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Disorders of Thrombosis and Hemostasis in Pregnancy : A Guide to Management.

By: Contributor(s): Material type: TextTextPublisher: Cham : Springer International Publishing AG, 2015Copyright date: ©2015Edition: 2nd edDescription: 1 online resource (433 pages)Content type:
  • text
Media type:
  • computer
Carrier type:
  • online resource
ISBN:
  • 9783319151205
Subject(s): Genre/Form: Additional physical formats: Print version:: Disorders of Thrombosis and Hemostasis in PregnancyDDC classification:
  • 618.364
LOC classification:
  • RC633-647
Online resources:
Contents:
Intro -- Preface to the Second Edition -- Contents -- Contributors -- 1: Hemostatic Changes in Normal Pregnancy -- 1.1 Introduction -- 1.2 Primary Hemostasis -- 1.2.1 Platelets -- 1.2.2 Von Willebrand Factor -- 1.2.3 Hematocrit -- 1.3 Coagulation System -- 1.3.1 Initiation of Coagulation -- 1.3.2 Overview of Coagulation and Its Regulation -- 1.3.3 Effect of Pregnancy on Coagulation Factors -- 1.4 Anticoagulant Pathways -- 1.4.1 Antithrombin -- 1.4.2 Protein C and Protein S -- 1.5 Fibrinolytic System -- 1.6 Measures of Coagulation -- 1.6.1 Measures of Primary Hemostasis -- 1.6.2 Standard Coagulation Tests -- 1.6.3 Global Assays of Coagulation -- 1.6.4 APC Resistance -- 1.7 Hemostasis in the Uteroplacental Circulation -- 1.8 Microparticles -- 1.9 Summary -- References -- 2: Anticoagulants and Antiplatelet Agents in Pregnancy -- 2.1 Introduction -- 2.2 Hemostatic Mechanism -- 2.3 Parenteral Anticoagulants -- 2.3.1 Unfractionated Heparin (UFH) -- 2.3.1.1 Pharmacokinetics of UFH -- 2.3.1.2 Safety and Efficacy of UFH in Pregnancy -- 2.3.1.3 Use in Lactation -- 2.3.2 Low-Molecular-Weight Heparins -- 2.3.2.1 Pharmacokinetics of LMWHs -- 2.3.2.2 Dosing and Monitoring of LMWHs During Pregnancy -- 2.3.2.3 Safety and Efficacy of LMWH in Pregnancy -- 2.3.2.4 Use in Breastfeeding -- 2.3.3 Fondaparinux -- 2.3.3.1 Pharmacokinetics of Fondaparinux -- 2.3.3.2 Use in Pregnancy -- 2.3.3.3 Use in Breastfeeding -- 2.3.3.4 Other Non-hemorrhagic Side-Effects -- 2.3.4 Heparin-Induced Thrombocytopenia -- 2.3.5 Effect of Heparin on Bone Turnover -- 2.3.6 Danaparoid Sodium -- 2.3.6.1 Pharmacokinetics of Danaparoid -- 2.3.6.2 Efficacy and Safety in Pregnancy -- 2.3.6.3 Use in Breastfeeding -- 2.3.7 Lepirudin -- 2.3.8 Argatroban -- 2.3.9 Reversal of Anticoagulant Effect -- 2.4 Antiplatelet Agents -- 2.4.1 Aspirin.
