- Email: [email protected]
P-016: Risk factors of stroke and venous thromboembolism in association with combined oral contraceptives use
Abstracts / Thrombosis Research 151, Suppl. 1 (2017) S103–S140
S115
P-016 Risk factors of stroke and venous thromboembolism in association with combined oral contraceptives use
P-018 Amniotic fluid embolism presenting in the second and third trimester and subsequent pregnancy outcome
P. Dulíˇcek 1 , E. Ivanová 1 , P. Sadílek 1 , M. Beránek 2 IVth Internal Department- Hematology, University Hospital and Medical faculty, Hradec Králové; 2 Department of Clinical Biochemistry, University Hospital and Medical faculty, Hradec Králové
T. Cahan, H. De Castro, A. Kalter, M.J. Simchen Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Tel Aviv, Israel
1
Introduction: Thrombotic diathesis has been a well-known complication of COC´s. We analyzed the role of inherited and acquired thrombophilia on the onset of a thrombotic event in a cohort of 770 females (700 with VTE, 70 with stroke) in association with COC´s. We also assessed the duration of COC´s till thrombotic event, additional eliciting risk factors and tobacco use. Materials and methods: All women were recruited in the period of 1997 – 2014 and most of them came from the East Bohemia. All females with stroke were examinated with a CT scan. VTE was always objectively confirmed (US, lung perfusion scanning, CT, angio CT).Laboratory work-up contained: Protein C, protein S, antithrombin, F V Leiden mutation, F IIG20210A mutation, APS – lupus anticoagulans (LA), ACLa, anti beta2/gly I antibody, homocystein. Results: In cohort with stroke, ischemic stroke attacked 13 females, TIA 17 females, and CVT 40 females. Thrombophilia was detected in 20 f. (29%), inherited in 17 cases (24%), (F V Leiden 11x, F II G20210A 5x, 1x combined mutation). Acquired thrombophilia was identified in 3 cases (APS 2× in one case incipient/early stage of polycythemia vera, with JAK-2 kinase positivity. In cohort with VTE inherited thrombophilia was found in 42% with predominance of F V Leiden (33%). Cigarette smoking was significantly increased in the group with stroke (50%/25%). Prevalence of cigarette smoking in the group with VTE didn’t exceed frequency in population (25%) Conclusion: The absolute risk of stroke and VTE is very low in healthy women on COC´s, The frequency of thrombosis is further possible to decrease with keeping the rules before the prescription, healthy life style and type of contraception.
P-017 High prevalence of mental disorders among patients with inherited protein S deficiency: a case report series S. Hoirisch-Clapauch 1 , A.E. Nardi 2 1 Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil; 2 Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
Objective: Amniotic fluid embolus (AFE) is a life-threatening event occurring around labor and delivery, presenting as cardio-respiratory collapse and disseminated intravascular coagulation (DIC). Data regarding presentation during 2nd trimester uterine evacuation and regarding rates of recurrence is scarce. Materials and methods: A retrospective single center cohort study was performed. All cases of AFE were included and described as well as pregnancy outcomes in subsequent pregnancies of AFE survivors. Results: Between 2003–2015 approximately 120,000 women gave birth at Sheba Medical Center. Of these, 12 women suffered suspected AFE, for an estimated incidence of 1:10,000. Clinical presentation included respiratory distress, cardiovascular collapse and DIC. Nine (75%) cases occurred during delivery: 2 during elective cesarean sections (CS) and 7 which started as vaginal deliveries, of which 4 culminated in emergent CS. Three women (25%) presented with AFE during uterine evacuation following second trimester miscarriage. Of the 12 women, one maternal death occurred and one woman suffered anoxic brain damage. Treatment included inotropic agents, blood product transfusion, and hysterectomy due to uncontrolled bleeding in two patients. Clinical presentation was similar between 2nd and 3rd trimester/labor AFE. Four AFE survivors had a total of ten subsequent pregnancies; five resulting in an uncomplicated vaginal birth, four ended in miscarriage and uneventful uterine evacuations, one pregnancy was an ectopic pregnancy treated with expectant management. No recurrence of AFE was documented. Conclusions: AFE can occur during midtrimester uterine evacuation as well as around delivery with similar clinical features. Subsequent pregnancies are not associated with a complicated outcome.
