Contemporary challenges in psychiatry.
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Biomedical subjects
Publications and source records attributed to J F Cade.
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Fourteen patients were treated with anticoagulants during 15 pregnancies. Eleven had venous thrombosis, three with pulmonary embolism; three had prosthetic heart valves; and one had mitral stenosis with pulmonary hypertension. All 15 were treated with heparin and 10 with warfarin. The mean duration of heparin therapy was 4.5 weeks and of warfarin 14 weeks. There were two minor episodes of recurrent thromboembolism and three minor haemorrhagic episodes during anticoagulant therapy. No fetal or neonatal complications occurred.There appears to be no ideal anticoagulant regimen for treating thromboembolic disease in pregnancy. A compromise approach based on experimental and clinical findings is suggested, which is considered to offer reasonable protection to the mother without undue risk to the fetus. This is heparin when an anticoagulant is indicated in the first trimester, after 37 weeks' gestation, and for the treatment of the initial thromboembolic episodes. Oral anticoagulants are used at other times when long-term anticoagulant therapy is indicated.
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The placental barrier to coagulation factors was assessed by measuring their levels in maternal venous and neonatal umbilical arterial and venous blood and was found to be largely complete. Detailed coagulation assessments in a large number of term and premature neonates showed that term neonates had a mild coagulation deficiency at birth. Premature neonates had a more definite deficiency, which became more severe with increasing prematurity. Mortality in low birth weight premature infants was associated with a severe coagulation deficiency, and was frequently due to cerebral haemorrhage. It is suggested that the coagulation system of low birth weight infants should be assessed to enable prophylactic treatment of those with a severe deficiency.
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