2.4.1.1 Pharmacokinetics of Aspirin -- 2.4.1.2 Aspirin-Other Points for Consideration -- 2.4.1.3 Use in Pregnancy -- 2.4.1.4 Use in Breastfeeding -- 2.4.2 Clopidogrel -- 2.4.2.1 Pharmacokinetics of Clopidogrel -- 2.4.2.2 Use in Pregnancy -- 2.4.2.3 Lactation -- 2.4.3 Dipyridamole -- 2.4.3.1 Pharmacokinetics of Dipyridamole -- 2.4.3.2 Use in Pregnancy -- 2.4.3.3 Use in Breastfeeding -- 2.5 Oral Anticoagulants -- 2.5.1 Vitamin K Antagonists -- 2.5.1.1 Use in Pregnancy -- 2.5.1.2 Use in Breastfeeding -- 2.5.2 The New Oral Anticoagulant Agents -- 2.5.2.1 Direct Thrombin Inhibitors (DTI) -- 2.5.2.2 Use in Pregnancy -- 2.5.2.3 Use in Breastfeeding -- 2.5.2.4 Factor Xa Inhibitors -- 2.5.2.5 Use in Pregnancy -- 2.5.2.6 Use in Breastfeeding -- 2.6 Case Study -- References -- 3: Systemic Thromboembolism in Pregnancy: Heritable and Acquired Thrombophilias -- 3.1 Introduction -- 3.2 Heritable Thrombophilias Associated with an Increased Risk of Venous Thrombosis -- 3.2.1 Antithrombin Deficiency -- 3.2.2 Protein C Deficiency -- 3.2.3 Protein S Deficiency -- 3.2.4 F5G1691A (FVR506Q, Factor V Leiden) -- 3.2.5 F2G20210A -- 3.2.6 Other Candidate Heritable Thrombophilias -- 3.2.7 Antiphospholipid Syndrome (APS) -- 3.3 Limitations of Laboratory Measurement and the Implications for Establishing a Causal Relationship and Developing Testing Strategies with Clinical Utility -- 3.4 Overview of Heritable Thrombophilia as It Relates to Pregnancy-Associated Venous Thrombosis -- 3.4.1 Treatment of Pregnancy-­Associated Venous Thrombosis -- 3.4.2 Prevention of Pregnancy-­Associated Venous Thrombosis -- 3.5 Overview of Heritable Thrombophilia as It Relates to Pregnancy Morbidity -- 3.5.1 Pregnancy Loss -- 3.5.2 Preeclampsia and Intrauterine Growth Restriction -- 3.5.3 Recommendations -- 3.6 Purpura Fulminans in the Newborn -- References.
4: Systemic Thromboembolism in Pregnancy: Thromboprophylaxis -- 4.1 Introduction -- 4.2 Assessment of Thromboembolic Risk -- 4.2.1 Thrombophilia: Heritable -- 4.2.1.1 Factor V Leiden and Prothrombin G20210A -- 4.2.1.2 Antithrombin, Protein C, and Protein S Deficiencies -- 4.2.1.3 MTHFR -- 4.2.2 Thrombophilia: Antiphospholipid Syndrome -- 4.2.3 Previous Venous Thromboembolism -- 4.2.3.1 Recurrent VTE -- 4.2.3.2 Temporary Risk Factor- Associated VTE -- 4.2.3.3 Single Previous Estrogen Related -- 4.2.3.4 Single Previous Unprovoked -- 4.2.3.5 Thrombophilia Related -- 4.2.4 Obesity -- 4.2.5 Age -- 4.2.6 First-Trimester Events -- 4.2.7 Mode of Delivery -- 4.2.8 Immobility -- 4.2.9 Hospital Admission -- 4.3 Thromboprophylaxis -- 4.3.1 Efficacy -- 4.3.2 Pharmacological Agents -- 4.3.2.1 Low-Molecular-Weight Heparins (LMWHs) -- 4.3.2.2 Unfractionated Heparin -- 4.3.2.3 Danaparoid -- 4.3.2.4 Fondaparinux -- 4.3.2.5 Low Dose Aspirin -- 4.3.2.6 Warfarin -- 4.3.2.7 Dextran -- 4.3.2.8 Oral Thrombin and Xa Inhibitors -- 4.3.3 Contraindications to Pharmacological Thromboprophylaxis -- 4.3.4 Graduated Compression Stockings -- 4.3.5 Monitoring -- 4.3.6 Timing -- 4.3.7 Duration -- 4.4 Management in Specific Situations -- 4.4.1 Thrombophilia -- 4.4.1.1 Antithrombin Deficiency -- 4.4.1.2 Antiphospholipid Syndrome -- 4.4.2 Previous VTE -- 4.4.2.1 Thrombophilia Testing -- 4.4.3 Obesity -- 4.4.4 Mode of Delivery -- 4.4.5 Thromboprophylaxis at Delivery -- 4.5 Case Studies -- References -- 5: Systemic Thromboembolism in Pregnancy: Venous Thromboembolism -- 5.1 Introduction -- 5.2 Epidemiology -- 5.3 Pathophysiology of Venous Thromboembolism -- 5.4 Diagnosis of Venous Thromboembolism -- 5.4.1 Diagnosis of Deep Venous Thrombosis -- 5.4.2 Diagnosis of Pulmonary Embolism.
