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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 5/2021

01-05-2021 | Anticoagulant | Maternal-Fetal Medicine

Should pregnant women with anticoagulant prophylaxis benefit from scheduled delivery?

Authors: Florence Feucht, Pierre Richart, Nathalie Trillot, Louise Ghesquiere, Charles Garabedian, Damien Subtil

Published in: Archives of Gynecology and Obstetrics | Issue 5/2021

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Abstract

Purpose

When vaginal delivery is considered in women with low-molecular-weight heparin (LMWH) treatment, epidural analgesia is contraindicated for 12–24 h after the last injection. We evaluated the proportion of epidural analgesia depending on whether this is scheduled delivery (labor induction after stopping LMWH) or unscheduled delivery (stopping LMWH at labor onset).

Methods

Retrospective hospital study running from 2015 to 2017. Inclusion criteria for patients with LMWH treatment were: singleton pregnancy, gestational age ≥ 38 weeks of gestation and possible vaginal delivery. The primary endpoint was the epidural analgesia rate. Secondary endpoints included risks for caesarean section, deep vein thrombosis, and postpartum hemorrhage.

Results

Among 129 patients, 54 had scheduled delivery (41.9%). In practice, only 44 of them had labor induction (81.5%) and 54 of the 75 patients in the unscheduled delivery group had spontaneous delivery (72.0%). There was no significant difference in the rate of epidural analgesia between the "scheduled" and "unscheduled" groups (52/54 (96.3%) vs. 66/75 (88.0%) (p = 0.12)), and no difference in the secondary endpoints.

Conclusion

High access rates to epidural analgesia are observed in both scheduled and unscheduled deliveries. Scheduled delivery does not appear to be a really advantageous strategy for women with LMWH prophylaxis.
Literature
1.
2.
3.
Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M et al (2010) Rise in maternal mortality in the Netherlands. BJOG Int J Obstet Gynaecol. 117:399–406CrossRef
4.
Saucedo M, Deneux-Tharaux C, Bouvier-Colle M-H (2013) Maternal mortality in France, 2007–2009. J Gynecol Obstet Biol Reprod. 42:613–627CrossRef
5.
Greer IA (2006) Anticoagulants in pregnancy. J Thromb Thrombolysis. 21:57–65CrossRef
6.
Deruelle P, Coulon C (2007) The use of low-molecular-weight heparins in pregnancy–how safe are they? Curr Opin Obstet Gynecol. 19:573–577CrossRef
7.
Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA et al (2003) Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 28:172–197PubMed
8.
Gogarten W, Vandermeulen E, Van Aken H, Kozek S, Llau JV, Samama CM et al (2010) Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol. 27:999–1015CrossRef
9.
Collins J, Bowles L, MacCallum PK (2005) Prevention and management of venous thromboembolism in pregnancy. Br J Hosp Med Lond Engl 2016(120):S26-34
10.
Lindqvist PG, Bremme K, Hellgren M, for the Swedish Society of Obstetrics and Gynecology (SFOG) Working Group on Hemostatic Disorders (Hem-ARG) (2011) Efficacy of obstetric thromboprophylaxis and long-term risk of recurrence of venous thromboembolism. Acta Obstet Gynecol Scand. 90:648–653CrossRef
11.
Philippe A, Ruivard M, Auclair C, Accoceberry M, Bonnin M, Pouly J-L et al (2015) Anticoagulation and peripartum management. Gynecol Obstet Fertil. 71:322–329
12.
Roueli A, Cesario E, Amsellem J, Agman A, Vauthier-Brouzes D, Nizard J (2017) Is a therapeutic anticoagulation window needed for delivery when using prophylactic low molecular weight heparin during pregnancy? A retrospective monocentric study. Eur J Obstet Gynecol Reprod Biol. 215:118–123CrossRef
13.
Boulvain M, Marcoux S, Bureau M, Fortier M, Fraser W (2001) Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol. 15:131–138CrossRef
14.
Cammu H, Martens G, Ruyssinck G, Amy J-J (2002) Outcome after elective labor induction in nulliparous women: a matched cohort study. Am J Obstet Gynecol. 186:240–244CrossRef
15.
Grobman WA et al (2018) Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 379(6):513–523CrossRef
16.
Le Ray C, Carayol M, Bréart G, Goffinet F, PREMODA Study Group (2007) Elective induction of labor: failure to follow guidelines and risk of cesarean delivery. Acta Obstet Gynecol Scand. 86:657–665CrossRef
17.
Lepercq J, Conard J, Borel-Derlon A, Darmon JY, Boudignat O, Francoual C et al (2001) Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies. BJOG Int J Obstet Gynaecol. 108:1134–1140CrossRef
18.
Sanson BJ, Lensing AW, Prins MH, Ginsberg JS, Barkagan ZS, Lavenne-Pardonge E et al (1999) Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb Haemost. 81:668–672CrossRef
19.
20.
Bara L, Samama M (1988) Pharmacokinetics of low molecular weight heparins. Acta Chir Scand Suppl. 543:65PubMed
21.
Pabinger I, Grafenhofer H, Kaider A, Kyrle PA, Quehenberger P, Mannhalter C et al (2005) Risk of pregnancy-associated recurrent venous thromboembolism in women with a history of venous thrombosis. J Thromb Haemost JTH. 3:949–954CrossRef
22.
De Stefano V, Martinelli I, Rossi E, Battaglioli T, Za T, Mannuccio Mannucci P et al (2006) The risk of recurrent venous thromboembolism in pregnancy and puerperium without antithrombotic prophylaxis. Br J Haematol. 135:386–391CrossRef
23.
Henderson J, Redshaw M (2013) Women’s experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand. 92:1159–1167PubMed
24.
Bates SM et al (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2:3317–3359CrossRef
Metadata
Title
Should pregnant women with anticoagulant prophylaxis benefit from scheduled delivery?
Authors
Florence Feucht
Pierre Richart
Nathalie Trillot
Louise Ghesquiere
Charles Garabedian
Damien Subtil
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 5/2021
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-020-05850-6

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