Abstract Objectives Hospitalization during pregnancy and childbirth increases the risk of Venous Thromboembolism Risk (VTE). This study applied a VTE risk score to all hospitalized pregnant women to ascertain its effectiveness in preventing maternal death from VTE until 3 months after discharge. Methods In this interventional study, patients were classified as low- or high-risk according to the VTE risk score (Clinics Hospital risk score). High-risk patients (score ≥ 3) were scheduled for pharmacological Thromboprophylaxis (TPX). Interaction analysis of the main risk factors was performed using Odds Ratio (OR) and Poisson regression with robust variance. Results The data of 10694 cases (7212 patients) were analyzed; 1626 (15.2%, 1000 patients) and 9068 (84.8%, 6212 patients) cases were classified as high-risk (score ≥ 3) and low-risk (score < 3), respectively. The main risk factors (Odds Ratio, 95% Confidence Interval) for VTE were age ≥ 35 and < 40 years (1.6, 1.4-1.8), parity ≥ 3 (3.5, 3.0-4.0), age ≥ 40 years (4.8, 4.1-5.6), multiple pregnancies (2.1, 1.7-2.5), BMI ≥ 40 kg/m2 (5.1, 4.3-6.0), severe infection (4.1, 3.3-5.1), and cancer (12.3, 8.8-17.2). There were 10 cases of VTE: 7/1636 (0.4%) and 3/9068 (0.03%) in the high- and low-risk groups, respectively. No patient died of VTE. The intervention reduced the VTE risk by 87%; the number needed to treat was 3. Conclusions This VTE risk score was effective in preventing maternal deaths from VTE, with a low indication for TPX. Maternal age, multiparity, obesity, severe infections, multiple pregnancies, and cancer were the main risk factors for VTE.

OBJECTIVES: Hospitalized patients with cancer are at high risk of developing venous thromboembolism, and the risk increases with pregnancy. The aim of this study was to apply a thromboprophylaxis protocol with a venous thromboembolism risk score for hospitalized pregnant women with cancer and to evaluate the effects on maternal morbidity and mortality. METHODS: A longitudinal and prospective study was conducted from December 2014 to July 2016. The venous thromboembolism risk score was modified from the guidelines of the Royal College of Obstetricians and Gynaecologists. Patients were classified as low (score <3) or high risk (score ≥3). The high-risk group received thromboprophylaxis with low-molecular-weight heparin, unless the patient had a contraindication for anticoagulation. One patient could have undergone more than one evaluation. RESULTS: Fifty-two ratings were descriptively analyzed: 34 (65.4%) were classified as high risk, and 28/34 (82.3%) received low-molecular-weight heparin, 1 received unfractionated heparin, and 5 did not receive intervention. Most patients (23/52; 44.2%) had breast cancer. The main risk factors for venous thromboembolism in the high-risk group were chemotherapy (within 6 months; 22/34; 64.7%). No patient exhibited venous thromboembolism, adverse effects of anticoagulation or death up to three months after hospitalization. CONCLUSIONS: Most pregnant women with cancer had a high risk for venous thromboembolism at the time of hospitalization. Breast cancer was the most prevalent cancer, and recent chemotherapy was the main risk factor for anticoagulation. The application of a thromboprophylaxis protocol and determination of a venous thromboembolism risk score for these patients was useful for the prevention of maternal morbidity and mortality due to venous thromboembolism.

OBJETIVO: Descrever desfechos obstétricos e frequência de trombofilias em gestantes com óbito fetal de repetição após a 20a semana de gravidez. MÉTODOS: Avaliação de desfechos obstétricos em uma série de casos de gestantes com óbito fetal de repetição após a 20a semana de gestação, acompanhadas de 2001 a 2013. A atividade de antitrombina, atividade da proteína C e S, presença de fator V de Leiden, presença da mutação do gene de protrombina e presença de síndrome antifosfolípide foram avaliadas nessas pacientes. RESULTADOS: Foram incluídas 20 pacientes que tinham óbito fetal de repetição. Trombofilias foram encontradas em 11 delas, sendo 7 diagnosticadas como síndrome antifosfolípide, 3 como deficiência de proteína S e 1 como mutação do gene da protrombina. Todas foram tratadas com heparina subcutânea (heparina não fracionada ou enoxaparina) e 14 delas com ácido acetilsalicílico (AAS) durante toda a gestação. Complicações obstétricas ocorreram em 15 pacientes e incluíram: restrição de crescimento fetal intrauterino (25%), placenta prévia (15%), índice de líquido amniótico diminuído (25%), pré-eclâmpsia grave (10%), sofrimento fetal (5%) e óbito fetal (5%). A idade gestacional média do parto foi de 35,8±3,7 semanas e o peso dos recém-nascidos foi, em média, de 2.417,3±666,2 g. CONCLUSÃO: A pesquisa de trombofilias deve ser realizada em todas as gestantes com óbitos fetais de repetição após a 20a semana de gestação, como forma de identificar possíveis fatores causas passíveis de tratamento.

