Planned induction versus spontaneous delivery among women using prophylactic anticoagulation therapy: a retrospective study.
Adult
Anticoagulants
/ administration & dosage
Delivery, Obstetric
/ statistics & numerical data
Female
Heparin, Low-Molecular-Weight
/ administration & dosage
Humans
Labor, Induced
/ adverse effects
Length of Stay
Pregnancy
Retrospective Studies
Time Factors
Venous Thromboembolism
/ prevention & control
Anticoagulation
induction
low-molecular weight heparin
outcomes
peripartum
thromboprophylaxis
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
accepted:
27
03
2020
pubmed:
14
4
2020
medline:
1
9
2020
entrez:
14
4
2020
Statut:
ppublish
Résumé
To examine the outcomes of planned induction of labour versus spontaneous onset of labour among women using prophylactic-dose low-molecular weight heparin (LMWH) therapy. Retrospective cohort study. University hospital. Women receiving antepartum prophylactic LMWH therapy undergoing a trial of vaginal delivery. Charts from 2018-2019 were reviewed. Duration of anticoagulation interruption and eligibility to receive neuraxial anaesthesia. Data from 199 women were analysed; 78 (39.2%) were admitted following spontaneous onset of labour and 121 (60.8%) underwent planned induction of labour. Compared to women who underwent planned induction of labour, women who presented with spontaneous onset of labour had a shorter median admission-to-delivery interval (4.7 versus 29.3 hours, P < 0.001). Similarly, intervals from the last LMWH injection to delivery (25.8 versus 48.2 hours, P < 0.001) and to the first postpartum LMWH injection (41.2 versus 63.7 hours, P < 0.001) were shorter. Among those with spontaneous onset of labour, 69 (88.5%) were eligible to receive neuraxial anaesthesia. Rates of postpartum haemorrhage and blood transfusion were similar between the groups. No thrombotic events were encountered in those with spontaneous onset of labour, but four (3.3%) women who delivered following induction of labour developed a postpartum thrombotic event. Planned induction of labour was associated with a higher risk of postpartum thrombotic events than was spontaneous onset of labour (4 of 121 [3.3%] versus 0 of 78 [0%]), presumably due to prolonged duration of anticoagulation interruption, although the difference was not statistically significant. Allowing spontaneous onset of labour was associated with comparable rates of bleeding complications, and only a low proportion (9 of 78, 11.5%) were not eligible to receive neuraxial anaesthesia. Planned induction among women using prophylactic LMWH therapy might increase the risk of thromboembolic complications.
Identifiants
pubmed: 32281735
doi: 10.1111/1471-0528.16247
doi:
Substances chimiques
Anticoagulants
0
Heparin, Low-Molecular-Weight
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1241-1248Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Royal College of Obstetricians and Gynaecologists.
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