Feto-Maternal Complications of Anticoagulant Use Before and After Childbirth: Feto-Maternal Complications of Anticoagulant Use

Shafia Khan; Rabia Parveen; Sheeba Faryal; Mubeen Ahmed Memon; Farah Liaquat; Urooj Jahan Khan; Purneet Kumar

doi:10.54393/pjhs.v5i09.2296

Authors

Shafia Khan Department of Obstetrics and Gynaecology, Ibn-e-Sina University, Mirpurkhas, Pakistan
Rabia Parveen Department of Obstetrics and Gynaecology, Shaikh Zaid Women Hospital, Larkana, Pakistan
Sheeba Faryal Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Mubeen Ahmed Memon Department of Pulmonology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Farah Liaquat Department of Obstetrics and Gynaecology, Baqai Medical University, Karachi, Pakistan
Urooj Jahan Khan Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Purneet Kumar Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i09.2296

Keywords:

Anticoagulants, Pregnancy, Feto-Maternal Outcomes, Heparin

Abstract

Anticoagulants prevent blood clotting, but their use in pregnancy poses challenges due to bleeding risks, particularly during delivery and postpartum. Objectives: To evaluate the maternal and fetal complications associated with anticoagulant use before and after childbirth, considering the safety and effectiveness of low molecular weight heparin and Warfarin. Methods: A cohort study was conducted at the Tertiary Care Hospital of Sindh, from August 2022 to July 2023. 266 pregnant women were chosen via consecutive sampling. Pregnant women with a gestational age of > 12 weeks, aged 18-35 years probably taking anti-coagulation therapy during pregnancy and puerperium were included in the study. While women suffering from any major systemic illness and women taking any other potential teratogenic drugs were excluded. Results: Maternal complications occurred in 53% of participants, with postpartum hemorrhage being the most frequent (19.9%), significantly higher in the low molecular weight heparin group (p<0.05). Pre-eclampsia affected 10.5% of participants, predominantly in low molecular weight heparin users (p=0.028). Fetal complications were reported in 59.3% of cases, with intrauterine growth restriction (13.5%) and premature birth (18.0%) being the most common. Stillbirths were more frequent among Warfarin users. Neonatal intensive care admission was required for 11.3% of infants, with low molecular weight heparin exposure showing the highest incidence. Conclusions: It was concluded that low molecular weight heparin was with poor maternal outcomes such as postpartum hemorrhage, wound hematoma, deep vein thrombosis, and pre-eclampsia, while fetal complications included intrauterine growth restriction, stillbirth, premature birth and low birth weight.

References

Devis P and Knuttinen MG. Deep Venous Thrombosis in Pregnancy: Incidence, Pathogenesis and Endovascular Management. Cardiovascular Diagnosis and Therapy. 2017 Dec; 7(Suppl 3): S309. doi: 10.21037/cdt.2017.10.08.

Maughan BC, Marin M, Han J, Gibbins KJ, Brixey AG, Caughey AB et al. Venous Thromboembolism During Pregnancy and the Postpartum Period: Risk Factors, Diagnostic Testing, and Treatment. Obstetrical & Gynecological Survey. 2022 Jul; 77(7): 433-44. doi: 10.1097/OGX.0000000000001043.

Varrias D, Spanos M, Kokkinidis DG, Zoumpourlis P, Kalaitzopoulos DR. Venous Thromboembolism in Pregnancy: Challenges and Solutions. Vascular Health and Risk Management. 2023 Dec; 19: 469-84. doi: 10.2147/VHRM.S404537.

Bannow BS, Federspiel JJ, Abel DE, Mauney L, Rosovsky RP, Bates SM. Multidisciplinary Care of the Pregnant Patient with or At Risk For Venous Thromboembolism: A Recommended Toolkit from the Foundation for Women and Girls with Blood Disorders Thrombosis Subcommittee. Journal of Thrombosis and Haemostasis. 2023 Jun; 21(6): 1432-40. doi: 10.1016/j.jtha.2023.03.015.

Jenneker M, Ramnarain H, Sebitloane H. A Clinical Conundrum: Review of Anticoagulation in Pregnant Women with Mechanical Prosthetic Heart Valves. Cardiovascular Journal of Africa. 2022 Nov; 33(6): 322-8. doi: 10.5830/CVJA-2022-028.

