11 results on '"Skeith, Leslie"'
Search Results
2. Understanding and Preventing Placenta-Mediated Pregnancy Complications.
- Author
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Skeith L, Blondon M, and Ní Áinle F
- Subjects
- Abruptio Placentae epidemiology, Adult, Antibodies, Antiphospholipid blood, Anticoagulants therapeutic use, Antiphospholipid Syndrome complications, Antiphospholipid Syndrome diagnosis, Antiphospholipid Syndrome drug therapy, Female, Fetal Growth Retardation epidemiology, Fetal Mortality trends, Humans, Placenta pathology, Platelet Aggregation Inhibitors therapeutic use, Pre-Eclampsia epidemiology, Pre-Eclampsia etiology, Pregnancy, Pregnancy Complications etiology, Pregnancy Complications physiopathology, Risk Factors, Thrombophilia complications, Thrombophilia diagnosis, Thrombophilia drug therapy, Aspirin therapeutic use, Heparin, Low-Molecular-Weight therapeutic use, Pre-Eclampsia prevention & control, Pregnancy Complications prevention & control
- Abstract
Placenta-mediated pregnancy complications are clinically important conditions and include preeclampsia, placental abruption, intrauterine growth restriction, and late fetal loss. Pathophysiology is complex, and may be linked to prothrombotic disorders such as antiphospholipid syndrome, whose understanding is still evolving. In this narrative review, we will present the latest evidence to better understand hemostatic mechanisms of preeclampsia, as well as in women with placenta-mediated pregnancy complications and inherited thrombophilia or antiphospholipid antibodies. Using four clinical scenarios, the mixed results of preventive efforts through the use of antithrombotic drugs (aspirin, heparin) will be discussed. We will also review knowledge gaps and ongoing research., Competing Interests: L.S.: Honoraria from Leo Pharma; research funding from CSL Behring. M.B: no conflicts of interest. F.N.A.: Research funding (paid via an IIS to the host university) from Bayer, Leo Pharma, and Actelion., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2020
- Full Text
- View/download PDF
3. Managing pregnancy-associated clinical emergencies in systemic lupus erythematosus: a case-based approach.
- Author
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Choi M, Butler E, Clarke A, Girard LP, Gibson P, and Skeith L
- Subjects
- Adult, Antibodies, Antiphospholipid blood, Emergency Medical Services, Female, HELLP Syndrome drug therapy, Humans, Lupus Erythematosus, Systemic drug therapy, Pregnancy Complications drug therapy, Purpura, Thrombotic Thrombocytopenic drug therapy, Thrombocytopenia, Anticoagulants therapeutic use, HELLP Syndrome diagnosis, Lupus Erythematosus, Systemic diagnosis, Pre-Eclampsia diagnosis, Pregnancy, Pregnancy Complications diagnosis, Purpura, Thrombotic Thrombocytopenic diagnosis
- Abstract
Introduction : Systemic lupus erythematosus (SLE)-related thrombocytopenia during pregnancy and the postpartum period have been associated with adverse pregnancy outcomes and perinatal complications. In this case report, we present two SLE patients with thrombocytopenia emergencies secondary to HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and thrombotic thrombocytopenic purpura (TTP). Areas covered : The first case involved a 26-year-old woman, G1P0 at 26 weeks gestation (GA), with high-titer antiphospholipid antibodies (aPL) (positive lupus anticoagulant, anti-beta 2 glycoprotein-1 (aβ2GP1), anti-cardiolipin) and non-criteria aPL to phosphatidylserine/prothrombin complex and anti-domain 1 β2GP1. This case highlights the risks associated with aPL in pregnancy, considers management issues relating to anticoagulation during pregnancy and highlights the importance of maintaining a high index of suspicion for diagnosis of HELLP in SLE patients. The second case was a 36-year-old female, G3P2 at 32 weeks GA, with class III lupus nephritis (LN) who developed severe pre-eclampsia, which included mild thrombocytopenia. This case illustrates the challenges in identifying and differentiating between three pregnancy emergencies that can be seen in SLE patients (pre-eclampsia, LN, and TTP) and presents the management of TTP in peripartum SLE. Expert opinion : These two cases remind us of the importance of timely diagnosis and management of thrombocytopenia in this population.
- Published
- 2020
- Full Text
- View/download PDF
4. The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study.
- Author
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Skeith L, Le Gal G, de Vries JIP, Middeldorp S, Goddijn M, Kaaja R, Gris JC, Martinelli I, Schleußner E, Petroff D, Langlois N, and Rodger MA
- Subjects
- Adult, Anticoagulants therapeutic use, Databases, Factual, Female, Heparin, Low-Molecular-Weight therapeutic use, Humans, Pregnancy, Retrospective Studies, Young Adult, Cesarean Section, Labor, Induced, Labor, Obstetric, Pregnancy Complications epidemiology
- Abstract
Background: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction)., Methods: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor., Results: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p = 0.01)., Conclusions: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.
