4 articles
Venous thromboembolism is one of the leading causes of maternal morbidity and mortality. Pregnancy induces a hypercoagulable state as an adaptive mechanism to prevent hemorrhage during childbirth. These physiological changes significantly increase the risk of venous thromboembolism – by up to six-fold during pregnancy and up to 10-fold during the postpartum period compared to the non-pregnant population. Given these risks, proper identification of patients who may benefit from thromboprophylaxis is essential to improve maternal outcomes.
This manuscript reviews medical articles and current clinical guidelines on thromboprophylaxis in pregnancy and the puerperium, highlighting similarities, differences, and practical considerations in the management of at-risk patients. International guidelines developed to aid clinicians in venous thromboembolism risk stratification and prevention, including the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the American Society of Hematology, and the National Institute for Health and Care Excellence were analyzed.
The incidence of Venous thromboembolism ranges from 1 to 2 per 1,000, with up to 80% attributed to deep vein thrombosis cases occurring during the antepartum period, and 20%-25% being pulmonary embolism cases. In contrast, the incidence of pulmonary embolism is significantly higher after childbirth, with 40% to 60% of all pulmonary embolism cases occurring during the postpartum period. The impact of venous thromboembolism is not limited to mortality. Acute venous thromboembolism and the need for long-term anticoagulant therapy are associated with a significant clinical and psychological burden, while potential long-term sequelae, such as pulmonary hypertension and post-thrombotic syndrome, can have lifelong consequences. Ensuring thromboprophylaxis is essential, and the primary responsibility lies with the obstetrician. Ultimately, effective thromboprophylaxis is about balancing efficacy and safety between the need to prevent a potentially life-threatening event and the cost of an increased risk of bleeding.
Effective thromboprophylaxis during pregnancy and the puerperium remains a critical component of maternal care. The national protocol aims to assist healthcare professionals in identifying women at increased risk of venous thromboembolism during pregnancy, childbirth, and the postpartum period, and in making evidence-based decisions regarding the use of thromboprophylaxis and anticoagulant agents.
Umbilical cord pathology can contribute to neonatal asphyxia, stillbirth, and postnatal death in numerous cases. However, the diagnosis of umbilical cord pathology remains imperfect, and its impact on pregnancy course and outcome is often underestimated. Therefore, prenatal diagnosis of umbilical cord pathology is becoming increasingly important in preventing intra- and postnatal morbidity and mortality. Early detection of these abnormalities enables the development of necessary strategies for optimal pregnancy and delivery management.
The study included 190 patients divided into 2 groups: L1 – 95 patients with UC abnormalities, and L0 – 95 with a normal UC. A p-value of less than 0.05 was regarded as statistically significant.
The development of umbilical cord pathology was frequently observed in pregnant women exposed to harmful workplace factors (psychological and emotional stress, p=0.01), harmful habits (smoking, p=0.04), and primiparas (p=0.005) with complicated gynecological and somatic histories, as well as those with a history of UC pathology in previous pregnancies (p<0.0001). Pregnancy and labor progression in patients with cord pathology showed a high rate of complications compared to control group, including urinary tract disorders (p=0.02), preterm labor at 27-28 weeks (p=0.01), polyhydramnios, which was ten times more frequent (p=0.002), and fetal growth restriction (p=0.02). In the study group, a prolonged second stage of labor was observed (p=0.01), along with acute fetal hypoxia, which required urgent pregnancy termination (p=0.01) through vacuum extraction (p=0.0009) or C-section (p=0.04).
The analysis of the anamnestic and clinical peculiarities of the perinatal period in patients with UC pathology, compared to pregnant women without this pathology, confirmed that this commonly encountered obstetric condition represents a considerable risk factor for perinatal complications.
The onset and development of diabetic retinopathy are more common during pregnancy. Pregnancy has no long-term effect on diabetic retinopathy; however, in 50-70% of cases, changes in retinopathy continues. The probability of worsening is highest in the second trimester and up to one year postpartum. Additional factors that have been associated with disease progression include duration of diabetes, the degree of retinopathy at the time of conception, management of hyperglycemia, anemia, and development of associated hypertension. In cases of severe non-proliferative retinopathy, it is recommended to promptly initiate laser photocoagulation rather than wait for early proliferative changes. Maintaining good diabetic control before and during pregnancy can help prevent disease progression and serious vision loss.
Diabetic retinopathy management in pregnancy was the subject of a comprehensive review of the scientific and medical literature. A structured search was performed in the PubMed, Scopus and HINARI databases, considering relevant articles published in the last 10 years. The search terms used (in English) were: „Diabetic retinopathy”; „pregnancy”; „laser photocoagulation”; „intravitreal steroids”; „anti-vascular endothelial growth factor”.
It is suggested that women with diabetes receive pre-conception and post-pregnancy counselling from a multidisciplinary team including an ophthalmologist, endocrinologist, and perinatologist, as diabetic retinopathy may worsen during pregnancy. The risk of progression of the disease and the importance of appropriate metabolic control before and during pregnancy should be clearly explained to the patient. Careful monitoring is required in patients with advanced gestation, significant retinopathy, concomitant hypertension, and nephropathy.
The risk of retinopathy development may increase during pregnancy. Serious effects can arise for both the mother and the fetus, even though retinopathy is not common during pregnancy. It is possible to avoid significant retinopathy by carefully planning a young diabetic woman's pregnancy and proceeding promptly to laser photocoagulate in cases of severe non-proliferative retinopathy. A tendency for regress is frequently seen in diabetic retinopathy during the post-natal period. Subsequent pregnancies do not significantly increase the risk of progression if the retinopathy is stable before pregnancy.
Hematological inflammatory markers may be promising diagnostic markers for assessing the severity of intrahepatic cholestasis of pregnancy. The aim of the study was to evaluate and compare the levels of hematological inflammatory markers in intrahepatic cholestasis of pregnancy.
A prospective cohort study of 142 clinical cases, divided into two groups depending on the presence of cholestasis gravidarum, was carried out. The research was conducted by assessing the level of bile acids and hematological inflammatory markers in the mother's blood, as well as by studying medical records. The IBM Statistics SPSS 21 program was used to process the statistical data. To compare categorical variables, the χ² without the Yates' continuity correction test was applied.
There was an increase in platelet-to-lymphocyte ratio in pregnant women with intrahepatic cholestasis of pregnancy compared to the control group (146.0±6.8 versus 135.2±7.3, respectively). The values of neutrophil-to-lymphocyte ratio and the average volume of platelets were similar in both groups. At the same time, the study found a decrease in the values of erythrocyte distribution among women whose pregnancy was complicated by cholestasis gravidarum.
The study showed a significant increase in platelet-to-lymphocyte ratio in women whose pregnancy was complicated by cholestasis gravidarum, as well as an increase in this indicator with increasing levels of bile acids. Thus, this ratio may be a promising diagnostic marker in assessing the severity of intrahepatic cholestasis of pregnancy.