Anest. intenziv. Med. 2017;28(2):93-100

Deep vein thrombosis and pulmonary embolism in pregnancyAnestezie v gynekologii a porodnictví - Přehledový článek

J. Mannová^1,*, M. Penka², P. Štourač³

¹ Anesteziologicko resuscitační oddělení, Nemocnice Havlíčkův Brod

^1,2 Oddělení klinické hematologie, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity, Brno

³ Klinika dětské anesteziologie a resuscitace, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity, Brno

Pulmonary embolism (PE) is the leading cause of maternal mortality in the developed world. During gravidity the incidence of deep vein thrombosis (DVT) is five to seven times higher and can be increased by other risk factors. Despite concerns for foetal teratogenicity and oncogenicity and maternal risks associated with diagnostic testing, and potential adverse effects of pharmacological treatment, an accurate diagnosis of pulmonary embolism and a timely therapeutic intervention are crucial. Compression ultrasonography is a non-invasive test with high sensitivity for the diagnosis of symptomatic deep vein thrombosis. For the diagnosis of pulmonary embolism, D-Dimer testing has only limited diagnostic value in gravidity. V/Q scans are generally preferred because of lower radiation dose to the mother, on the other hand, CT pulmonary angiography is the first-line test to detect PE in the haemodynamically unstable pregnant women. Low-molecular-weight heparin is currently the therapy of choice for venous thromboembolism. Thrombolysis is reserved for massive life-threatening pulmonary embolism with haemodynamic compromise. The peripartum management of pulmonary embolism in pregnant women is always a great challenge for the multidisciplinary team. When venous thromboembolism (VTE) is diagnosed near term, consideration should be given to the placement of a retrievable inferior vena cava (IVC) filter. Reversal of anticoagulation without IVC filter protection is strongly discouraged in the 2-week period after VTE diagnosis. If the therapy of pulmonary embolism is started earlier, planned delivery with induction of labour or Caesarean Section at term with short-term discontinuation of low-molecular-weight heparin minimizes the risk of bleeding and permits neuroaxial anaesthesia / analgesia.

Keywords: pregnancy; venous thromboembolism; diagnosis; treatment; peripartum management

Received: November 21, 2016; Accepted: January 6, 2017; Published: April 1, 2017  Show citation