[Antithrombotic therapy and pregnancy]

Induction or spontaneous labor for pregnant patients on anticoagulants?

OBJECTIVE

There are two approaches to peripartum management for pregnant patients undergoing anticoagulation treatments: spontaneous labor or scheduling an induction. A long interval without anticoagulation is a thrombosis risk factor, while a short interval leads to risks of delivery without epidural analgesia or post partum hemorrhage. Our objective was to evaluate the impact of planned induction versus spontaneous labor on obtaining neuraxial analgesia.

MATERIALS AND METHODS

A retrospective single-center study was conducted from 2012 to 2020 including all patients on preventive or curative low molecular-weight heparin at the time of delivery, excluding planned cesarean sections. The rates of neuraxial analgesia were compared between two groups: spontaneous labor and induction, as well as the intervals without anticoagulants.

RESULTS

127 patients were included. In the spontaneous labor group, 78% (44/56) received neuraxial analgesia versus 88% (37/42) in the induction group (p = 0.29). For curative dose treatment, the rate of neuraxial analgesia was 45,5% in the spontaneous group versus 78,6% (p = 0.12). The median time without anticoagulation was 34 h [26-46] in the spontaneous labor group and 43 h [34-54] in the induction group (p = 0.01), without an increased incidence of thrombosis. The rate of postpartum hemorrhage did not differ between the two groups.

CONCLUSION

Planned induction tended to increase the rate of neuraxial analgesia, without reaching significance, and most women in spontaneous labor accessed analgesia. Peripartum management should be a shared decision with the patient considering the obstetrical and thrombosis risk context for each patient.

[The influence of anticoagulant and antiagregant therapy during pregnancy on clinical characteristics and outcomes of periventricular hemorrhages in newborns]

AIM

To evaluate the characteristics of periventricular hemorrhages (PVH) in newborns of mothers receiving antiplatelet and anticoagulation therapy during pregnancy with hypercoagulation syndrome.

MATERIAL AND METHODS

One hundred and twelve newborns with PVH were evaluated: group 1 - 37 children, born after a pregnancy with hypercoagulation syndrome and antithrombotic therapy; group 2 - 55 children, born after a pregnancy without hypercoagulation syndrome and with preventive antithrombotic therapy; group 3 - 20 children, born after a pregnancy without hypercoagulation syndrome and without antithrombotic therapy. All newborns underwent clinical and neurologic examinations combined with assessment using special scales and intracranial ultrasound evaluation.

RESULTS AND CONCLUSION

Maternal anticoagulation therapy during pregnancy in groups I and 2 was associated with more severe condition of newborns with PVH (significantly prolonged artificial lung ventilation, more premature births, larger hemorrhage) compared to newborns in group 3. Follow-up of infants in groups I and 2 demonstrated a significantly slower progress of postural muscle tone, psychological and psychomotor development compared to infants in group 3. Hypercoagulation syndrome treatment during pregnancy significantly affects the severity of newborn's condition at birth and the development of severe neurological impairments in long-term period.