P-019 Fetal and maternal morbidity associated with late preterm delivery due to preeclampsia B.Z. Shachar 1 *, M. Zadok 1 , S. Mazaki-Tovi 1,2 , M.J. Simchen 1,2 Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *E-mail: [email protected]
1
Background: Protein S is a major natural anticoagulant with profibrinolytic properties that also enhances proliferation and differentiation of neural stem cells. Mental disorders characterised by defective neurogenesis, such as schizophrenia and major depression, are prevalent in patients with low levels of free protein S due to autoantibodies or chronic inflammation. Our hypothesis was that these disorders would be prevalent among individuals with inherited protein S deficiency, as well. Methods: In this study, conducted at a tertiary Brazilian hospital, 14 adults with inherited protein S deficiency from five different families underwent psychiatric evaluation. Results: Currently, three participants suffer with mental illness, severe enough to cause serious impairment in social, occupational or school functioning (21% vs. 3% of the general population). Two of them have schizophrenia and one, bipolar disorder refractory to treatment. Eight have ever experienced a psychotic episode (57% vs. 15% of the general population). Discussion: The observation that mental symptoms are highly prevalent among individuals with inherited protein S deficiency, but not ubiquitous, suggests a multifactorial model. We postulate that low tissue plasminogen activator (tPA) levels would be an additional element in the pathogenesis of mental disorders related to protein S deficiency. This is because tPA has roles similar to that of protein S: it promotes fibrin clot degradation and is involved in the mechanism of adult neurogenesis. Conclusion: Studies with larger cohorts are required to validate our data and to elucidate the role of low tPA levels in the pathogenesis of mental disorders related to protein S deficiency.
Objective: We aimed to evaluate maternal and neonatal morbidities associated with induction of labor in late preterm severe preeclampsia (PET). Study design: This was a retrospective case-control study. Study group included women with a singleton pregnancy who underwent late preterm (34.0–36.6 weeks’ gestation) iatrogenic delivery due to severe PET, matched with singleton-carrying women with late preterm spontaneous delivery. Analysis included maternal demographics, length of hospitalization, obstetric complications, mode of delivery and neonatal complications including: birth weight, growth restriction (birth weight<10th percentile defined as SGA), APGAR scores, respiratory, infectious, neurological, hemodynamic, and metabolic complications. Results: Study group included 99 women with iatrogenic late preterm delivery due to severe PET. Controls were 99 women with late preterm spontaneous delivery. Mean maternal age was similar for the 2 groups. Maternal hospitalization was prolonged for the study group, and more study group women had a cesarean delivery (74% vs. 39%, p<0.001). Compared to controls, birth weight was significantly lower for study group (mean BW 2301±474 vs. 2431±404gr, respectively, p<0.0001), although gestational age at delivery was slightly, but significantly, higher for study group (35.1 vs. 34.6 weeks, p<0.0001). SGA proportion was also significantly higher for study group compared with control neonates (20/99 vs 7/99, p=0.008). Most neonatal morbidities were significantly less frequent in study group infants (including O2 supplementation, hypoglycemia and need for TPN), although sepsis rates were higher. Conclusion: Although smaller and more SGA, late preterm neonates born after induction of labor for severe PET suffer less neonatal complications than late preterm neonates born spontaneously.
S115
P-016 Risk factors of stroke and venous thromboembolism in association with combined oral contraceptives use
P-018 Amniotic fluid embolism presenting in the second and third trimester and subsequent pregnancy outcome
P. Dulíˇcek 1 , E. Ivanová 1 , P. Sadílek 1 , M. Beránek 2 IVth Internal Department- Hematology, University Hospital and Medical faculty, Hradec Králové; 2 Department of Clinical Biochemistry, University Hospital and Medical faculty, Hradec Králové
T. Cahan, H. De Castro, A. Kalter, M.J. Simchen Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Tel Aviv, Israel
1
Introduction: Thrombotic diathesis has been a well-known complication of COC´s. We analyzed the role of inherited and acquired thrombophilia on the onset of a thrombotic event in a cohort of 770 females (700 with VTE, 70 with stroke) in association with COC´s. We also assessed the duration of COC´s till thrombotic event, additional eliciting risk factors and tobacco use. Materials and methods: All women were recruited in the period of 1997 – 2014 and most of them came from the East Bohemia. All females with stroke were examinated with a CT scan. VTE was always objectively confirmed (US, lung perfusion scanning, CT, angio CT).Laboratory work-up contained: Protein C, protein S, antithrombin, F V Leiden mutation, F IIG20210A mutation, APS – lupus anticoagulans (LA), ACLa, anti beta2/gly I antibody, homocystein. Results: In cohort with stroke, ischemic stroke attacked 13 females, TIA 17 females, and CVT 40 females. Thrombophilia was detected in 20 f. (29%), inherited in 17 cases (24%), (F V Leiden 11x, F II G20210A 5x, 1x combined mutation). Acquired thrombophilia was identified in 3 cases (APS 2× in one case incipient/early stage of polycythemia vera, with JAK-2 kinase positivity. In cohort with VTE inherited thrombophilia was found in 42% with predominance of F V Leiden (33%). Cigarette smoking was significantly increased in the group with stroke (50%/25%). Prevalence of cigarette smoking in the group with VTE didn’t exceed frequency in population (25%) Conclusion: The absolute risk of stroke and VTE is very low in healthy women on COC´s, The frequency of thrombosis is further possible to decrease with keeping the rules before the prescription, healthy life style and type of contraception.
