Thrombophilia and Recurrent Pregnancy Loss : Is heparin still the drug of choice?

The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact. Thorombophilia creates a hypercoaguable state which leads to arterial and/or venous thrombosis at the site of implantation or in the placental blood vessels. Anticoagulants are an effective treatment against RPL in women with acquired thrombophilia due to antiphospholipid syndrome. The results of the use of anticoagulants for treating RPL in women with inherited thrombophilia (IT) are encouraging, but recently four major multicentre studies have shown that fetal outcomes (determined by live birth rates) may not be as favourable as previously suggested. Although the reported side-effects for anticoagulants are rare and usually reversible, the current recommendation is not to use anticoagulants in women with RPL and IT, or for those with unexplained losses. This review examines the strength of the association between thrombophilia and RPL and whether the use of anticoagulants can improve fetal outcomes

Gestational and Pregestational Diabetes Mellitus in Omani Women : Comparison of obstetric and perinatal outcomes

Objectives: The aim of this study was to assess the prevalence of gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM) among pregnant women in Oman and compare their obstetric and perinatal outcomes. Methods: This retrospective study assessed the obstetric and perinatal outcomes of pregnant Omani women with GDM or PGDM who delivered at the Sultan Qaboos University Hospital in Muscat, Oman, between January 2009 and December 2010. Results: There were a total of 5,811 deliveries during the study period. Of the 5,811 women who gave birth, 639 women were found to have diabetes mellitus (11.0%). A total of 581 of the diabetic women had GDM (90.9%) and only 58 (9.1%) had PGDM. Women with PGDM had a significantly higher incidence of pre-eclampsia (P = 0.022), preterm deliveries (P <0.001) and Caesarean sections (P <0.001). Neonatal complications, such as respiratory distress syndrome (RDS), neonatal hypoglycaemia, neonatal jaundice and subsequent admission to a neonatal intensive care unit (NICU) were significantly higher for neonates born to mothers with PGDM compared to those born to mothers with GDM (P <0.001). The corrected perinatal mortality rates for women with PGDM and GDM were 34.5 and 13.7 per 1,000 live births, respectively. Conclusion: In this Omani cohort, women with PGDM were at higher risk of developing obstetric and perinatal complications such as pre-eclampsia, preterm delivery and Caesarean delivery compared to women with GDM. In addition, neonates who had mothers with PGDM had higher rates of RDS, neonatal hypoglycaemia, neonatal jaundice and admission to the NICU

Nursing Care for Pregnant Adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73476/1/0884217503252191.pd

EUROmediCAT signal detection: an evaluation of selected congenital anomaly-medication associations

To evaluate congenital anomaly (CA)-medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Data from 15 EUROCAT registries (1995-2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. Thirteen out of 27 CA-medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70-8.53; congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99-14.20/OR 28.20, 95% CI 4.63-122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70-22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10-1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28-2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk-forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible

Effects of maternal age, parity and pre-pregnancy body mass index on the glucose challenge test and gestational diabetes mellitus

أهداف البحث: يهدف البحث لدراسة تأثير العمر، وعدد الولادات ومعامل كتلة الجسم على اختبار التحدي للجلوكوز ٥٠ غرام الإيجابي وسكري الحمل لدى السيدات الحوامل العمانيات السليمات. طرق البحث: اُستخدم ٥٠ غراما من الجلوكوز لإجراء اختبار التحدي للجلوكوز على ٣٠٧ سيدة عمانية حامل سليمة خلال الأسبوع ٢٤-٢٨ من الحمل. اُعتبر اختبار التحدي للجلوكوز إيجابيا إذا كان مستوى الجلوكوز في الدم< ٧.٨ ملمول⁄ ل، عند قياسه بعد ساعة واحدة. وتم تأكيد تشخيص السيدات بسكري الحمل باختبار تحمل الجلوكوز عن طريق الفم بعد ساعتين من استخدام ٧٥ غراما من الجلوكوز، عندما يكون أي من قيمة الاختبار عند الصوم أو بعد ساعتين من تناول ٧٥ غراما من الجلوكوز <٥.٥ ملمول⁄ ل و <٨ ملمول⁄ ل، على التوالي، تعتبر السيدات مصابات بسكري الحمل. النتائج: تم اختبار ٣٠٧ سيدة، وتحديد ٨٣ (٠٣¸٢٧٪) سيدة لديها اختبار إيجابي، و٢٣ (٥¸٧٪) حالة إيجابية لسكري الحمل. يزداد اختبار التحدي للجلوكوز الإيجابي وسكري الحمل بشكل كبير مع زيادة عمر الأم، من ٢٠٪ و ٢¸٢ ٪ على التوالي، لدى السيدات اللاتي أعمارهن ≤ ٢٥عاما إلى ٨¸٣٧٪ و٧¸١٤٪ على التوالي، عند السيدات اللاتي أعمارهن < ٣٥ عاما. كما يزداد اختبار التحدي للجلوكوز الإيجابي وسكري الحمل بشكل كبير مع زيادة معامل كتلة الجسم قبل الحمل من ٨¸١٩٪ و٨¸٣٪ على التوالي، لدى السيدات بمعدل كتلة الجسم ≤ ٢٥ كجم⁄ م٢ إلى ٨¸٣٧٪ و٩¸٩٪، على التوالي عند السيدات بمعدل كتلة الجسم < ٢٥ كجم⁄ م٢. الاستنتاجات: عمر الأمهات ومعامل كتلة الجسم قبل الحمل لهما تأثير كبير على اختبار التحدي للجلوكوز ٥٠ غرام الإيجابي وسكري الحمل