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Wednesday, 17 September 2014

Antenatal heparin thrombopropylaxis

A randomised trial has found no benefit to antenatal low molecular weight heparin/dalteparin prescription (commonly prescibed in the UK during pregnancy).  Thrombophilia simply means an increased risk of blood clots, for example many women find themselves being offered/given heparin in pregnancy because they have three or more of the following characteristics:

Age >35 years
BMI > 30
Para 3 or more
Serious varicose veins
Twin pregnancy
Previous DVT

The article is here:

It's conclusions are:
"Antepartum prophylactic dalteparin does not reduce the occurrence of venous thromboembolism, pregnancy loss, or placenta-mediated pregnancy complications in pregnant women with thrombophilia at high risk of these complications and is associated with an increased risk of minor bleeding."

"Using low molecular weight heparin unnecessarily medicalizes a woman's pregnancy and is costly."

Wednesday, 3 September 2014

The third stage of labour (placenta and membranes)

 "CONCLUSION: This study suggests that 'holistic psychophysiological care' in the third stage labour is safe for women at low risk of postpartum haemorrhage. 'Active management' was associated with a seven to eight fold increase in postpartum haemorrhage rates for this group of women. Further prospective observational evaluation would be helpful in testing this association."

Just read this and will look into it a bit more when I have time (what was the "holistic psycho-physiological management, was it a homogeneous approach or did it comprise a variety of practices?  I personally have found that a number of approaches work equally well, depending on the woman, her position, where the placenta is, how long the third stage has lasted, maternal effort/tiredness etc) but it should certainly affect practice and the information given to women with regard to active management.