A Case of Maternal Vitamin K Deficiency Associated with Hyperemesis Gravidarum: Its Potential Impact on Fetal Blood Coagulability

Shigemi, Daisuke; Nakanishi, Kazuhiro; Miyazaki, Miwa; Shibata, Yoshie; Suzuki, Shunji

doi:10.1272/jnms.82.54

Cited by 12 publications

(27 citation statements)

References 11 publications

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“…A fall in Factor VII causes a prolonged PT, with a normal APTT. Prolongation of PT has already been shown in some HG patients [1, 4, 5]. VK administration rapidly ameliorated the prolonged PT in this patient.…”

Section: Discussionsupporting

confidence: 54%

“…Although this was not measured in this patient, protein induced by vitamin K absence or antagonist- (PIVKA-) II, a more sensitive marker than PT or PT-INR and is preferred over direct VK measurement, may reveal earlier detection of VK-deficiency, and, thus, its measurement may be considered in patients with HG, especially at the time of surgery. Robinson et al [6], who reported HG-related VK-deficiency-induced maternal hemorrhagic diathesis (epistaxis), recommended that “prophylactic VK replacement should be considered in cases in which HG is severe and protracted.” Another report also supported this view [4]. Although this sounds reasonable, further studies are necessary to determine whether universal prophylactic administration of VK in severe HG patients should be performed.…”

Section: Discussionmentioning

confidence: 57%

“…Of them, neonatal hemorrhage and VK-deficiency embryopathy-fetopathy have been paid attention to [1–4]. Here, we describe intraperitoneal hemorrhage in a pregnant woman with HG.…”

Section: Introductionmentioning

confidence: 94%

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Intraperitoneal Hemorrhage in a Pregnant Woman with Hyperemesis Gravidarum: Vitamin K Deficiency as a Possible Cause

Baba

Morisawa

Saito

et al. 2016

Case Reports in Obstetrics and Gynecology

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Hyperemesis gravidarum can cause various vitamin deficiencies. Vitamin K deficiency can lead to coagulopathy or hemorrhagic diathesis. A nulliparous Japanese woman with hyperemesis gravidarum at 105/7 weeks was admitted with giant myoma, intestinal obstruction, and abdominal pain. Treatment for a degenerative myoma was instituted with intravenous antibiotics. The abdominal pain ameliorated, but intestinal obstruction persisted. At 166/7 weeks, we performed laparotomy for release of intestinal obstruction, when intraabdominal bleeding of 110 mL existed. Blood tests revealed coagulopathy secondary to vitamin K deficiency. The coagulopathy responded to intravenous vitamin K injection. Coagulopathy due to vitamin K deficiency can occur with hyperemesis gravidarum, and coexisting intestinal obstruction and broad-spectrum antibiotics can aggravate the deficiency.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 57%

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Intraperitoneal Hemorrhage in a Pregnant Woman with Hyperemesis Gravidarum: Vitamin K Deficiency as a Possible Cause

Baba

Morisawa

Saito

et al. 2016

Case Reports in Obstetrics and Gynecology

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“…In addition, Corona G et al reported the development of osmotic demyelination syndrome in these patients due to their metabolic disorders and hyponatremia [20]. In another study, Shigemi et al reported that fetal coagulation developed in HG patients due to a vitamin K deficiency [21].…”

Section: Discussionmentioning

confidence: 99%

Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum

Şahin

Madendağ

Şahin

et al. 2018

BMC Pregnancy Childbirth

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BackgroundNausea and vomiting occur 50–90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8–2% before the 20th week of gestational age. The symptoms generally start during the 5–6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16–20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting.MethodsThe study population consisted of two groups of pregnant volunteers at 5–12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups.ResultsIn total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD3 levels were significantly lower than in the control group (p < 0.001).ConclusionsThe data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms.Trial registrationNCT02862496 Date of registration: 21/07/2016.

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“…[172]. Malnutrition and vitamin K deficiency might promote HG [173]. The avoidance of substances, odors, or food, which tends to irritate the patient and promote nausea, is considered a supplemental help.…”

Section: Therapymentioning

confidence: 99%

Immunology of hepatic diseases during pregnancy

2016

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The mother's immune system has to adapt to pregnancy accepting the semi-allograft fetus and preventing harmful effects to the developing child. Aberrations in feto-maternal immune adaptation may result in disease of the mother, such as liver injury. Five pregnancy-associated liver disorders have been described so far, however, little is known concerning immune alterations promoting the respective disease. These liver disorders are pre-eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP), acute fatty liver, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. On the other hand, pre-existing autoimmune liver injury of the mother can be affected by pregnancy. This review intends to summarize current knowledge linking feto-maternal immunology and liver inflammation with a special emphasis on novel potential biomarkers.

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A Case of Maternal Vitamin K Deficiency Associated with Hyperemesis Gravidarum: Its Potential Impact on Fetal Blood Coagulability

Cited by 12 publications

References 11 publications

Intraperitoneal Hemorrhage in a Pregnant Woman with Hyperemesis Gravidarum: Vitamin K Deficiency as a Possible Cause

Intraperitoneal Hemorrhage in a Pregnant Woman with Hyperemesis Gravidarum: Vitamin K Deficiency as a Possible Cause

Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum

Immunology of hepatic diseases during pregnancy

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