PMID- 25128485
OWN - NLM
STAT- MEDLINE
DCOM- 20150522
LR  - 20161125
IS  - 1532-3102 (Electronic)
IS  - 0143-4004 (Linking)
VI  - 35
IP  - 10
DP  - 2014 Oct
TI  - Unfractionated heparin and placental pathology in high-risk pregnancies: 
      secondary analysis of a pilot randomized controlled trial.
PG  - 816-23
LID - S0143-4004(14)00637-7 [pii]
LID - 10.1016/j.placenta.2014.07.010 [doi]
AB  - INTRODUCTION: Heparin is often prescribed during pregnancy with the intention of 
      improving perinatal outcomes on the basis that it exerts an anticoagulant action 
      in the inter-villous space. Accumulating in-vitro and in-vivo evidence indicates 
      that heparin's beneficial effects in pregnancy may result from 
      'non-anticoagulant' effects including the promotion of angiogenesis. METHODS: To 
      study the effect of heparin within the placenta, we performed secondary analyses 
      on a pilot trial where 32 women with negative thrombophilia screens and 
      second-trimester evidence of placental insufficiency were randomized to standard 
      care or antenatal self-administration of unfractionated heparin (UFH) 7500 IU 
      twice-daily. Serial placental ultrasound images were reviewed and compared with 
      histo-pathologic findings following delivery. RESULTS: There were no differences 
      between the two arms in either the evolution of abnormal placental lesions on 
      ultrasound (p = 0.75) or evidence of maternal vascular under-perfusion on 
      histopathology (p = 0.89). In pregnancies considered at increased risk for 
      adverse pregnancy outcomes based on previous history or abnormal serum marker 
      screen, early (second-trimester) placental ultrasound, reflecting developmental 
      pathology had better test characteristics (sensitivity 77.8%; positive predictive 
      value 80.8%) for predicting adverse pregnancy outcomes than third-trimester 
      ultrasound that is reflective of placental thrombotic injury. CONCLUSIONS: 
      Administration of UFH did not prevent the development or evolution of abnormal 
      placental lesions on placental ultrasound or evidence of maternal vascular 
      underperfusion on placental histo-pathology. Second-trimester placental 
      ultrasound may be of value in predicting those at greatest risk of adverse 
      outcomes.
CI  - Crown Copyright (c) 2014. Published by Elsevier Ltd. All rights reserved.
FAU - D'Souza, R
AU  - D'Souza R
AD  - Departments of Obstetrics & Gynaecology, Mount Sinai Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Keating, S
AU  - Keating S
AD  - Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, 
      Toronto, ON, Canada.
FAU - Walker, M
AU  - Walker M
AD  - Departments of Obstetrics & Gynaecology, Mount Sinai Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Drewlo, S
AU  - Drewlo S
AD  - Departments of Obstetrics & Gynaecology, Mount Sinai Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Kingdom, J
AU  - Kingdom J
AD  - Departments of Obstetrics & Gynaecology, Mount Sinai Hospital, University of 
      Toronto, Toronto, ON, Canada. Electronic address: john.kingdom@utoronto.ca.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20140724
PL  - Netherlands
TA  - Placenta
JT  - Placenta
JID - 8006349
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Female
MH  - Heparin/pharmacology/*therapeutic use
MH  - Humans
MH  - Pilot Projects
MH  - Placenta/diagnostic imaging/*drug effects/*pathology
MH  - Placental Insufficiency/diagnostic imaging/*drug therapy/pathology
MH  - Pregnancy
MH  - Pregnancy Outcome
MH  - Pregnancy Trimester, Second
MH  - Pregnancy, High-Risk
MH  - Treatment Outcome
MH  - Ultrasonography, Prenatal
OTO - NOTNLM
OT  - Adverse pregnancy outcomes
OT  - Placental histopathology
OT  - Placental ultrasound
OT  - Pregnancy
OT  - Unfractionated heparin
EDAT- 2014/08/17 06:00
MHDA- 2015/05/23 06:00
CRDT- 2014/08/17 06:00
PHST- 2014/04/03 00:00 [received]
PHST- 2014/06/17 00:00 [revised]
PHST- 2014/07/15 00:00 [accepted]
PHST- 2014/08/17 06:00 [entrez]
PHST- 2014/08/17 06:00 [pubmed]
PHST- 2015/05/23 06:00 [medline]
AID - S0143-4004(14)00637-7 [pii]
AID - 10.1016/j.placenta.2014.07.010 [doi]
PST - ppublish
SO  - Placenta. 2014 Oct;35(10):816-23. doi: 10.1016/j.placenta.2014.07.010. Epub 2014 
      Jul 24.