PMID- 21689371
OWN - NLM
STAT- MEDLINE
DCOM- 20120203
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 9
IP  - 8
DP  - 2011 Aug
TI  - Unfractionated heparin for second trimester placental insufficiency: a pilot 
      randomized trial.
PG  - 1483-92
LID - 10.1111/j.1538-7836.2011.04407.x [doi]
AB  - OBJECTIVE: To conduct a pilot randomized controlled trial of unfractionated 
      heparin (UFH) in women considered at high risk of placental insufficiency in the 
      second trimester. METHODS: Women with either false-positive first trimester 
      (pregnancy-associated placental protein-A [PAPP-A] < 0.35 MoM) or second 
      trimester (alpha-fetoprotein [AFP] > 2.0 MoM, inhibin > 3.0 MoM, human chorionic 
      gonadotropin > 4.0 MoM) serum screening tests or medical/obstetric risk factors 
      were screened for placental insufficiency by sonographic evaluation of the 
      placenta and uterine artery Doppler between 18 and 22 weeks. Thrombophilia 
      screen-negative women with two or three abnormal test categories were randomized 
      by 23+6 weeks to self-administration of subcutaneous unfractionated heparin (UFH) 
      7500 IU twice daily until birth or 34 weeks, or to standard care. Maternal 
      anxiety and other maternal-infant outcomes were determined. RESULTS: Thirty-two 
      out of 41 eligible women consented, with 16 women randomized to UFH and 16 to 
      standard care. There was no statistically significant difference identified 
      between the two treatment groups (standard care vs. UFH) for the following: 
      maternal anxiety score (mean [standard deviation]), 14.2 [+/- 1.6] vs. 14.0 [+/- 
      1.8]; birth weight (median [range]), 1795 [470-3295]g vs. 1860 [730-3050]g; 
      perinatal death, 3 vs. 0; severe preeclampsia, 2 vs. 6; placental weight < 10th 
      percentile, 7 vs. 4; or placental infarction, 4 vs. 3. CONCLUSION: Our study 
      design identified women at high risk of adverse maternal-infant outcomes 
      attributable to placental insufficiency. Women with evidence of placental 
      insufficiency were willing to undergo randomization and self-administration of 
      UFH without increased maternal anxiety.
CI  - (c) 2011 International Society on Thrombosis and Haemostasis.
FAU - Kingdom, J C P
AU  - Kingdom JC
AD  - Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Mount 
      Sinai Hospital, Toronto, ON, Canada. jkingdom@mtsinai.on.ca
FAU - Walker, M
AU  - Walker M
FAU - Proctor, L K
AU  - Proctor LK
FAU - Keating, S
AU  - Keating S
FAU - Shah, P S
AU  - Shah PS
FAU - McLeod, A
AU  - McLeod A
FAU - Keunen, J
AU  - Keunen J
FAU - Windrim, R C
AU  - Windrim RC
FAU - Dodd, J M
AU  - Dodd JM
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*administration & dosage
MH  - Anxiety/etiology
MH  - Feasibility Studies
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Middle Aged
MH  - Ontario
MH  - Pilot Projects
MH  - Placental Insufficiency/diagnostic imaging/*drug therapy
MH  - Pregnancy
MH  - Pregnancy Outcome
MH  - Pregnancy Trimester, Second
MH  - Self Administration/psychology
MH  - Treatment Outcome
MH  - Ultrasonography, Doppler
MH  - Ultrasonography, Prenatal
EDAT- 2011/06/22 06:00
MHDA- 2012/02/04 06:00
CRDT- 2011/06/22 06:00
PHST- 2011/06/22 06:00 [entrez]
PHST- 2011/06/22 06:00 [pubmed]
PHST- 2012/02/04 06:00 [medline]
AID - S1538-7836(22)07057-X [pii]
AID - 10.1111/j.1538-7836.2011.04407.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2011 Aug;9(8):1483-92. doi: 10.1111/j.1538-7836.2011.04407.x.