P-017 High prevalence of mental disorders among patients with inherited protein S deficiency: a case report series S. Hoirisch-Clapauch 1 , A.E. Nardi 2 1 Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil; 2 Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
Objective: Amniotic fluid embolus (AFE) is a life-threatening event occurring around labor and delivery, presenting as cardio-respiratory collapse and disseminated intravascular coagulation (DIC). Data regarding presentation during 2nd trimester uterine evacuation and regarding rates of recurrence is scarce. Materials and methods: A retrospective single center cohort study was performed. All cases of AFE were included and described as well as pregnancy outcomes in subsequent pregnancies of AFE survivors. Results: Between 2003–2015 approximately 120,000 women gave birth at Sheba Medical Center. Of these, 12 women suffered suspected AFE, for an estimated incidence of 1:10,000. Clinical presentation included respiratory distress, cardiovascular collapse and DIC. Nine (75%) cases occurred during delivery: 2 during elective cesarean sections (CS) and 7 which started as vaginal deliveries, of which 4 culminated in emergent CS. Three women (25%) presented with AFE during uterine evacuation following second trimester miscarriage. Of the 12 women, one maternal death occurred and one woman suffered anoxic brain damage. Treatment included inotropic agents, blood product transfusion, and hysterectomy due to uncontrolled bleeding in two patients. Clinical presentation was similar between 2nd and 3rd trimester/labor AFE. Four AFE survivors had a total of ten subsequent pregnancies; five resulting in an uncomplicated vaginal birth, four ended in miscarriage and uneventful uterine evacuations, one pregnancy was an ectopic pregnancy treated with expectant management. No recurrence of AFE was documented. Conclusions: AFE can occur during midtrimester uterine evacuation as well as around delivery with similar clinical features. Subsequent pregnancies are not associated with a complicated outcome.
P-019 Fetal and maternal morbidity associated with late preterm delivery due to preeclampsia B.Z. Shachar 1 *, M. Zadok 1 , S. Mazaki-Tovi 1,2 , M.J. Simchen 1,2 Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *E-mail: [email protected]
1
Background: Protein S is a major natural anticoagulant with profibrinolytic properties that also enhances proliferation and differentiation of neural stem cells. Mental disorders characterised by defective neurogenesis, such as schizophrenia and major depression, are prevalent in patients with low levels of free protein S due to autoantibodies or chronic inflammation. Our hypothesis was that these disorders would be prevalent among individuals with inherited protein S deficiency, as well. Methods: In this study, conducted at a tertiary Brazilian hospital, 14 adults with inherited protein S deficiency from five different families underwent psychiatric evaluation. Results: Currently, three participants suffer with mental illness, severe enough to cause serious impairment in social, occupational or school functioning (21% vs. 3% of the general population). Two of them have schizophrenia and one, bipolar disorder refractory to treatment. Eight have ever experienced a psychotic episode (57% vs. 15% of the general population). Discussion: The observation that mental symptoms are highly prevalent among individuals with inherited protein S deficiency, but not ubiquitous, suggests a multifactorial model. We postulate that low tissue plasminogen activator (tPA) levels would be an additional element in the pathogenesis of mental disorders related to protein S deficiency. This is because tPA has roles similar to that of protein S: it promotes fibrin clot degradation and is involved in the mechanism of adult neurogenesis. Conclusion: Studies with larger cohorts are required to validate our data and to elucidate the role of low tPA levels in the pathogenesis of mental disorders related to protein S deficiency.
Objective: We aimed to evaluate maternal and neonatal morbidities associated with induction of labor in late preterm severe preeclampsia (PET). Study design: This was a retrospective case-control study. Study group included women with a singleton pregnancy who underwent late preterm (34.0–36.6 weeks’ gestation) iatrogenic delivery due to severe PET, matched with singleton-carrying women with late preterm spontaneous delivery. Analysis included maternal demographics, length of hospitalization, obstetric complications, mode of delivery and neonatal complications including: birth weight, growth restriction (birth weight<10th percentile defined as SGA), APGAR scores, respiratory, infectious, neurological, hemodynamic, and metabolic complications. Results: Study group included 99 women with iatrogenic late preterm delivery due to severe PET. Controls were 99 women with late preterm spontaneous delivery. Mean maternal age was similar for the 2 groups. Maternal hospitalization was prolonged for the study group, and more study group women had a cesarean delivery (74% vs. 39%, p<0.001). Compared to controls, birth weight was significantly lower for study group (mean BW 2301±474 vs. 2431±404gr, respectively, p<0.0001), although gestational age at delivery was slightly, but significantly, higher for study group (35.1 vs. 34.6 weeks, p<0.0001). SGA proportion was also significantly higher for study group compared with control neonates (20/99 vs 7/99, p=0.008). Most neonatal morbidities were significantly less frequent in study group infants (including O2 supplementation, hypoglycemia and need for TPN), although sepsis rates were higher. Conclusion: Although smaller and more SGA, late preterm neonates born after induction of labor for severe PET suffer less neonatal complications than late preterm neonates born spontaneously.