5.4.2.1 Lung Imaging in Pregnancy and the Puerperium and Associated Radiation Risks -- 5.4.2.2 Lung Imaging in Pregnant Patients: Practice and Counseling Points -- 5.4.3 Diagnosis of Cerebral Vein and Venous Sinus Thrombosis -- 5.4.4 D-dimer -- 5.5 Management of Acute Venous Thromboembolism -- 5.5.1 Pharmacological Therapies: The Options in Patients with Acute Venous Thromboembolism -- 5.5.1.1 Unfractionated Heparin -- 5.5.1.2 Low-Molecular-Weight Heparin -- 5.5.2 Baseline Blood Investigations Prior to Initiating Anticoagulant Therapy -- 5.5.3 Management During Pregnancy -- 5.5.3.1 Antithrombotic Treatment -- 5.5.3.2 Management of the Limb in Acute DVT -- 5.5.3.3 Inferior Vena Cava Filter -- 5.5.3.4 Specific Situations in Pregnant Women with VTE -- 5.6 Acute Massive PE in Pregnancy -- 5.7 Planning for Delivery -- 5.7.1 Spontaneous Labor -- 5.7.2 Elective Cesarean Section -- 5.7.3 Induction of Labor -- 5.7.4 Regional Anesthesia and Low-Molecular-Weight Heparin -- 5.8 Management After Delivery -- 5.9 Post-thrombotic Syndrome -- 5.10 Conclusions -- 5.11 Case Study -- References -- 6: Systemic Thromboembolism in Pregnancy: Cerebrovascular Disease -- 6.1 Introduction -- 6.2 Incidence of Stroke in Pregnancy -- 6.3 Diagnosis of Cerebrovascular Disorders in Pregnancy -- 6.4 Ischemic Stroke -- 6.4.1 Risk Factors for Ischemic Stroke in Pregnancy -- 6.4.2 Management of Ischemic Stroke in Pregnancy -- 6.4.2.1 Treatment of Acute Ischemic Stroke in Pregnancy -- 6.4.2.2 Secondary Prevention of Ischemic Stroke in Pregnancy -- 6.5 Ischemic Stroke in Specific Situations -- 6.5.1 Patent Foramen Ovale -- 6.5.2 Mechanical Heart Valves -- 6.5.3 Antiphospholipid Syndrome -- 6.5.3.1 Incidence of Stroke Associated with Antiphospholipid Antibodies -- 6.5.3.2 Risk of Recurrent Stroke Associated with Antiphospholipid Syndrome.
6.5.3.3 Management of Antiphospholipid Syndrome Related Stroke in Pregnancy -- 6.5.4 Thrombotic Microangiopathies -- 6.5.5 Heritable Thrombophilia -- 6.5.6 Sickle Cell Disease -- 6.5.7 Myeloproliferative Neoplasms -- 6.5.8 Paroxysmal Nocturnal Hemoglobinuria -- 6.5.9 Hyperhomocysteinemia -- 6.5.10 Ischemic Stroke in the Context of Pregnancy Complications -- 6.5.10.1 Pre-eclampsia and Eclampsia -- 6.5.10.2 Other Pregnancy Complications Associated with Stroke -- 6.6 Cerebral Venous and Sinus Thrombosis -- 6.6.1 Diagnosis of Cerebral Venous and Sinus Thrombosis in Pregnancy -- 6.6.2 Treatment of Cerebral Venous and Sinus Thrombosis in Pregnancy -- 6.7 Hemorrhagic Stroke -- 6.7.1 Risk of Hemorrhagic Stroke -- 6.7.2 Risk of Recurrent Hemorrhagic Stroke -- 6.7.3 Diagnosis of Hemorrhagic Stroke -- 6.7.4 Management of Hemorrhagic Stroke in Pregnancy -- 6.7.4.1 Arterio-venous Malformations -- 6.7.4.2 Subarachnoid Hemorrhage -- 6.7.4.3 Other Causes of CNS Bleeding -- 6.8 Conclusion -- 6.9 Case Study -- References -- 7: Pregnancy Morbidity Associated with Thrombophilias: Recurrent Miscarriage -- 7.1 Background -- 7.1.1 Recurrent Miscarriage: A Defect in the Hemostatic Response? -- 7.2 Antiphospholipid Syndrome -- 7.2.1 Introduction -- Box 7.1: Pregnancy Morbidity Associated with Antiphospholipid Syndrome -- 7.2.2 Prevalence -- 7.2.3 Outcome of Untreated Pregnancies -- 7.2.4 Mechanisms of aPL Pregnancy Loss -- 7.2.5 Management of Recurrent Miscarriage Associated with aPL -- 7.2.5.1 Treatment of Obstetric Antiphospholipid Syndrome -- Non-criteria Obstetric Antiphospholipid Syndrome -- 7.2.5.2 Neonatal Complications -- 7.2.6 Heritable Thrombophilias -- 7.3 Tests of Global Haemostasis and Coagulation Activation -- 7.3.1 Thrombin-Antithrombin Complexes -- 7.3.2 Activated Protein C Resistance -- 7.4 Thromboelastography.
