Inhibitory effects of indomethacin on implantation and its related phenomena

Headache in pregnancy

Headache is a frequent symptom in women of childbearing age and during pregnancy. Benign and pathologic headaches may change in response to changes in estrogen after conception. Expected patterns of change are described for headaches that occur commonly during pregnancy. In addition, although treatment options are limited during pregnancy, a variety of effective medication and nonmedication treatments are available and should be offered to women with benign headaches that persist into the second trimester of pregnancy.

Pregnancy and chronic headache

Headache patterns in women change in relation to fluctuations in oestrogen levels. Increasing oestrogen levels in early pregnancy offer a protective effect against headache, particularly for women with migraine. However, some women continue to experience troublesome headache throughout pregnancy. Headache persisting at the end of the first trimester will usually continue without improvement for the remainder of pregnancy and should be treated. Safe and effective acute care treatment options include paracetamol, opioids and anti-emetics. The use of triptans during pregnancy is controversial and not broadly recommended. Safe and effective preventive treatments include relaxation, biofeedback, beta-blockers, some antidepressants and gabapentin in early pregnancy.

Obstetric management of antiphospholipid syndrome

The obstetric management of women with antiphospholipid (aPL) syndrome remains controversial. Despite recent advances, the controversies have been fueled by our limited understanding of the multi-factorial causes of aPL-associated pregnancy loss and the lack of data from randomized studies. We have escaped from the narrow confines of the concept of aPL pregnancy loss being purely thrombotic in aetiology and attention is now focused on the adverse effects of aPL on embryonic implantation and trophoblast invasion. Combined treatment with aspirin and heparin has been demonstrated in two randomized studies to lead to a high live birth rate in aPL pregnancies. However, successful pregnancies are characterized by a high rate of perinatal complications and some women are refractory to this treatment combination. In addition to addressing these issues, multi-centre studies, which should perhaps be internet based, are needed to identify those aPL that are causative of pregnancy complications and those that are not, the role of IVIG and the long-term follow-up of both mothers with aPL and their babies.