Can We Use Ondansetron In Pregnancy?

Can We Use Ondansetron In Pregnancy?

In this large cohort study of over 1.8 million pregnancies, first trimester ondansetron use was not associated with cardiac malformations or total congenital malformations. However, there was a small increased risk of oral clefts (3 additional cases per 10,000 women treated).

Forget the Blood Patch? A Medical Option That Works

Forget the Blood Patch? A Medical Option That Works

Administration of neostigmine and atropine vs placebo, in addition to usual care for post-dural puncture headache (PDPH), was highly effective in this RCT involving healthy postpartum women.

What Is a Normal Platelet Count In Pregnancy?

What Is a Normal Platelet Count In Pregnancy?

There is a normal drop in platelet count during pregnancy.  In the first trimester, the normal count is around 250,000 and decreases to about 225,000 at delivery.  Platelet counts <100,000 were rarely encountered in normal, uncomplicated pregnancies and should not generally be considered a physiologic change.

Acetaminophen 3rd Trimester and Ductal Closure

Acetaminophen 3rd Trimester and Ductal Closure

Acetaminophen use during late pregnancy was associated with premature ductus arteriosus closure in these two cases.

Better Medical Miscarriage Treatment

Better Medical Miscarriage Treatment

In women with confirmed first trimester pregnancy loss, the combination of mifepristone 200mg orally and misoprostol 800μg vaginally at 24 hours vs misoprostol 800μg alone resulted in improved complete expulsion at day 8 (NNT = 6) and decreased need for surgery: 9% vs 24%.

Low-Dose Perfusion or CTPA for PE in Pregnancy?

Low-Dose Perfusion or CTPA for PE in Pregnancy?

Low dose perfusion-only (LDQ) nuclear scan (the "Q" of the V/Q scan) or CTPA are the imaging studies of choice to diagnose PE in pregnant women.  LDQ (using one-third the normal technetium) had high accuracy and lower radiation dose and may be preferred over CTPA, assuming the CXR is normal.

Estrogen dose and progestogen type change PE risk

Short Attention Span Summary

Ingredients and dose matter in oral contraceptives.  Lower dose estrogen -  20 vs. 30-40 micrograms  - was safer, with lower risk for PE, stroke, and MI.  Regarding the progestogen, desogestrel and gestodene, compared to levonorgestrel, were associated with ~2x the risk of PE but not stroke or MI.  Why does this matter?  The first thing to know is that use of an oral contraceptive (OCP) is part of the PERC criteria.  And it's also important to know that all OCPs are not created equal.  Some have an even greater association with venous thromboembolism than others, and we need to know which ones.



Abstract

BMJ. 2016 May 10;353:i2002. doi: 10.1136/bmj.i2002.

Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study.

Weill A1, Dalichampt M2, Raguideau F3, Ricordeau P2, Blotière PO2,Rudant J2, Alla F2, Zureik M3.

Author information:

1Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France alain.weill@cnamts.fr.

2Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France.

3French National Agency for Medicines and Health Products Safety, Saint-Denis, France.

 

Abstract

OBJECTIVE:

 To assess the risk of pulmonary embolism, ischaemic stroke, and myocardial infarction associated with combined oral contraceptives according to dose of oestrogen (ethinylestradiol) and progestogen.

DESIGN:

 Observational cohort study.

SETTING:

 Data from the French national health insurance database linked with data from the French national hospital discharge database.

PARTICIPANTS:

 4 945 088 women aged 15-49 years, living in France, with at least one reimbursement for oral contraceptives and no previous hospital admission for cancer, pulmonary embolism, ischaemic stroke, or myocardial infarction, between July 2010 and September 2012.

MAIN OUTCOME MEASURES:

 Relative and absolute risks of first pulmonary embolism, ischaemic stroke, and myocardial infarction.

RESULTS:

 The cohort generated 5 443 916 women years of oral contraceptive use, and 3253 events were observed: 1800 pulmonary embolisms (33 per 100 000 women years), 1046 ischaemic strokes (19 per 100 000 women years), and 407 myocardial infarctions (7 per 100 000 women years). After adjustment for progestogen and risk factors, the relative risks for women using low dose oestrogen (20 µg v 30-40 µg) were 0.75 (95% confidence interval 0.67 to 0.85) for pulmonary embolism, 0.82 (0.70 to 0.96) for ischaemic stroke, and 0.56 (0.39 to 0.79) for myocardial infarction. After adjustment for oestrogen dose and risk factors, desogestrel and gestodene were associated with statistically significantly higher relative risks for pulmonary embolism (2.16, 1.93 to 2.41 and 1.63, 1.34 to 1.97, respectively) compared with levonorgestrel. Levonorgestrel combined with 20 µg oestrogen was associated with a statistically significantly lower risk than levonorgestrel with 30-40 µg oestrogen for each of the three serious adverse events.

CONCLUSIONS:

 For the same dose of oestrogen, desogestrel and gestodene were associated with statistically significantly higher risks of pulmonary embolism but not arterial thromboembolism compared with levonorgestrel. For the same type of progestogen, an oestrogen dose of 20 µg versus 30-40 µg was associated with lower risks of pulmonary embolism, ischaemic stroke, and myocardial infarction.

PMCID: PMC4862376 Free PMC Article

PMID: 27164970 [PubMed - in process]

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