Clinics in obstetrics and gynaecology最新文献_第8页

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01 Epub Date: 2021-05-26 DOI: 10.1016/S0306-3356(21)00018-2

Peter W. Howie

{"title":"Anticoagulants in Pregnancy","authors":"Peter W. Howie","doi":"10.1016/S0306-3356(21)00018-2","DOIUrl":"https://doi.org/10.1016/S0306-3356(21)00018-2","url":null,"abstract":"<div><p>Thromboembolic disorders are still a serious problem in pregnancy and anticoagulants have an important part to play in both treatment and prevention.</p><p>Warfarin is the most convenient drug to give but can cause maternal and fetal bleeding problems, especially during late pregnancy and delivery. There are also small risks of embryopathy from warfarin in early pregnancy but these may have been overstated. Heparin, which has to be given parenterally, does not cross the placental barrier but can still cause bleeding problems in pregnancy. Full intravenous heparin is only suitable for short-term use, and subcutaneous heparin has been introduced for long-term therapy. This regimen is a useful advance but long-term use still has problems of bruising and maternal bone demineralization.</p><p>The standard treatment of acute thromboembolic events in pregnancy is continuous intravenous heparin followed by either subcutaneous heparin or warfarin, the latter being changed at 36 weeks gestation. In the prophylaxis of thromboembolism, the trend istowards a more selective approach, anticoagulants being given during pregnancy to those at highest risk and during labour and the puerperium to all with a previous history of thromboembolism. Anticoagulants during pregnancy are necessary in patients with artificial heart valves and, because subcutaneous heparin is not sufficient, warfarin should be used until 36 weeks followed by continuous intravenous heparin until delivery.</p><p>No method of anticoagulation during pregnancy is entirely free of risk and all management policies must be based on an estimate of risk-benefit ratio in individual patients.</p></div>","PeriodicalId":75719,"journal":{"name":"Clinics in obstetrics and gynaecology","volume":"13 2","pages":"Pages 349-363"},"PeriodicalIF":0.0,"publicationDate":"1986-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92032662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Index 指数

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01 Epub Date: 2021-05-26 DOI: 10.1016/S0306-3356(21)00022-4

引用次数: 0

Epilepsy in Pregnancy 妊娠期癫痫

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01 Epub Date: 2021-05-26 DOI: 10.1016/S0306-3356(21)00019-4

I.G. Robertson

引用次数: 0

The Fate of Drugs in Pregnancy 怀孕期间药物的命运

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01 Epub Date: 2021-05-26 DOI: 10.1016/S0306-3356(21)00005-4

J.C. Mucklow

{"title":"The Fate of Drugs in Pregnancy","authors":"J.C. Mucklow","doi":"10.1016/S0306-3356(21)00005-4","DOIUrl":"https://doi.org/10.1016/S0306-3356(21)00005-4","url":null,"abstract":"<div><p>The response of mother and fetus/neonate to drugs administered to the pregnant woman is determined largely by drug disposition and elimination within and between mother and fetus. Physiological changes occurring in pregnancy may result in reduced plasma protein binding, an increase in the apparent volume of distribution, and more rapid metabolic and renal clearance of certain drugs than are usually found in non-pregnant women. The consequences are relevant for the peak concentration of drug achieved after a single dose, the half-life of the drug, and the drug concentration to which the fetus is exposed via the placenta. Drugs whose dosage may need to be altered in pregnancy include most anticonvulsants, lithium, digoxin, certain beta-blockers, ampicillin and cefuroxime; for drugs which have not been specifically investigated, no generalizations are possible.</p><p>Very few drugs given in pregnancy fail to cross the placenta and, as a rule, drug molecules not bound to plasma protein diffuse along a concentration gradient to establish and maintain an equilibrium. Because movement of drug molecules is bidirectional, the placenta is the main portal of exit from, as well as entry to, the fetus. The pharmacological response of the fetus to drugs which it receives depends mainly on the unbound concentration of drug in fetal blood-unwanted effects seldom occur if the maternal dose is correct; exceptions include tetracycline, antithyroid drugs, coumarin anticoagulants, aspirin, indomethacin and cerebral depressant drugs (opiates, barbiturates and phenothiazines). The total (bound plus unbound) drug concentration on the fetal side of the placenta is usually lower than on the maternal side except where differences in blood pH and/or protein binding lead to 'trapping’ of drug in the fetus; the latter phenomenon may prove hazardous after birth because of the neonate's limited capacity to eliminate drugs by metabolism and excretion.</p></div>","PeriodicalId":75719,"journal":{"name":"Clinics in obstetrics and gynaecology","volume":"13 2","pages":"Pages 161-175"},"PeriodicalIF":0.0,"publicationDate":"1986-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92032655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adverse Effects of Drugs in the First Trimester of Pregnancy 妊娠早期药物的不良反应

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01 Epub Date: 2021-05-26 DOI: 10.1016/S0306-3356(21)00006-6

Linda Beeley

引用次数: 0

Prescribing for labour. 为分娩开处方。

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01

G M Stirrat, T A Thomas

引用次数: 0

The treatment of gastrointestinal disease in pregnancy. 妊娠期胃肠疾病的治疗。

Clinics in obstetrics and gynaecology Pub Date : 1986-06-01

R D Atlay, A R Weekes