- Published
- 2019
- Full Text
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5. Are Anti-β2 Glycoprotein 1 Antibodies Associated with Placenta-Mediated Pregnancy Complications? A Nested Case-Control Study.
- Author
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Skeith L, Abou-Nassar KE, Walker M, Ramsay T, Booth R, Wen SW, Smith GN, and Rodger MA
- Subjects
- Adult, Antiphospholipid Syndrome diagnosis, Canada epidemiology, Case-Control Studies, Female, Humans, Infant, Newborn, Infant, Small for Gestational Age, Placenta Diseases diagnosis, Pre-Eclampsia epidemiology, Pregnancy, Pregnancy Complications epidemiology, Pregnancy Outcome, beta 2-Glycoprotein I immunology, Antibodies, Antiphospholipid blood, Antiphospholipid Syndrome epidemiology, Placenta Diseases epidemiology, Pregnancy Complications blood
- Abstract
Background: While anti-β2 glycoprotein 1 (anti-β2GP1) antibody positivity is included in the diagnostic criteria for antiphospholipid syndrome (APS), the association between anti-β2GP1 and the obstetrical complications of APS has been inconsistently reported and remains unclear., Objective: We completed a case-control study nested within the Canadian Ottawa and Kingston (OaK) Birth Cohort to evaluate the association between anti-β2GP1 antibody positivity and placenta-mediated pregnancy complications., Study Design: Five hundred cases were randomly selected among pregnant women who experienced any of the following independently adjudicated placenta-mediated pregnancy complications: preeclampsia, placental abruption, late pregnancy loss (≥ 12 weeks' gestation), and birth of a small-for-gestational age (SGA) infant < 10th percentile. Five hundred pregnant women without any placenta-mediated pregnancy complications were selected as controls. Stored blood samples were analyzed for the presence of anti-β2GP1 antibodies by enzyme-linked immunosorbent assay., Results: Anti-β2GP1 immunoglobulin G (IgG) and/or immunoglobulin M (IgM) antibodies in titers ≥ 20 G/M units (> 99th percentile) were present in 24 of 497 (4.8%) of controls and 33 of 503 (6.6%) of cases. There was no significant difference between cases and controls for the composite outcome of any placenta-mediated pregnancy complications (odds ratio, 1.38, 95% confidence interval [CI], 0.8-2.37, p = 0.25)., Conclusion: Our results call into question the association between anti-β2GP1 antibodies and placenta-mediated pregnancy complications, with further research needed., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Published
- 2018
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6. Diagnosis and management of postpartum ovarian vein thrombosis.
- Author
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Bannow BTS and Skeith L
- Subjects
- Adult, Female, Humans, Pregnancy, Venous Thrombosis diagnosis, Ovary blood supply, Postpartum Period, Pregnancy Complications diagnostic imaging, Pregnancy Complications therapy, Tomography, X-Ray Computed, Venous Thrombosis diagnostic imaging, Venous Thrombosis therapy
- Abstract
Case Presentation: A 26-year-old woman experienced persistent fever (39.5°C), chills, and right-lower-quadrant tenderness 3 days after caesarean delivery. A computed tomography (CT) scan of the abdomen and pelvis with contrast revealed enlargement of her right ovarian vein with an associated intraluminal filling defect. What is the best treatment of this patient?, Competing Interests: Conflict-of-interest disclosure: B.T.S.B. declares no competing financial interests. L.S. has received research funding from CSL Behring and has received honoraria from Leo Pharma., (© 2016 by The American Society of Hematology. All rights reserved.)
- Published
- 2017
- Full Text
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7. Preventing venous thromboembolism during pregnancy and postpartum: crossing the threshold.
- Author
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Skeith L
- Subjects
- Female, Humans, Pregnancy, Heparin, Low-Molecular-Weight therapeutic use, Postpartum Period, Pregnancy Complications prevention & control, Thromboembolism prevention & control
- Abstract
When should a patient with a known thrombophilia or prior venous thromboembolism (VTE) receive low-molecular-weight heparin (LMWH) prophylaxis during pregnancy and/or the postpartum period? Accurately predicting thrombotic and bleeding risks and knowing what to do with this information is at the heart of decision-making in these challenging scenarios. This article will explore the concept of a risk threshold from clinician and patient perspectives and provide guidance for the use of antepartum and postpartum LMWH prophylaxis in women with a known thrombophilia or prior VTE. Advice for the management of LMWH prophylaxis use around labor and delivery is also reviewed., Competing Interests: Conflict-of-interest disclosure: The author has received research funding from CSL Behring and honoraria from Leo Pharma., (© 2016 by The American Society of Hematology. All rights reserved.)
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- 2017
- Full Text
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8. Hypercoagulability and Inflammatory Markers in a Case of Congenital Thrombotic Thrombocytopenic Purpura Complicated by Fetal Demise.
