Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thrombosis of the internal jugular vein was associated with a severe syndrome of ovarian hyperstimulation. After in vitro fertilization, a twin pregnancy was obtained in a 31-year-old patient with severe endometriosis. On the day of follicle collection, plasma oestradiol was 3050 mg/ml. Ten ovocytes were collected and 3 embryos were implanted. A syndrome of severe ovarian hyperstimulation (ascites, pleural effusion) developed 3 weeks later and symptomatic treatment was given. Phlebitis of the upper left limb was diagnosed at 9 weeks amenorrhoea and echo-Doppler confirmed the diagnosis of subclavian and internal jugular venous thrombosis. Search for a cause was negative excepting a frank drop in protein S activity to 35%. Post-partum assay and assay in family members confirmed that the deficiency was acquired during pregnancy. The clinical course was favourable with anticoagulant therapy (heparin, then low-molecular weight heparin). Intra-uterine death of one of the fetuses occurred at 21 weeks amenorrhoea and a 2,550 g girl was born by vaginal delivery at 36 weeks. The Apgar score at birth was 10/10. In a review of the literature on vascular events in fertilization, programmes showed that severe syndromes of ovarian hyperstimulation, endogenous hyperestrogenism, multiple pregnancy and predominance of upper limb are the most frequently observed criteria. We emphasize the importance of preventing these thromboembolic events with subcutaneous heparin during the first trimester of pregnancy followed by low-molecular weight heparin, particularly in patients with a history of thromboembolism and/or patients with severe ovarian hyperstimulation.
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PMID:[Ovarian hyperstimulation syndrome and thrombosis. Apropos of a case of thrombosis of the internal jugular vein. Review of the literature]. 782 10

The prospective evaluation of the effect of thromboprophylaxis in women with one unexplained pregnancy loss from the 10th week of amenorrhea was performed. A total of 160 patients with heterozygous factor V Leiden mutation, prothrombin G20210A mutation, or protein S deficiency were given 5 mg folic acid daily before conception, to be continued during pregnancy, and low-dose aspirin 100 mg daily or low-molecular-weight heparin enoxaparin 40 mg was taken from the 8th week. Twenty-three of the 80 patients treated with low-dose aspirin and 69 of the 80 patients treated with enoxaparin had a healthy live birth (odds ratio [OR], 15.5; 95% confidence interval [CI], 7-34, P <.0001). Enoxaparin was superior to low-dose aspirin in each subgroup defined according to the underlying constitutional thrombophilic disorder. An associated protein Z deficiency and/or positive antiprotein Z antibodies were associated with poorer outcomes. The neonate weight was higher in the women successfully treated with enoxaparin, and neonates small for gestational age were more frequent in patients treated with low-dose aspirin. No significant side effects of the treatments could be evidenced in patients or newborns. As there is no argument to prove that low-dose aspirin may have been deleterious, these results support enoxaparin use during such at-risk pregnancies.
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PMID:Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. 1552 40