Isolated cerebral sinovenous thrombosis: a rare case of neonatal antiphospholipid syndrome

We describe a case of neonatal cerebral sinovenous thrombosis associated with the presence of anti-phospholipid antibodies (aPL). We recommend that in all cases of neonatal thrombosis, the couple mother-infant should be extensively tested for the presence of both acquired (aPL) and congenital thrombophilia

Lights and shadows on the use of metformin in pregnancy: from the preconception phase to breastfeeding and beyond

During pregnancy, the complex hormonal changes lead to a progressive decrease of insulin sensitivity that can drive the onset of gestational diabetes (GDM) or worsen an already-known condition of insulin resistance like type 2 diabetes, polycystic ovarian syndrome (PCOS), and obesity, with complications for the mother and the fetus. Metformin during pregnancy is proving to be safe in a growing number of studies, although it freely crosses the placenta, leading to a fetal level similar to maternal concentration. The aim of this literature review is to analyze the main available evidence on the use of metformin during, throughout, and beyond pregnancy, including fertilization, lactation, and medium-term effects on offspring. Analyzed studies support the safety and efficacy of metformin during pregnancy. In pregnant women with GDM and type 2 diabetes, metformin improves obstetric and perinatal outcomes. There is no evidence that it prevents GDM in women with pregestational insulin resistance or improves lipid profile and risk of GDM in pregnant women with PCOS or obesity. Metformin could have a role in reducing the risk of preeclampsia in pregnant women with severe obesity, the risk of late miscarriages and preterm delivery in women with PCOS, and the risk of ovarian hyperstimulation syndrome, increasing the clinical pregnancy rate in women with PCOS undergoing in vitro fertilization (IVF/FIVET). Offspring of mothers with GDM exposed to metformin have no significant differences in body composition compared with insulin treatment, while it appears to be protective for metabolic and cardiovascular risk

Anti-inflammatory and immunosuppressive drugs and reproduction

Rheumatic diseases in women of childbearing years may necessitate drug treatment during a pregnancy, to control maternal disease activity and to ensure a successful pregnancy outcome. This survey is based on a consensus workshop of international experts discussing effects of anti-inflammatory, immunosuppressive and biological drugs during pregnancy and lactation. In addition, effects of these drugs on male and female fertility and possible long-term effects on infants exposed to drugs antenatally are discussed where data were available. Recommendations for drug treatment during pregnancy and lactation are given

Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. A European multicentre retrospective study.

Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. A European multicentre retrospective study

Mothers' antiphospholipid antibodies during pregnancy and the relation to offspring outcome.

Mothers' antiphospholipid antibodies during pregnancy and the relation to offspring outcome

Anty-inflammatory and immunosuppressive drugs and reproduction

Anti-inflammatory and immunosuppresive drugs and reproductio

An interlabial mass.

An interlabial mass

Hydroxychloroquine as additional treatment in pregnant patients with refractory APS

We greatly appreciated the results of the PREGNancy in women with ANTiphospholipid Syndrome study by Saccone et al1 assessing the risk of obstetric complications in women with primary antiphospholipid syndrome (APS) that is associated with a specific antibody profile

Isolated cerebral sinovenous thrombosis: a rare case of neonatal antiphospholipid syndrome.

We describe a case of neonatal cerebral sinovenous thrombosis associated with the presence of anti-phospholipid antibodies (aPL). We recommend that in all cases of neonatal thrombosis, the couple mother-infant should be extensively tested for the presence of both acquired (aPL) and congenital thrombophilia

Haemoglobin discordances in twins: is "really" due to differences in timing of cord clamping? A consideration to Verbeek L and co-authors

Dear Editor, We read with interest the article by Verbeek L. et al [1], showing that the second-born twin has higher levels of hemoglobin (Hb) than first-born co-twins after vaginal delivery (VD; Hb differential effect does not occur in twins delivered by Caesarean section. Since Hb difference is present in both uncomplicated monochorionic (MC) and dichorionic (DC) twin pairs, authors focused on the time difference of umbilical cord clampings (UCC) for the two twins, rather than vascular anastomoses (absent in DC twins). Precise timing data unfortunately were not recorded. However, beside UCC timing, other factors should be taken into account for the VD management. Recent observations have provided compelling evidence demonstrating that UCC timing is not the only determinant of net placental -to-infant blood transfusion [2]; uterine contractions and lung aeration result to be determinant factors influencing umbilical artery and venous blood flows[2]. Specifically the uterine contractions during the third stage of labor significantly increase the placental-to-neonatal gradient and may facilitate 50% of placental transfusion [3]; such effect is also reported in single term neonates when the "two step" head-to-body delivery method is used [4]. In our opinion, uterine contractions can affect the placental transfusion more than UCC timing in the vaginally born twins: the second-born twin is exposed to the contractions that lead to the birth of the first twin! These additional contractions can increase the placental transfusion and the risk of polycithemia both in DC and MC twins; moreover, in second-born MC twin, contractions can determine acute inter-twin blood transfusion through placental vascular anastomoses. In agreement with authors [1], targeted studies in the twins delivered vaginally should be carried out to establish the optimal UCC timing; anyway we recommend evaluating also the effect of uterine contractions as well as medications administered to the mothers, such as oxytocin-like components