Low Molecular Weight Heparin therapy during gestation: is it really innocent for both mother and fetus?

Abstract

The etiology of gastric perforation in newborn has not been described yet. It is a rare pathology and has been accepted mostly as spontaneously occurring. In this case report, we present a newborn who was admitted with hematemesis, hematochezia, abdominal distension and pneumoperitoneum at the abdominal x-ray. A gastric perforation was found at abdominal exploration. The symptoms, signs and our exploration findings support a strong possibility of association of low molecular weight heparin (LMWH) and the gastric perforation. LMWH treatment during the pregnancy may cause a massive gastric bleeding in baby so that gastric outlet obstruction with coagulum plug and perforation may occur secondarily.

Keywords

• newborn, low molecular weight heparin, gastric perforation

References

1. Soo AI, Gye-Yeo L, Hahn ST. Spontaneous gastric perforation in a neonate presenting with massive hydroperitoneum Pediatr Radiol 2005; 35:1212-14
2. Kawasey Y , Ishıı T, Arai H and Uga N. Gastrointestinal perforation in very low- birthweight infants Pediatrics International 2006; 48:599-603
3. Jawad AJ et al. Spontaneous neonatal gastric perforation Pediatric Surgery Int 2002; 18:396-99
4. Leone RJ, Krasna IH Spontaneous neonatal gastric perforation: Is it really spontaneous? Journal of Pediatric Surgery 2000; 35:1066-69
5. Carmen R, Tayyaba H, Milner et al. Efficacy and safety of once daily low molecular weight heparin (tinzaparin sodium) in high risk pregnancy. Blood Coagulation and Firinolysis 2008; 19: 689-92.
6. Deruellea P, Coulonb C. The use of low- molecular-weight heparins in pregnancy – how safe are they? Current Opininon in Obstetrics and Gynecology 2007; 19:573-77.
7. Maslovitz S, Many A, Landsberg JA et al. The safety of low molecular weight heparin therapy during labor. The Journal of Maternal- Fetal and Neonatal Medicine, 2005; 17:39-43
8. Grosfeld JL, Molinari F, Chaet M, Engum SA, West KW, Rescorla FJ, Scherer LR 3rd. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery 1996;120:650- 55

9. Pelizzo G, Dubois R, Lapillonne A, Laine X, Claris O, Bouvir R, Chappuis JP. Gastric necrosis in newborn: a report of 11 cases. Pediatr Surg Int 1998; 13:346-49.
10. Abadir J, Emil S, Nguyen N. Abdominal foregut yearexperience. JPediatr Surg 2005;40:1903- 07. inchildren: a10
11. Kara CS, Ilce Z, Celayir S, Sarimurat N, Erdogan E, Yeker D. Neonatal gastric perforation: review of 23 years'experience. SurgToday 2004;34:243-45. 12. Gauderer MW.Percutaneous
12. gastrostomy-20 years later: a historical
13. perspective. J Pediatr Surg. 2001;36:217-19.
14. Lyold JR: The etiology of gastrointestinal perforation in the newborn.J pediatr Surg 1969; 4:77-84
15. Lylod J, Espiasse E,Bernstein J: Etiology of gastrointestinal Harper Hosp Bull 1964; 22:224 in newborn. 15. Richard J Leone, Irwin H. Krasna. 'Spontaneous' neonatal gastric perforation: is it really spontaneous? J Pediatr Surg 2000; 35: 1066-69.
16. Miserez M,Barten S, Geboes K,et al:surgical thearpy and histological abnormalities in functional isolated small bowel obstruction and idiopathic gastrointestinal perforation in very low birth weight infant. World J Surg 2003;27:350-55 17. Shoerter N,Liu J ,Money D et al: İndomethacin- associated bowel perforation: A study of possible risk factors. J pediatr Surg 1999;34:442-44