[Pregnancy planning and follow-up of a pregnant woman with sickle cell disease]

Pregnancy is a high-risk situation in sickle cell patients, both for the mother and the foetus. It considerably increases the risk of an acute complication (vaso-occlusive crisis, acute chest syndrome, infection, thrombosis) of sickle cell disease. In addition, this condition increases the risk of placental vascular complications (in utero growth retardation, pre-eclampsia, retroplacental haematoma and in utero foetal death).

Risk status and traumatic birth perception in pregnancy

OBJECTIVE

In this study, the effect of high-risk pregnancies on pregnant women's perception of anxiety and traumatic birth was examined.

DESIGN AND METHODS

Data in a comparative descriptive study involving 156 pregnant women, collected by pregnant information form, State and Trait Anxiety, and Traumatic Birth Perception Scale.

RESULTS

It was found that 44.9% of the pregnant women in the study were between the ages of 24-29, 79.5% wanted to give birth normally, and 62.8% feared vaginal delivery. There was a low level of positive correlation between traumatic anxiety and perception of traumatic delivery in high-risk pregnant women, and a moderate positive relationship between traumatic anxiety and traumatic delivery perception in low risk pregnant women (p < 0.05).

PRACTICE IMPLICATIONS

It is recommended to determine the risk factors that will create a perception of traumatic birth in pregnant women and to plan holistic care aimed at preventing traumatic births.

How Can Rotational Thromboelastometry as a Point-of-Care Method Be Useful for the Management of Secondary Thromboprophylaxis in High-Risk Pregnant Patients?

Thromboprophylaxis with low-molecular-weight heparin (LMWH) for patients with a history of venous thromboembolism (VTE) is suggested. Rotational thromboelastometry (ROTEM^®) represents an innovative point-of-care method enabling the complex and quick evaluation of hemostasis. However, there are only episodic cases of its use for hemostasis assessment and guidance of LMWH in pregnancy. Therefore, we provide the results of unique prospective and longitudinal monitoring of hemostasis in high-risk pregnant women, which we used for the individualized optimalization of secondary thromboprophylaxis. According to the shortening of clot formation time (CFT) in EXTEM (p = 0.0007 from the 26th gestational week vs. controls) and INTEM (p = 0.002 from the 35th gestational week), increase in alpha angle (AA) in EXTEM, INTEM, and HEPTEM, and the persistence of increase in maximum clot firmness (MCF) in EXTEM, INTEM, and HEPTEM (p < 0.001 from the 26th and 35th gestational week vs. controls for EXTEM and INTEM, p = 0.0012 from the 26th gestational week in HEPTEM), LMWH dose was modified. Even after the postpartum period, AA in EXTEM was steeper than in controls (p = 0.0007), indicating that hemostasis is not fully normalized after 6–8 weeks following delivery. Therefore, ROTEM may be a useful tool for the individual evaluation of the termination of anticoagulant thromboprophylaxis.

The relationship between serum zinc level and preeclampsia

BACKGROUND

Preeclampsia is one of the commonest causes of prenatal and maternity related death in the world. Preeclampsia is caused by multiple factors and finding any factor related to this disorder can help on time prevention of this disease, which reduces the mortality of mothers and infants. Zinc deficiency is a possible risk factor for risky pregnancies and the results of studies on this subject are controversial. This study investigated the relationship between mothers' serum zinc and risky pregnancies.

METHODS

This was a case-control study on 48 normal pregnancies as controls and 48 preeclamptic pregnancies as case group. The women were studied in their third month of pregnancy. Simple random sampling was done based on inclusion and exclusion criteria. The two groups were matched in mothers' age, pregnancy age, number of childbirth, and socioeconomic status. Data were collected by blood sampling and a questionnaire. Serum zinc level was assessed by atomic absorption spectrometry method. Data were analyzed using SPSS Software.

RESULTS

The level of serum zinc in most women in both groups was under 50 mg/dl (62.5% in normal pregnancy group and 79.2% in preeclamptic group). There was no significant difference between the mean (SD) serum zinc concentration of the two groups (47.83 (12.72) for normal pregnancy and 43.66 (11.98) for preeclampsia). There was an association between serum zinc concentration and the severity of preeclampsia (p = 0.04, r = -0.12). We did not find any significant relation between serum zinc level and the following variables: mothers' age (p = 0.15, r = -0.11), pregnancy age (p = 0.07, r = -0.24), and parity (p = 0.02, r = -0.39).

CONCLUSIONS

The findings of this study showed that the assessment of serum zinc level does not have any clinical values for managing preeclampsia. However, based on the relationship between serum zinc concentration and the severity of preeclampsia in this study, we recommend assessment of serum zinc concentration as an index for predicting the severity of preeclampsia.