Anemia is common in fetuses exposed to warfarin as blood constantly seeps into the interstitial fluid or amniotic cavity. High doses of warfarin and heavy bleeding lead to abortion and stillbirth. Osteocalcin is another protein dependent on vitamin K for correct folding and function. Osteocalcin is normally secreted by osteoblast cells and plays a role in aiding correct bone mineralization and bone maturation. In the presence of warfarin and subsequent absence of vitamin K and active osteocalcin, bone mineralization and growth are stunted. Prevention
Fetal warfarin syndrome is prevented by withholding prescription to pregnant women or those trying to conceive. As warfarin can remain in the mothers body for up to five days, warfarin should not be administered in the days leading up to conception. Doctors must take care to ensure women of reproductive age are aware of the risks to the baby should they get pregnant, before prescribing warfarin. For some women, such as those with prosthetic heart valves, anticoagulation medication cannot be suspended during pregnancy as the risk of thrombus and emboli is too high. In such cases an alternate anticoagulant, which cannot pass through the placental barrier to the fetus, is proscribed in place of warfarin. Heparin is one such anticoagulant medication, although its efficacy in patients with prosthetic heart valves is not well established. New anticoagulant medications, which are efficacious and non-teratogenic such as ximelagatran continue to be developed.
Diversion colitis is an inflammation of the colon which can occur as a complication of ileostomy or colostomy, where symptoms may occur between one month and three years following surgery. It also occurs frequently in a neovagina created by colovaginoplasty, with varying delay after the original procedure. Despite the presence of a variable degree of inflammation the most suggestive histological feature remains the prominent lymphoid aggregates. Symptoms and signs
People may be asymptomatic but common symptoms are abdominal discomfort, anorectal pain, mucous discharge and rectal bleeding that develops from the inflamed mucosa of the distal, unused colon. Diagnosis
Diagnosis is aided by knowing the full clinical history. Treatment
In many milder cases after ileostomy or colostomy, diversion colitis is left untreated and disappears naturally. Possible pharmacologic treatments include short-chain fatty acid irrigation, steroid enemas and mesalazine. For surgical candidates, reanastomosis is a reversal procedure carried out to restore bowel continuity that effectively halts the symptoms of diversion colitis. == References ==