7.5 Conclusions.
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Intro -- Preface to the Second Edition -- Contents -- Contributors -- 1: Hemostatic Changes in Normal Pregnancy -- 1.1 Introduction -- 1.2 Primary Hemostasis -- 1.2.1 Platelets -- 1.2.2 Von Willebrand Factor -- 1.2.3 Hematocrit -- 1.3 Coagulation System -- 1.3.1 Initiation of Coagulation -- 1.3.2 Overview of Coagulation and Its Regulation -- 1.3.3 Effect of Pregnancy on Coagulation Factors -- 1.4 Anticoagulant Pathways -- 1.4.1 Antithrombin -- 1.4.2 Protein C and Protein S -- 1.5 Fibrinolytic System -- 1.6 Measures of Coagulation -- 1.6.1 Measures of Primary Hemostasis -- 1.6.2 Standard Coagulation Tests -- 1.6.3 Global Assays of Coagulation -- 1.6.4 APC Resistance -- 1.7 Hemostasis in the Uteroplacental Circulation -- 1.8 Microparticles -- 1.9 Summary -- References -- 2: Anticoagulants and Antiplatelet Agents in Pregnancy -- 2.1 Introduction -- 2.2 Hemostatic Mechanism -- 2.3 Parenteral Anticoagulants -- 2.3.1 Unfractionated Heparin (UFH) -- 2.3.1.1 Pharmacokinetics of UFH -- 2.3.1.2 Safety and Efficacy of UFH in Pregnancy -- 2.3.1.3 Use in Lactation -- 2.3.2 Low-Molecular-Weight Heparins -- 2.3.2.1 Pharmacokinetics of LMWHs -- 2.3.2.2 Dosing and Monitoring of LMWHs During Pregnancy -- 2.3.2.3 Safety and Efficacy of LMWH in Pregnancy -- 2.3.2.4 Use in Breastfeeding -- 2.3.3 Fondaparinux -- 2.3.3.1 Pharmacokinetics of Fondaparinux -- 2.3.3.2 Use in Pregnancy -- 2.3.3.3 Use in Breastfeeding -- 2.3.3.4 Other Non-hemorrhagic Side-Effects -- 2.3.4 Heparin-Induced Thrombocytopenia -- 2.3.5 Effect of Heparin on Bone Turnover -- 2.3.6 Danaparoid Sodium -- 2.3.6.1 Pharmacokinetics of Danaparoid -- 2.3.6.2 Efficacy and Safety in Pregnancy -- 2.3.6.3 Use in Breastfeeding -- 2.3.7 Lepirudin -- 2.3.8 Argatroban -- 2.3.9 Reversal of Anticoagulant Effect -- 2.4 Antiplatelet Agents -- 2.4.1 Aspirin.

2.4.1.1 Pharmacokinetics of Aspirin -- 2.4.1.2 Aspirin-Other Points for Consideration -- 2.4.1.3 Use in Pregnancy -- 2.4.1.4 Use in Breastfeeding -- 2.4.2 Clopidogrel -- 2.4.2.1 Pharmacokinetics of Clopidogrel -- 2.4.2.2 Use in Pregnancy -- 2.4.2.3 Lactation -- 2.4.3 Dipyridamole -- 2.4.3.1 Pharmacokinetics of Dipyridamole -- 2.4.3.2 Use in Pregnancy -- 2.4.3.3 Use in Breastfeeding -- 2.5 Oral Anticoagulants -- 2.5.1 Vitamin K Antagonists -- 2.5.1.1 Use in Pregnancy -- 2.5.1.2 Use in Breastfeeding -- 2.5.2 The New Oral Anticoagulant Agents -- 2.5.2.1 Direct Thrombin Inhibitors (DTI) -- 2.5.2.2 Use in Pregnancy -- 2.5.2.3 Use in Breastfeeding -- 2.5.2.4 Factor Xa Inhibitors -- 2.5.2.5 Use in Pregnancy -- 2.5.2.6 Use in Breastfeeding -- 2.6 Case Study -- References -- 3: Systemic Thromboembolism in Pregnancy: Heritable and Acquired Thrombophilias -- 3.1 Introduction -- 3.2 Heritable Thrombophilias Associated with an Increased Risk of Venous Thrombosis -- 3.2.1 Antithrombin Deficiency -- 3.2.2 Protein C Deficiency -- 3.2.3 Protein S Deficiency -- 3.2.4 F5G1691A (FVR506Q, Factor V Leiden) -- 3.2.5 F2G20210A -- 3.2.6 Other Candidate Heritable Thrombophilias -- 3.2.7 Antiphospholipid Syndrome (APS) -- 3.3 Limitations of Laboratory Measurement and the Implications for Establishing a Causal Relationship and Developing Testing Strategies with Clinical Utility -- 3.4 Overview of Heritable Thrombophilia as It Relates to Pregnancy-Associated Venous Thrombosis -- 3.4.1 Treatment of Pregnancy-­Associated Venous Thrombosis -- 3.4.2 Prevention of Pregnancy-­Associated Venous Thrombosis -- 3.5 Overview of Heritable Thrombophilia as It Relates to Pregnancy Morbidity -- 3.5.1 Pregnancy Loss -- 3.5.2 Preeclampsia and Intrauterine Growth Restriction -- 3.5.3 Recommendations -- 3.6 Purpura Fulminans in the Newborn -- References.