- Author
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Skeith, Leslie, Hurd, Kelle, Chaturvedi, Shruti, Chow, Lorraine, Nicholas, Joshua, Lee, Adrienne, Young, Daniel, Goodyear, Dawn, Soucie, Jennifer, Girard, Louis, Dufour, Antoine, and Agbani, Ejaife O.
- Subjects
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THROMBOTIC thrombocytopenic purpura , *PREGNANCY complications , *HYPERTENSION - Abstract
Background: Congenital thrombotic thrombocytopenic purpura (cTTP) is a rare disorder caused by an inherited genetic deficiency of ADAMTS13 and affects less than one per million individuals. Patients who are diagnosed with TTP during pregnancy are at increased risk of maternal and fetal complications including fetal demise. We present a case of a 32-year-old G3P0 (gravida 3, para 0) who presented at 20 weeks gestation with a new diagnosis of congenital TTP (cTTP) and fetal demise. Methods: We describe the pathophysiology of pregnancy complications in a patient with cTTP using platelet procoagulant membrane dynamics analysis and quantitative proteomic studies, compared to four pregnant patients with gestational hypertension, four pregnant patients with preeclampsia, and four healthy pregnant controls. Results: The cTTP patient had increased P-selectin, tissue factor expression, annexin-V binding on platelets and neutrophils, and localized thrombin generation, suggestive of hypercoagulability. Among 15 proteins that were upregulated, S100A8 and S100A9 were distinctly overexpressed. Conclusions: There is platelet-neutrophil activation and interaction, platelet hypercoagulability, and proinflammation in our case of cTTP with fetal demise. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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9. Guidance for the diagnosis of pulmonary embolism during pregnancy: Consensus and controversies.
- Author
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Wan, Tony, Skeith, Leslie, Karovitch, Alan, Rodger, Marc, and Le Gal, Grégoire
- Subjects
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PULMONARY embolism , *PREGNANCY complications , *PREGNANT women , *MATERNAL mortality , *DISEASE incidence , *DIAGNOSIS - Abstract
Pulmonary embolism (PE) is one of the leading causes of maternal mortality despite a low incidence of PE during pregnancy. Several challenges surround the diagnosis of PE in pregnant women and the existing clinical guidelines provide weak recommendations on selecting the appropriate investigations for suspected PE in pregnancy. The purpose of this narrative review is to compare and contrast the recommendations of current clinical guidelines and review the evidence underpinning the recommendations on the evaluation of suspected PE in pregnancy. Consensus and controversies, knowledge gaps and areas requiring further research will be highlighted. [ABSTRACT FROM AUTHOR]
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- 2017
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10. Pulmonary Complications of Pregnancy: Venous Thromboembolism.
- Author
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Skeith, Leslie and Rodger, Marc A.
- Subjects
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PREGNANCY , *THROMBOEMBOLISM , *HEPARIN , *PREGNANCY complications , *OBSTETRICAL emergencies - Abstract
Unique considerations are needed when diagnosing and treating venous thromboembolism (VTE) in women who are pregnant or postpartum. What are the risks to the fetus, such as drug exposure or the risk of radiation with diagnostic imaging? How does the physiology of pregnancy affect imaging techniques and anticoagulation management? How should anticoagulation be managed around labor and delivery? These questions highlight some of the important considerations needed when managing a pregnant patient with suspected or confirmed VTE. This review outlines what is known about the epidemiology, pathophysiology, clinical risk factors, diagnosis, and therapeutic management of VTE in pregnancy. We also review our preferred diagnostic and treatment algorithm for a pregnant patient with suspected or confirmed VTE. [ABSTRACT FROM AUTHOR]
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- 2017
- Full Text
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11. Anticoagulants to prevent recurrent placenta-mediated pregnancy complications: Is it time to put the needles away?
- Author
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Skeith, Leslie and Rodger, Marc
- Subjects
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PREECLAMPSIA prevention , *OBSTETRICS , *ANTICOAGULANTS , *PREGNANCY complications , *ABRUPTIO placentae , *ETIOLOGY of diseases , *MOLECULAR weights - Abstract
Placenta-mediated pregnancy complications, such as pre-eclampsia, placental abruption, birth of a small-for-gestational age infant and late pregnancy loss, are common and carry significant morbidity and mortality. The etiology of placenta-mediated pregnancy complications is likely multifactorial and may include abnormal coagulation activation of the maternal-fetal interface. The use of antepartum low-molecular-weight heparin (LMWH) prophylaxis to prevent recurrent placenta-mediated pregnancy complications has become common practice despite limited and conflicting evidence to support its use. This paper reviews the evidence, including recently published data from an individual patient level meta-analysis, which challenges the role of LMWH in preventing recurrent placenta-mediated pregnancy complications. Incorporating this recent evidence, we recommend against the use of LMWH to prevent recurrent placenta-mediated pregnancy complications in women with and without inherited thrombophilia. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
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