PURPOSE: To evaluate pregnancy outcome and thrombophilia frequency in women with recurrent fetal death. METHODS: Evaluation of obstetric outcomes in a retrospective cohort of pregnant women with recurrent stillbirth after the 20th week, from 2001 to 2013. Antithrombin activity, protein C and S activity, factor V Leiden, prothrombin gene mutation and antiphospholipid syndrome were analyzed. RESULTS: We included 20 patients who had recurrent fetal death. Thrombophilia were found in 11 of them, 7 diagnosed with antiphospholipid syndrome, 3 with protein S deficiency and 1 with prothrombin gene mutation. All of them were treated with subcutaneous heparin (unfractionated heparin or enoxaparina) and 14 of them with acetylsalicylic acid (AAS) during pregnancy. Obstetric complications occurred in 15 patients and included: intrauterine fetal growth restriction (25%), placenta previa (15%), reduced amniotic fluid index (25%), severe preeclampsia (10%), fetal distress (5%), and stillbirth (5%). The mean gestational age at delivery was 35.8±3.7 weeks and newborn weight averaged 2,417.3±666.2 g. CONCLUSION: Thrombophilia screening should be performed in all pregnant women with recurrent fetal death after the 20th week as a way to identify possible causal factors suitable for treatment.

A doença de Behçet (DB) é uma vasculite sistêmica com freqüente ocorrência de fenômenos trombóticos. Os autores relatam o caso de gestação de paciente com DB de difícil controle prévio e concomitante heterozigoze para o fator V, com história prévia de múltiplas erisipelas nos membros inferiores e história familiar de tromboembolismo. A gestação evoluiu com remissão da DB e foi usado heparina fracionada profilática. Os autores discutem os envolvimentos de fatores trombofílicos na gestação de pacientes com DB.

Behçet's disease (BD) is a systemic vasculitis in which thrombosis is a common clinical complication. We report a case of a pregnant woman with BD and the presence of heterozigous factor V, previous erisipela lesions and family history of thromboembolisms. Her BD evolved to remission during gestation, nevertheless, low molecular weight heparin was maintaned during pregnancy. In this report, we discuss the thrombophilic aspects in pregnant women with BD.

Objetivos: determinar a eficácia e a segurança do tratamento de gestantes com síndrome antifosfolípide com a heparina associada à aspirina em baixas doses, e determinar possíveis fatores agravantes da síndrome. Métodos: 17 pacientes portadoras da síndrome antifosfolípide foram submetidas a rigoroso acompanhamento pré-natal. A heparina foi utilizada na dose de 10.000 UI/dia e a aspirina na dose de 100 mg/dia. Foram analisados resultados perinatais e maternos, mediante a utilização do teste do chi² e do teste exato de Fischer. Resultados: o índice de recém-nascidos vivos foi de 88,2% nas gestações tratadas dessas pacientes contra 13,3% nas gestações prévias não-tratadas dessas mesmas pacientes. Foi alta a incidência de complicações gestacionais: oligoidrâmnio (40%), sofrimento fetal anteparto (33,3%), crescimento intra-uterino retardado (33,3%), diabetes mellitus gestacional (29,4%), pré-eclâmpsia (23,5%) e prematuridade (60%). A presença do lúpus eritematoso sistêmico foi indicação de mau prognóstico. Nenhum efeito colateral significativo foi observado durante o tratamento. Conclusões: o tratamento adotado se mostrou efetivo na obtenção de maior índice de recém-nascidos vivos, seguro, mas incapaz de impedir a alta incidência de complicações maternas e perinatais associadas à síndrome. O lúpus eritematoso sistêmico se mostrou um fator agravante da síndrome antifosfolípide.

Purpose: to determine the effectiveness and the safety of treatment with heparin and low-dose aspirin in pregnant women with antiphospholipid syndrome, and to determine possible deteriorating factors for this syndrome. Methods: 17 patients with antiphospholipid syndrome were submitted to a rigorous antenatal care. Patients were treated with a fixed dose of heparin (10,000 IU/day) associated with low-dose aspirin (100 mg/day). We analyzed perinatal and maternal results, using chi² test and Fischer's exact test. Results: the overall live birth rate was 88.2% in treated pregnancies of these patients versus 13.3% of their previous nontreated pregnancies. The incidence of adverse pregnancy outcomes was very significant: oligohydramnios (40%), fetal distress (33.3%), fetal growth retardation (33.3%), gestational diabetes (29.4%), preeclampsia(23.5%), and preterm delivery (60%). The presence of systemic lupus erythematosus was an indication of poor prognosis. No significant side effects were observed during the treatment. Conclusions: this treatment was effective to improve live birth rate, safe, but it was not able to avoid adverse pregnancy outcomes associated with antiphospholipid syndrome. Systemic lupus erythematosus was a deteriorating factor for this syndrome.