4: Systemic Thromboembolism in Pregnancy: Thromboprophylaxis -- 4.1 Introduction -- 4.2 Assessment of Thromboembolic Risk -- 4.2.1 Thrombophilia: Heritable -- 4.2.1.1 Factor V Leiden and Prothrombin G20210A -- 4.2.1.2 Antithrombin, Protein C, and Protein S Deficiencies -- 4.2.1.3 MTHFR -- 4.2.2 Thrombophilia: Antiphospholipid Syndrome -- 4.2.3 Previous Venous Thromboembolism -- 4.2.3.1 Recurrent VTE -- 4.2.3.2 Temporary Risk Factor- Associated VTE -- 4.2.3.3 Single Previous Estrogen Related -- 4.2.3.4 Single Previous Unprovoked -- 4.2.3.5 Thrombophilia Related -- 4.2.4 Obesity -- 4.2.5 Age -- 4.2.6 First-Trimester Events -- 4.2.7 Mode of Delivery -- 4.2.8 Immobility -- 4.2.9 Hospital Admission -- 4.3 Thromboprophylaxis -- 4.3.1 Efficacy -- 4.3.2 Pharmacological Agents -- 4.3.2.1 Low-Molecular-Weight Heparins (LMWHs) -- 4.3.2.2 Unfractionated Heparin -- 4.3.2.3 Danaparoid -- 4.3.2.4 Fondaparinux -- 4.3.2.5 Low Dose Aspirin -- 4.3.2.6 Warfarin -- 4.3.2.7 Dextran -- 4.3.2.8 Oral Thrombin and Xa Inhibitors -- 4.3.3 Contraindications to Pharmacological Thromboprophylaxis -- 4.3.4 Graduated Compression Stockings -- 4.3.5 Monitoring -- 4.3.6 Timing -- 4.3.7 Duration -- 4.4 Management in Specific Situations -- 4.4.1 Thrombophilia -- 4.4.1.1 Antithrombin Deficiency -- 4.4.1.2 Antiphospholipid Syndrome -- 4.4.2 Previous VTE -- 4.4.2.1 Thrombophilia Testing -- 4.4.3 Obesity -- 4.4.4 Mode of Delivery -- 4.4.5 Thromboprophylaxis at Delivery -- 4.5 Case Studies -- References -- 5: Systemic Thromboembolism in Pregnancy: Venous Thromboembolism -- 5.1 Introduction -- 5.2 Epidemiology -- 5.3 Pathophysiology of Venous Thromboembolism -- 5.4 Diagnosis of Venous Thromboembolism -- 5.4.1 Diagnosis of Deep Venous Thrombosis -- 5.4.2 Diagnosis of Pulmonary Embolism.

