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Anticoagulation in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Rachel A. Newman, Ather Mehboob, Judith H. Chung
Pregnancy is a hypercoagulable state resulting from low-level activation of intravascular coagulation. This physiologic adaptation helps in prevention of hemorrhage at the time of implantation, maintenance of the utero-placental interface, and hemostasis in the third stage of labor. However, hypercoagulability of pregnancy coupled with stasis related to the gravid state leads to an increased risk of venous thromboembolism (VTE) as compared to the nonpregnant state.
Dyspnea
Published in Lauren A. Plante, Expecting Trouble, 2018
Routine adaptations of pregnancy can mask signs and symptoms of pathological dyspnea and increase susceptibility to the more dangerous etiologies of dyspnea. The hypercoagulability of pregnancy increases the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), increased venous return following delivery can unmask cardiac pathology, and pregnancy-specific pathologies such as amniotic fluid embolus complicate the workup for dyspnea of pregnancy. Suspicion must remain high for a pathological etiology despite the fact that the vast majority of complaints are benign.
Postpartum spontaneous renal blood vessel rupture followed by pulmonary artery thromboembolism associated with protein C deficiency
Published in Journal of Obstetrics and Gynaecology, 2019
Patients with a protein C deficiency (PCD) have a thromboembolic tendency (Marlar and Mastovich 1990; Alving and Comp 1992; Lockwood 1999; Guler et al. 2013). The hypercoagulability of pregnancy can aggravate the thromboembolic risk of PCD, so a specific management of PCD patients is necessary during pregnancy and the peripartum period. Here, we report a rare case of a postpartum renal blood vessel rupture followed by a pulmonary artery thromboembolism associated with PCD, and discuss the optimal care for pregnant women with PCD.
Simultaneous decompressive craniectomy and caesarean section
Published in British Journal of Neurosurgery, 2023
The hypercoagulability of pregnancy led to CVST, with secondary venous infarction, intracerebral haemorrhage, cerebral oedema and rising ICP. Anticoagulation was commenced to treat the CVST, which with the underlying pre-eclampsia increased the risk of the intracerebral haematoma enlarging. As the haematoma enlarged, ICP rose further, leading to coma, as well as foetal distress. Decompressive craniectomy was performed to save the life of the mother, whilst caesarean section delivered the foetus and treated the pre-eclampsia.