Maternal Warfarin Research Articles

Warfarin- and aspirin-associated fetal intracranial haemorrhage

Warfarin can cross the placental barrier and can cause perinatal intraventricular haemorrhage irrespective of maternal INR (international normalized ratio) level. The prevalence of perinatal intraventricular haemorrhage related to maternal warfarin is 4.6– 5.1% in autopsy studies of stillbirth. Previously reported cases of warfarin-associated fetal intracranial haemorrhage in pregnant women with a mechanical heart valve are shown in Table 1. This is a case report of a neonate who experienced perinatal intraventricular haemorrhage related to maternal warfarin.

Low-dose maternal warfarin intake resulting in fetal warfarin syndrome: In search for a safe anticoagulant regimen during pregnancy.

Fetal exposure to maternal ingestion of warfarin is known to produce certain dysmorphic features in the neonate, known as fetal warfarin syndrome (FWS). There is a general consensus that maternal intake of warfarin at a daily dose of 5 mg or less is safe both for the infant and the mother. We report four cases of FWS born to mothers with rheumatic heart disease on warfarin prophylaxis during pregnancy at a dose less than 5 mg/day. Along with typical facial features of FWS and multiple epiphyseal stippling in skeletal x-ray, Case 1 had Dandy-Walker malformation and Case 2 had laryngo-tracheomalacia and patent ductus arteriosus. We emphasize the need for optimizing the choice and dosage schedule of anticoagulants during pregnancy, least harmful for the mother and her developing fetus.

The effect of warfarin dosage on maternal and fetal outcomes in pregnant women with prosthetic heart valves.

There are several challenges in the management of pregnant women with mechanical heart valves. Pregnancy increases the risk of thromboembolism and there is currently no consensus on the safest anticoagulation method during pregnancy. The objective of the study was to determine the correlation between the warfarin dose and pregnancy outcome in pregnant women with prosthetic heart valves. Warfarin in pregnancy was associated with a low risk of valve thrombosis or maternal death. The risk for fetal abnormalities was not related to the maternal warfarin dosage. However, the risk for stillbirth was significantly increased with increasing doses of warfarin.

Foetal cerebral hemispheric atrophy and porencephaly after intrauterine exposure to maternal warfarin for mechanical prosthetic heart valve

Foetal cerebral hemispheric atrophy and porencephaly after intrauterine exposure to maternal warfarin for mechanical prosthetic heart valve

Optic Nerve Dysfunction in a Child Following Low-Dose Maternal Warfarin Exposure

Because the embryopathy associated with maternal warfarin use seems dose-dependent, some physicians advocate low-dose warfarin for pregnant women requiring anticoagulation. The current case, however, highlights that optic nerve dysfunction (as well as other signs of warfarin embryopathy) can occur after low-dose maternal warfarin exposure.

How we manage venous thromboembolism during pregnancy

During pregnancy, physiologic and anatomic changes can complicate the diagnosis of venous thromboembolism (VTE) as well as the management of patients with a high risk of or established VTE. As in nonpregnant subjects, clinical diagnosis of VTE by itself is unreliable and accurate objective testing is essential. Few diagnostic studies of VTE have been performed in pregnant women and, therefore, approaches are largely extrapolated from those used in nonpregnant subjects with modifications to limit the radiation exposure and overcome the limitations of diagnostic testing in pregnancy. Therapy of established VTE during pregnancy consists of therapeutic doses of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH), generally given throughout pregnancy subcutaneously and for 4 to 6 weeks after childbirth. A key unresolved issue includes the optimum dosing of LMWH therapy. Maternal warfarin can be safely used after childbirth because it is safe to use in the breast-fed infant of a mother receiving warfarin. Finally, pregnant women with prior VTE (with or without a hypercoagulable state) have an increased risk of recurrent venous thrombosis. A recent study has demonstrated that for women with a single episode of prior VTE, many can be managed without anticoagulants. However, for many, anticoagulant therapy with prophylactic UFH or LMWH is a reasonable option.

Fetal intracranial haemorrhage and maternal warfarin

Fetal intracranial haemorrhage and maternal warfarin

Chondrodysplasia punctata and maternal warfarin treatment.

A case of an infant with chondrodysplasia punctata born in December 1976 to a mother who had taken warfarin during the first trimester of pregnancy is reported. The mother was diagnosed as having thromboembolic pulmonary hypertension with a possible relationship to the oral contraceptives she had taken the preceding year. The oral contraceptives were discontinued. At 24 weeks gestation she was admitted to the hospital with a history of vaginal bleeding and she was taken off warfarin and given heparin. The baby was born at 29 weeks severely asphyxiated at birth. The infant was wasted with abnormal facies with pronounced nasal hypoplasia. Pronounced stippling of all epiphyses was shown by a radiograph of the infant on the 10th day. It is likely that the condition was a phenocopy of the genetic syndrome induced by the teratogenic effect of warfarin.

Relationship of maternal warfarin therapy in pregnancy to chondrodysplasia punctata: Report of a case

Relationship of maternal warfarin therapy in pregnancy to chondrodysplasia punctata: Report of a case