Antenatal Drugs Affecting Vitamin K Status of the Fetus and the Newborn

Stroke during Pregnancy: Therapeutic Options and Role of Percutaneous Device Closure

“…During pregnancy, this is advantageous at the time of delivery and the attendant risks of peripartum haemorrhage, as well as the risks of osteoporosis and thrombocytopaenia incurred when using heparin [21]. Warfarin is an alternative, however, it is associated with embryopathy, particularly in doses greater than 5 mg daily [22]; warfarin predisposes to cerebral microhaemorrhage and intraventricular haemorrhage resulting in microcephaly and developmental delay [23]. Ideally, warfarin should be avoided between 6 and 12 weeks gestation and requires transitioning to low molecular weight heparin in anticipation of delivery.…”

Warfarin Embryopathy

“…The most commonly reported malformations were nasal hypoplasia [1^7], chondrodysplasia punctata [2,4,5,8^10], cleft lip and=or palate [1,3,11], choanal stenosis [2,24], ¢nger and toe defects [7,11], ocular defects [1,4,12] and brain anomalies [1,2,4,6,11,12,21,25]. Nasal hypoplasia involves stunted growth of the septum, resulting in a depressed nasal bridge.…”

“…Other fetal defects reported less frequently were cervical spine myelopathy [13,14], calci¢cations in the alar or septal cartilages [2,14], subependymal intraventricular hemmorhage [1,6,21], and hydrocephalus [1,11]. Rare types of malformation described in at least one case included choanal atresia or stenosis with nasolacrimal duct mucocele, holoprosencephaly, and solitary maxillary incisor [15]; dextrocardia situs inversus [16]; schizencephaly [17]; laryngeal or tracheal cal-ci¢cation [18]; urinary tract anomaly [19]; tetralogy of Fallot [20]; mental retardation [4]; toe deformities [5]; and brachydactyly of terminal phalanges [7].…”

Effect of maternal anticonvulsant treatment on neonatal blood coagulation

“…As immediate prophylaxis with intramuscular vitamin K at birth might well have prevented all the published cases of documented symptomatic factor deficiency unassociated with trauma to the liver or spleen, many clinicians will prefer to give a physiological dose of vitamin K to the baby at delivery, rather than a pharmacological dose to the mother before delivery, as is frequently recommended,4 17 23 26 especially while there remains any continuing possibility that high doses could be carcinogenic 2728 The problem should become less common as other drugs come to be used in the management of adult epilepsy—valproate, in particular, does not seem to cause neonatal hypoprothrombinaemia 3…”