thrombocytopenia which resolved when low-molecular-weight heparin was instituted. A primigravid woman presented at 11 weeks gestation with bilateral femoral occlusive thrombi extending above the renal veins. Investigations revealed AT deficiency, thrombocytopenia and renal infarction. After low-molecular-weight heparin was substituted for unfractionated heparin, the thrombocytopenia resolved and although the pregnancy was lost, the patient made a full recovery. Author's Address: University Department of Obstetrics and Gynaecology, Glasgow Royal Infirmary, UK.
-- Roberta Speyer Founder of OBGYN.net President and CEO roberta.speyer@elecomm.com Elecomm Internet Applications http://www.obgyn.net 1909 West Koenig Lane (512) 451-2842 Austin, Texas 78756-1210 (512) 377-5626 FAX
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