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  3. The Obstetric Hematology Manual
  • Cited by 11
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    • Publisher:
      Cambridge University Press
      Publication date:
      December 2010
      April 2010
      ISBN:
      9780511676451
      DOI:
      https://doi.org/10.1017/CBO9780511676451
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      • Subjects:
      Obstetrics and Gynecology, Reproductive Medicine, Medicine, Hematology
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    Subjects:
    Obstetrics and Gynecology, Reproductive Medicine, Medicine, Hematology
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    Book description

    Obstetric hematology is a fast-growing area of medicine covering the diagnosis and management of hematological problems of pregnancy. Comprehensive in approach, The Obstetric Hematology Manual addresses the many hematological conditions that can cause serious problems in pregnancy, delivery and the post-partum period for both mother and baby. Written by a team of international authorities, this text provides up-to-date, evidence-based guidelines on best care, as well as sound advice based on the experience and opinion of experts. Where appropriate, basic principles are discussed to clarify the rationale for management, and systems and procedures for disease prevention are highlighted. Many conditions and cases are discussed, including venous thromboembolism, pre-eclampsia, anemia, thrombocytopenia and inherited disorders. This book will appeal to both trainees and practitioners in obstetrics, obstetric medicine, obstetric anesthesia and hematology. It is also an accessible text for midwives, nurses, and laboratory staff.

    Reviews

    '… does an excellent job of reviewing the relevant data and then presenting it in a practical and aesthetically pleasing manner. … will certainly prove an invaluable addition to the libraries of clinicians who deal with these patients.'

    Source: Doody's

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    Contents

    Page 2 of 2

    Contents
    • Chapter 16 - Genetic counseling and pre-natal diagnosis in hemophilia
      pp 194-200
    • View abstract

      Summary

      This chapter addresses the management of pregnancy in women with mechanical heart valves and discusses the maternal and fetal risks associated with the different anticoagulant options, to enable clinicians and women to make the most informed choice in this challenging clinical situation. Thromboembolic complications of mechanical valves include valve thrombosis, causing valve obstruction or systemic embolization, mainly cerebrovascular accidents (CVA) but also myocardial infarction or embolization into peripheral arteries. Systemic thromboembolism can develop from either obstructed or non-obstructed valves. Oral anticoagulants, such as warfarin and acenocoumarol, are the most effective agents for prevention of valve thrombosis and systemic thromboembolism during pregnancy in women with mechanical heart valves. Management of women in the peri-delivery period requires close clinical monitoring, given the bleeding risks associated with therapeutic anticoagulation. A planned delivery allows for better control and adjustment of anticoagulation.
    • Chapter 17 - Pre-eclampsia
      pp 203-217
    • View abstract

      Summary

      This chapter addresses the practical obstetric and anesthetic management of women on prophylactic heparin and therapeutic anticoagulation in the peri-partum period, and the dilemmas for obstetricians, anesthetists, and hematologists. It considers issues surrounding use of thrombolytic agents in pregnancy, and unusual but complex situations such as cardiopulmonary bypass in pregnancy. Increasing use of prophylactic anticoagulants in pregnancy, both for venous thromboprophylaxis and to modify fetal risk, as in antiphospholipid syndrome, means that more women are now reaching the peri-partum period on anticoagulants, usually a low molecular weight heparin. The safety in pregnancy of other antiplatelet agents such as clopidogrel or ticlopidine at usual therapeutic doses has not been established and they are rarely used. Most of the women requiring prophylactic doses of anticoagulant will be given one of the low molecular weight heparins (LMWH).
    • Chapter 19 - Myeloproliferative disorders
      pp 229-242
    • View abstract

      Summary

      Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis and/or obstetric morbidity in the presence of persistent antiphospholipid antibodies (aPL) namely, lupus anticoagulant antibodies (LAC), anti-cardiolipin antibodies (aCL) and/or anti-β2-glycoprotein I antibodies. The syndrome produces a spectrum of disease, both in terms of clinical manifestations and the presence of other autoimmune conditions. The disease is classified as primary antiphospholipid syndrome (PAPS) when it occurs in the absence of any features of other autoimmune disease, and secondary where other autoimmune disease is present secondary antiphospholipid syndrome (SAPS). Upto 30% of patients with APS have minor valvular abnormalities, which usually do not cause hemodynamic disturbance. Individual treatment strategies for the management of the APS in pregnancy in part depend on the assessment of a number of different factors. The first treatment used and studied for pregnant patients with APS, was a combination of corticosteroids and low dose aspirin.
    • Chapter 20 - Effects of chemoradiotherapy for hematological malignancy on fertility and pregnancy
      pp 243-252
    • View abstract

      Summary

      Successful pregnancy requires trophoblast invasion into the maternal uterine spiral arteries converting them into large dilated vessels. Microthrombi are frequently found in the vessels of the placentas from women who have experienced pregnancy loss and placental infarction has been described in the placentas of some, but not all, women who have a pregnancy loss and who have thrombophilia. Published meta-analyses suggest that factor V Leiden, prothrombin G20210A, and protein S deficiency are associated with an increased risk of recurrent early pregnancy loss and non-recurrent late pregnancy loss. Women with a history of pregnancy loss merit increased surveillance in subsequent pregnancies and should be given folic acid during pregnancy. Despite the lack of evidence from randomized, double-blind, placebo-controlled trials, many clinicians are offering women with a history of pregnancy loss found to have a heritable thrombophilia self-administered prophylactic doses of low molecular weight heparin daily low dose aspirin in subsequent pregnancies.

    Page 2 of 2

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