Use of Aspirin and Low-Molecular-Weight Heparin to Prevent Recurrence of Maternal Floor Infarction in Women without Evidence of Antiphospholipid Antibody Syndrome

Makino, Aiko; Suzuki, Yoshikatu; Yamamoto, Taro; Satô, Takeshi; Kojima, Kazuhisa; Suzumori, Kaoru

doi:10.1159/000076708

Cited by 13 publications

(13 citation statements)

References 11 publications

(12 reference statements)

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“…Heparin was reported in cases with MFI with or without antiphospholipid syndrome (APAS). In cases with APAS, treatment did not eradicate the underlying pathology but reduced its severity, whereas in absence of APAS, heparin improved outcome and maintained normal fetal growth . In a case of APAS and recurrent MFI where aspirin and heparin had failed, i.v.…”

Section: Discussionmentioning

confidence: 98%

“…In cases with APAS, treatment did not eradicate the underlying pathology but reduced its severity, 8 whereas in absence of APAS, heparin improved outcome and maintained normal fetal growth. 9 In a case of APAS and recurrent MFI where aspirin and heparin had failed, i.v. immunoglobulin was started preconceptually and improved the outcome of two consecutive pregnancies with evidence of MFI on placental pathology.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Maternal floor infarction: Management of an underrecognized pathology

Alsahan

Grynspan

Dadelszen

et al. 2013

J of Obstet and Gynaecol

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Maternal floor infarction is a relatively rare condition characterized clinically by severe early onset fetal growth restriction with features of uteroplacental insufficiency. It has a very high recurrence rate and carries a significant risk or fetal demise. Pathological characteristics include massive and diffuse fibrin deposition along the decidua basalis and the perivillous space of the basal plate. We present a case of recurrent maternal floor infarction and propose diagnostic clues as well as potential therapeutic options.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Maternal floor infarction: Management of an underrecognized pathology

Alsahan

Grynspan

Dadelszen

et al. 2013

J of Obstet and Gynaecol

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“…From this time, we used low molecular weight heparin as a stronger anticoagulant therapy. We carried out an elective cesarean section and the infant was a 2239‐g girl 77 . From this case, we conclude that anticoagulant therapy might exert protection against maternal floor infarction and IUGR.…”

Section: Aspirin and Unexplained Intrauterine Growth Restriction And mentioning

confidence: 87%

“…found no decrease in the numbers of small for gestational age or low birthweight babies 76 . In 2004, we reported a case of IUGR complicated with maternal floor infarction in a patient not suffering from any antiphospholipid antibody syndrome 77 . Marked placenta enlargement with severe fetal growth restriction and oligohydramunios was evident at 19 weeks of gestation, but the patient had no medical history of autoimmune disease or any blood coagulation disorders and testing for syphilis was negative.…”

Section: Aspirin and Unexplained Intrauterine Growth Restriction And mentioning

confidence: 91%

Anticoagulant therapy and pregnancy

Makino¹,

Sugiura‐Ogasawara

2008

Reprod Medicine & Biology

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Low dose aspirin therapy is one of the anticoagulant treatments used during pregnancy. Anticoagulant agents may be useful for several disorders, such as recurrent miscarriage, preeclampsia, fetal growth restriction and infertility. However, it is unclear whether anticoagulant therapy can increase the live birth rate in all of these cases. Recent data suggest that a low-dose aspirin and heparin combination therapy is effective in the prevention of recurrent pregnancy loss in women with antiphospholipid syndrome. Thrombogenic diseases, for example, protein C deficiency, protein S deficiency, factor XII deficiency and hyperhomocysteinemia, may cause pregnancy loss. The etiology of recurrent miscarriage is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Although 70% of recurrent pregnancy losses are unexplained, anticoagulant therapy is effective in maintaining pregnancy without antiphospholipid antibody syndrome. We conclude that a low-dose aspirin and heparin combination therapy can be useful for unexplained cases of recurrent pregnancy loss without antiphospholipid antibody syndrome. (Reprod Med Biol 2008; 7: 1-10)

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“…The preference of aspirin usage in our medical center may be due to the prevention of fetal growth restriction and a reversible increase in uterine blood flow [31], whereas evidence on the use of LMWH from randomized control trials in both in vitro and in vivo studies remained inconsistent [32–36]. The use of heparin, including LMWH, was established for the prevention/improvement of thrombophlebitis in the pathological hypercoagulability during pregnancy [37]. Meanwhile, the dosage regimen of coagulant used in our medical center mainly focused on alone and duplex medications rather than triple combination.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial

et al. 2019

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BackgroundAnticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section.MethodsThis was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n = 110) and 22gauge traditional spinal needles (control group, n = 92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (∆VAS), VAS of back puncture point 24, 48 and 72 h after operation (VASdural-24 h, VASdural-48 h and VASdural-72 h, respectively), maternal satisfaction and hospitalization stay.ResultsNo parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24 h, VASlbp-48 h and VASlbp-72 h (P = 0.056; P = 0.813; P = 0.189, respectively) between two groups. In experimental group, VASdural (P = 0.017), ∆VAS (P = 0.001) and VASdural-24 h (P < 0.0001) were lower, whereas maternal satisfaction was higher (P = 0.046). There was no significant difference in VASdural-48 h, VASdural-72 h, urination function, strength recovery and hospitalization stay (P = 0.069; P = 0.667; P = 0.105; P = 0.133; P = 0.754, respectively) between the two groups.ConclusionsMinimally invasive spinal anesthesia provided lower VASdural, VASdrual-24 h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time.Trial registrationThis study was registered at www.ClinicalTrials.gov at November 11th, 2016 (NCT02987192).

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Use of Aspirin and Low-Molecular-Weight Heparin to Prevent Recurrence of Maternal Floor Infarction in Women without Evidence of Antiphospholipid Antibody Syndrome

Cited by 13 publications

References 11 publications

Maternal floor infarction: Management of an underrecognized pathology

Maternal floor infarction: Management of an underrecognized pathology

Anticoagulant therapy and pregnancy

Minimally invasive spinal anesthesia for cesarean section in maternal anticoagulation therapy: a randomized controlled trial

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