Ahmet Güner MD, Macit Kalçık MD, Mustafa Ozan Gürsoy MD, Sabahattin Gündüz MD, Astarcıoglu MA, Emrah Bayam MD et al. Comparison of Different Anticoagulation Regimens Regarding Maternal and Fetal Outcomes in Pregnant Patients with Mechanical Prosthetic Heart Valves (From The Multicenter ANATOLIA-PREG Registry). Lupus. 2023 June; 32(9): 1126-1133. doi: 10.1177/09612033231184675.

James AH, Sugrue R, Federspiel JJ. Novel Antithrombotic Agents in Pregnancy Anticoagulants and Antiplatelet Agents. Clinical Obstetrics and Gynecology. 2023 Mar; 66(1): 196-207. doi: 10.1097/GRF.0000000000000740.

Zaidi SR and Jenkins SM. Anticoagulant Therapy in Pregnancy. 2024 Jan.

Singh KK, Gupta A, Fatima S, Ambreen S, Isermann B, Kohli S. Direct Oral Anticoagulants Cause Placental Vascular Abnormalities and Epigenetic Reprogramming in Placenta and the Offspring. Hämostaseologie. 2023 Feb; 43(S01): T-04. doi: 10.1055/s-0042-1760482.

Kaul A, Bhaduaria D, Pradhan M, Jain M, Prasad N, Patel M et al. Beyer-Westendorf J, Tittl L, Bistervels I, Middeldorp S, Schaefer C, Paulus W et al. Safety of Direct Oral Anticoagulant Exposure During Pregnancy: A Retrospective Cohort Study. The Lancet Haematology. 2020 Dec; 7(12): e884-91. doi: 10.1016/S2352-3026(20)30327-6.

Rodger MA, Carrier M, Le Gal G, Martinelli I, Perna A, Rey E et al. Meta-analysis of Low-Molecular-Weight Heparin to Prevent Recurrent Placenta-Mediated Pregnancy Complications. Blood, The Journal of the American Society of Hematology. 2014 Feb; 123(6): 822-8. doi: 10.1182/blood-2013-01-478958.

McLintock C. Anticoagulant Therapy in Pregnant Women with Mechanical Prosthetic Heart Valves: No Easy Option. Thrombosis Research. 2011 Feb; 127: S56-60. doi: 10.1016/S0049-3848(11)70016-0.

Villani M, Ageno W, Grandone E, Dentali F. The Prevention and Treatment of Venous Thromboembolism in Pregnancy. Expert Review of Cardiovascular Therapy. 2017 May; 15(5): 397-402. doi: 10.1080/14779072.2017.1319279.

Obeagu EI and Obeagu GU. Postpartum Haemorrhage among Women Delivering Through Spontaneous Vaginal Delivery: Prevalence and Risk Factors. International Journal of Current Research in Chemistry and Pharmaceutical Sciences. 2023; 10(8): 22-6. doi: 10.22192/ijcrcps.2023.10.08.003.

Umurungi J, Ferrando F, Cilloni D, Sivera P. Cerebral Vein Thrombosis and Direct Oral Anticoagulants: A Review. Journal of Clinical Medicine. 2024 Aug; 13(16): 4730. doi: 10.3390/jcm13164730.

Meng SH, Li JH, Zuo LJ, Feng LM. The Outcomes of Pregnant and Postpartum Patients with Cerebral Venous Sinus Thrombosis After Anticoagulant Therapy. Medicine. 2021 Jul; 100(26): e26360. doi: 10.1097/MD.0000000000026360.

Lo HW, Chen CJ, Tsai EM. Pregnancy Outcomes for Women with Non-Criteria Antiphospholipid Syndrome After Anticoagulant Therapy. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2020 Jan; 244: 205-7.

Lafalla O, Esteban LM, Lou AC, Cornudella R, Domínguez M, Sanz G et al. Clinical Utility of Thrombophilia, Anticoagulant Treatment, and Maternal Variables As Predictors of Placenta-Mediated Pregnancy Complications: an Extensive Analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2021 Feb; 34(4): 588-98. doi: 10.1080/14767058.2019.1611764.

Kearsley R and Stocks G. Venous Thromboembolism in Pregnancy—Diagnosis, Management, and Treatment. British Journal of Anesthesia Education. 2021 Mar; 21(3): 117-23. doi: 10.1016/j.bjae.2020.10.003.

Kalaitzopoulos DR, Panagopoulos A, Samant S, Ghalib N, Kadillari J, Daniilidis A et al. Management of Venous Thromboembolism in Pregnancy. Thrombosis Research. 2022 Mar; 211: 106-13. doi: 10.1016/j.thromres.2022.02.002.