The Experts below are selected from a list of 54 Experts worldwide ranked by ideXlab platform
Hajnalka Olga Balint - One of the best experts on this subject based on the ideXlab platform.
-
pregnancy in women with a mechanical heart valve data of the european society of cardiology registry of pregnancy and cardiac disease ropac
Circulation, 2015Co-Authors: Iris M Van Hagen, Jolien W Rooshesselink, Titia P E Ruys, Waltraut M Merz, Sorel Goland, Harald Gabriel, Malgorzata Lelonek, Olga Trojnarska, Wael Al Mahmeed, Hajnalka Olga BalintAbstract:Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive Prepregnancy Counseling and centralization of care.
Iris M Van Hagen - One of the best experts on this subject based on the ideXlab platform.
-
pregnancy in women with a mechanical heart valve data of the european society of cardiology registry of pregnancy and cardiac disease ropac
Circulation, 2015Co-Authors: Iris M Van Hagen, Jolien W Rooshesselink, Titia P E Ruys, Waltraut M Merz, Sorel Goland, Harald Gabriel, Malgorzata Lelonek, Olga Trojnarska, Wael Al Mahmeed, Hajnalka Olga BalintAbstract:Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive Prepregnancy Counseling and centralization of care.
A H Bittles - One of the best experts on this subject based on the ideXlab platform.
-
changing profile of couples seeking genetic Counseling for consanguinity in australia
American Journal of Medical Genetics Part A, 2005Co-Authors: Katrina E Port, Helen Mountain, John Nelson, A H BittlesAbstract:Consanguineous marriage is rare in most Western countries and, for example, in the USA it may be subject to regulation by both civil legislation and religious proscription. This is not the case in many regions of Asia and Africa where marriage within the family is strongly favored. Since the 1970s there has been widespread migration to North America, Western Europe, and Australasia from communities which encourage consanguineous marriage. To assess the effect of this trend on a genetic Counseling program, the records of 302 couples referred to Genetic Services of Western Australia for consanguinity Counseling were abstracted for the period 1975-2001. Overall, a family history of genetic disease or a previously affected child was reported in 28.8% of cases. Premarital or Prepregnancy Counseling on grounds of consanguinity was sought by 41.0% of couples, and a further 18.2% of consanguineous couples had been referred because of a consanguineous pregnancy. In 7.6% of cases a relationship closer than first cousin was involved. Through time there was a significant increase in the numbers of consanguineous consultands, and their patterns of religious affiliation and ethnic origin widened markedly. Although effectively excluded from entry to Australia prior to 1975, couples of Asian origin accounted for 25.5% of all consanguineous consultands. With ongoing migration, changes in the ethnic profiles and the specific Counseling requirements of consanguineous couples can be expected to continue and probably accelerate.
Juno Obedin-maliver - One of the best experts on this subject based on the ideXlab platform.
-
Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals
Current Obstetrics and Gynecology Reports, 2020Co-Authors: Erica I. Martinez, Augustus Klein, Juno Obedin-maliverAbstract:The purpose of this narrative review is to expand routine Prepregnancy Counseling and anticipatory guidance to include people of all genders. Transgender, gender diverse, and non-binary (TGNB) individuals who were assigned female at birth may wish to parent, conceive, and carry a pregnancy, but are not included in guidelines for routine Prepregnancy Counseling. In addition to the topics covered in routine Prepregnancy Counseling, there are several unique considerations for Prepregnancy care for TGNB individuals including perinatal testosterone use, gender dysphoria and distress, chest/breastfeeding, and navigation of clinical environments. Research in the area of TGNB medical care continues to grow as the visibility of these communities increases. However, data are limited surrounding pregnancy and Prepregnancy-related care. Therefore, we present Prepregnancy medical, surgical, social, and practice of care considerations for TGNB populations in light of other known health and healthcare experiences of TGNB patients. We outline several clinical recommendations to support clinicians in providing inclusive Prepregnancy care. These recommendations aim to highlight the unique needs of TGNB individuals while recognizing that each patient’s experience and goals must be individualized to them.
Wael Al Mahmeed - One of the best experts on this subject based on the ideXlab platform.
-
pregnancy in women with a mechanical heart valve data of the european society of cardiology registry of pregnancy and cardiac disease ropac
Circulation, 2015Co-Authors: Iris M Van Hagen, Jolien W Rooshesselink, Titia P E Ruys, Waltraut M Merz, Sorel Goland, Harald Gabriel, Malgorzata Lelonek, Olga Trojnarska, Wael Al Mahmeed, Hajnalka Olga BalintAbstract:Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive Prepregnancy Counseling and centralization of care.