5.4.2.1 Lung Imaging in Pregnancy and the Puerperium and Associated Radiation Risks -- 5.4.2.2 Lung Imaging in Pregnant Patients: Practice and Counseling Points -- 5.4.3 Diagnosis of Cerebral Vein and Venous Sinus Thrombosis -- 5.4.4 D-dimer -- 5.5 Management of Acute Venous Thromboembolism -- 5.5.1 Pharmacological Therapies: The Options in Patients with Acute Venous Thromboembolism -- 5.5.1.1 Unfractionated Heparin -- 5.5.1.2 Low-Molecular-Weight Heparin -- 5.5.2 Baseline Blood Investigations Prior to Initiating Anticoagulant Therapy -- 5.5.3 Management During Pregnancy -- 5.5.3.1 Antithrombotic Treatment -- 5.5.3.2 Management of the Limb in Acute DVT -- 5.5.3.3 Inferior Vena Cava Filter -- 5.5.3.4 Specific Situations in Pregnant Women with VTE -- 5.6 Acute Massive PE in Pregnancy -- 5.7 Planning for Delivery -- 5.7.1 Spontaneous Labor -- 5.7.2 Elective Cesarean Section -- 5.7.3 Induction of Labor -- 5.7.4 Regional Anesthesia and Low-Molecular-Weight Heparin -- 5.8 Management After Delivery -- 5.9 Post-thrombotic Syndrome -- 5.10 Conclusions -- 5.11 Case Study -- References -- 6: Systemic Thromboembolism in Pregnancy: Cerebrovascular Disease -- 6.1 Introduction -- 6.2 Incidence of Stroke in Pregnancy -- 6.3 Diagnosis of Cerebrovascular Disorders in Pregnancy -- 6.4 Ischemic Stroke -- 6.4.1 Risk Factors for Ischemic Stroke in Pregnancy -- 6.4.2 Management of Ischemic Stroke in Pregnancy -- 6.4.2.1 Treatment of Acute Ischemic Stroke in Pregnancy -- 6.4.2.2 Secondary Prevention of Ischemic Stroke in Pregnancy -- 6.5 Ischemic Stroke in Specific Situations -- 6.5.1 Patent Foramen Ovale -- 6.5.2 Mechanical Heart Valves -- 6.5.3 Antiphospholipid Syndrome -- 6.5.3.1 Incidence of Stroke Associated with Antiphospholipid Antibodies -- 6.5.3.2 Risk of Recurrent Stroke Associated with Antiphospholipid Syndrome.

6.5.3.3 Management of Antiphospholipid Syndrome Related Stroke in Pregnancy -- 6.5.4 Thrombotic Microangiopathies -- 6.5.5 Heritable Thrombophilia -- 6.5.6 Sickle Cell Disease -- 6.5.7 Myeloproliferative Neoplasms -- 6.5.8 Paroxysmal Nocturnal Hemoglobinuria -- 6.5.9 Hyperhomocysteinemia -- 6.5.10 Ischemic Stroke in the Context of Pregnancy Complications -- 6.5.10.1 Pre-eclampsia and Eclampsia -- 6.5.10.2 Other Pregnancy Complications Associated with Stroke -- 6.6 Cerebral Venous and Sinus Thrombosis -- 6.6.1 Diagnosis of Cerebral Venous and Sinus Thrombosis in Pregnancy -- 6.6.2 Treatment of Cerebral Venous and Sinus Thrombosis in Pregnancy -- 6.7 Hemorrhagic Stroke -- 6.7.1 Risk of Hemorrhagic Stroke -- 6.7.2 Risk of Recurrent Hemorrhagic Stroke -- 6.7.3 Diagnosis of Hemorrhagic Stroke -- 6.7.4 Management of Hemorrhagic Stroke in Pregnancy -- 6.7.4.1 Arterio-venous Malformations -- 6.7.4.2 Subarachnoid Hemorrhage -- 6.7.4.3 Other Causes of CNS Bleeding -- 6.8 Conclusion -- 6.9 Case Study -- References -- 7: Pregnancy Morbidity Associated with Thrombophilias: Recurrent Miscarriage -- 7.1 Background -- 7.1.1 Recurrent Miscarriage: A Defect in the Hemostatic Response? -- 7.2 Antiphospholipid Syndrome -- 7.2.1 Introduction -- Box 7.1: Pregnancy Morbidity Associated with Antiphospholipid Syndrome -- 7.2.2 Prevalence -- 7.2.3 Outcome of Untreated Pregnancies -- 7.2.4 Mechanisms of aPL Pregnancy Loss -- 7.2.5 Management of Recurrent Miscarriage Associated with aPL -- 7.2.5.1 Treatment of Obstetric Antiphospholipid Syndrome -- Non-criteria Obstetric Antiphospholipid Syndrome -- 7.2.5.2 Neonatal Complications -- 7.2.6 Heritable Thrombophilias -- 7.3 Tests of Global Haemostasis and Coagulation Activation -- 7.3.1 Thrombin-Antithrombin Complexes -- 7.3.2 Activated Protein C Resistance -- 7.4 Thromboelastography.

7.5 Conclusions.

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