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Background: The use of intravenous (IV) iron sucrose was approved for the obstetric and gynecologic (OBGYN) population at our mother–child teaching hospital in 2006 for intolerance or nonresponse to oral iron supplements, contraindication to intramuscular (IM) iron, and rapid increase of the hemoglobin desired in iron-deficient patients. Objectives: ( a) To describe the indications and doses of IV iron sucrose used in OBGYN, ( b) to assess monitoring, and ( c) to describe the adverse effect profile. Methods: A retrospective study of patients admitted to the OBGYN wards with at least one prescription of IV iron from January 1, 2006, to March 31, 2010, was conducted. A standardized data collection sheet was used to record data. Results: A total of 164 prescriptions of IV iron were reviewed in 128 women. The indications for IV iron were anemia before delivery (n = 76), intolerance or no response to oral iron (n = 61), or intolerance or contraindication to IM iron (n = 27). Fourteen doses (9%) were appropriate, and the others were too low. Prior to prescription, ferritin or serum iron levels were assessed in 31% of women and hemoglobin electrophoresis in nearly all of Black or Asian women. One-week follow-up hemoglobin levels were measured after 66 prescriptions (40.2%). Adverse effects, mostly pain at the injection site, were reported in 18 (11%) occasions. Conclusions: IV iron is prescribed in OBGYN patients to obtain a rapid hemoglobin increase or when oral iron is not tolerated or inefficacious. The dose prescribed is generally too low, baseline essential testing often omitted, and appropriate follow-up monitoring incomplete. IV iron is well tolerated.

Resume Notre travail visait a comparer le taux de macrosomie et la moyenne de poids de naissance (en percentile) de nouveau-nes de meres diabetiques de type 1 (DT1) traitees par pompe a insuline sous-cutanee (PSC) ou par multi-injections quotidiennes d’insuline (MIQ). Il s’agit d’une etude retrospective, incluant les grossesses mono-fœtales de patientes DT1, dont l’issue de grossesse est survenue a plus de 16 semaines de grossesse, au CHU Sainte-Justine (Montreal, Quebec, Canada), entre le 1 er janvier 2000 et le 31 janvier 2009. Au total, 14 grossesses sous PSC et 94 sous MIQ ont ete evaluees. L’HbA 1c aux 1 er , 2 e et 3 e trimestres de grossesse n’etait pas significativement differente entre les groupes PSC et MIQ. Le percentile des poids de naissance (92±11 versus 77 ± 26) et le taux de macrosomie (71,4% versus 42,6%, respectivement) etaient significativement plus eleves dans le groupe PSC ( p

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 3 - p. 281-286

Objectives To study the platelet function response to low-dose ASA with the Platelet Function Analyzer (PFA-100) in pregnant women and to identify maternal characteristics associated with non-responsiveness. Methods We conducted a prospective cohort study involving 87 pregnant women on ASA. The platelet function response to ASA was measured as the closure time obtained with epinephrine cartridges (CT-EPI) by the PFA-100. Non-response to ASA was defined as a CT-EPI ≤ 150 seconds after four weeks of therapy. Non-responders were given an escalating dose of ASA and their CT-EPI was tested again. Results After four weeks of enteric-coated ASA 81mg daily, 25/87 women (28.7%) were non-responders (95% CI 16.1 to 41.4). Among these women, a CT-EPI ≤ 150 seconds was found in 8/24 women (33.3%) after another four weeks of alternating ASA 81mg and 162mg daily. After a further four-week course of ASA 162mg daily, a CT-EPI ≤ 150 seconds was found in 3/6 women (50.0%). Among the women who initially responded and who were reassessed at 24–32 weeks of pregnancy, the CT-EPI was ≤ 150 seconds in 9/36 (25.0%). There was no statistical difference in maternal characteristics between ASA responders and non-responders. Conclusion A significant number of pregnant women showed a lack of platelet function response to ASA 81mg that was in most cases overcome with higher dosing. Furthermore, the prevalence of non-responsiveness increased with advancing pregnancy.

Background: Pancreatitis is an uncommon but well-described entity in pregnancy and labour, with most cases attributable to biliary disease. Preeclampsia is not an established cause of pancreatitis. Case: A 29-year-old woman with preeclampsia and adverse features at 33 weeks' gestation developed pancreatitis during her labour induction. Investigations ruled out known etiologies of pancreatitis. The woman was monitored clinically, biochemically, and radiologically, and underwent a Caesarean delivery of a healthy infant. Both the pancreatitis and preeclampsia resolved rapidly postpartum. Given her benign clinical picture, no specific therapeutic intervention was deemed necessary for the pancreatitis, and she was discharged 5 days postpartum. Conclusion: The clinical course and investigations of this woman suggest that preeclampsia should be considered as a cause of pancreatitis.

Objective: To compare the performance in screening for gestational carbohydrate intolerance of the 1-h 50-g glucose challenge test (GCT), fasting plasma glucose (FPG) and fasting capillary glucose (FCG). Design and methods: FPG and FCG were measured at the same time as the GCT in 188 women. Gestational carbohydrate intolerance was diagnosed according to the Canadian Diabetes Association criteria. We constructed receiver operator characteristic (ROC) curves and compared the sensitivity and specificity of the FPG, FCG and GCT. Results: Gestational diabetes was diagnosed in 11.2% women and gestational impaired glucose tolerance in 8.4%. The areas under the ROC curves for the FPG, the GCT and the FCG were not statistically different ( P = 0.26). The GCT yielded a better specificity than the FPG and the FCG for a comparable level of sensitivity. Conclusions: The GCT is better than the FPG in our population and is cost effective.

Considerable maternal and perinatal mortality and morbidity are associated with placental-mediated pregnancy complications. Preventative options are limited. Because thrombosis is frequently observed in the uteroplacental circulation of women with placental-mediated pregnancy complications, a number of studies have investigated anticoagulation therapy using unfractionated heparin or low-molecular-weight heparin as a preventative option. Most such studies were conducted in women with thrombophilia; the limited data available for women without thrombophilia are unconvincing. This pilot randomized controlled trial evaluated the effectiveness of dalteparin, a low-molecular-weight heparin, in preventing the recurrence of placental-mediated pregnancy complications in women without thrombophilia who are at high risk for these complications. A total of 114 pregnant women were randomized to receive dalteparin (study group, n = 57) or no dalteparin (control group, n = 57). Inclusion criteria at randomization were gestational age < 17 weeks, absence of thrombophilia, and occurrence in the immediate previous pregnancy of one or more of the following: severe preeclampsia, unexplained newborn weight ≤ the fifth percentile, abruptio placentae, or unexplained intrauterine death. Women in the study group received dalteparin for 23.0 ± 7.0 weeks. The primary outcome was a composite of one or more of the following: severe preeclampsia, newborn weight ≤ the fifth percentile or major abruptio placentae resulting in delivery before 34 weeks' gestation. Data were available for 110 women in the final analysis. The primary outcome occurred less frequently in the study group than the control group (5.5% [3 of 55] vs. 23.6% [13 of 55]); the adjusted odds ratio was 0.15, with a 95% confidence interval of 0.03―0.70). No statistically significant differences between the 2 groups were found for the secondary outcomes of nonsevere preeclampsia, birth weight between sixth and 10th percentile and gestational age at delivery. Neither heparin-induced thrombocytopenia nor hemorrhage was observed in the women receiving dalteparin. The findings in this pilot study show that the recurrence of placental-mediated complications in women without thrombophilia is reduced by prophylactic doses of dalteparin, but the results require confirmation in larger randomized trials.