Pulmonary embolism in pregnant women and women in childbirth

Siromaha, S.O.; Rusnak, A. O.; Lezhnenko, S.P.; Ogorodnyk, A.O.; Davydova, Iu.V.; Лазоришинец, В.В.

doi:10.15574/pp.2019.80.30

Cited by 2 publications

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“…Ключевые слова: беременность, сердечная патология, особенности диагностического алгоритма, стратификация риска. вих порушень гемостазу, сімейної форми леге невої артеріальної гіпертензії, патології коро нарних артерій, патології міокарда [15,18,19]. Сімейний анамнез визначали з урахуванням анамнезу трьох поколінь, і звертали увагу на аортальну чи іншу серцево судинну патологію, у тому числі раптову серцеву смерть у родичів, а також вивчали дані обстеження або поперед ніх медичних записів, у тому числі результати молекулярно генетичного тестування.…”

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“…За наявності пароксиз мальної форми порушень ритму серця або за наявності відповідних скарг, пацієнтці при значали холтер або подвійний моніторинг електрокардіографії. Білатеральна компресій на ультразвукова допплерографія -неінва зивний тест із чутливістю 97% та специфічні стю 94% для діагностики проксимального тромбозу глибоких вен -застосовували в пацієнток під час діагностування вірогідності тромбоемболії легеневої артерії [14,18]. Радіологічні методи візуалізації (рентгеноско пія, рентгенографія та ангіо КТ) мають обме ження при вагітності, проте використовували ся нами для підтвердження або виключення таких життєзагрозливих станів, як гостре роз шарування аорти, тромбоемболія легеневої артерії та гострий коронарний синдром.…”

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Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team

Сіромаха¹,

Davydova²,

Limanskaya³

et al. 2021

UJPP

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Features of diagnosis of the cardiovascular system in a pregnant or parturient woman affect the correct choice of strategy for their medical care. Examination of a woman with pathology of the heart and great vessels at the gravidity stage requires comprehensive support of the pregnancy heart team with the obligatory involvement of specialists in a particular pathology. The paper presents the vision of the National Team of Obstetric Cardiology and Cardiac Surgery for diagnostic algorithms for different types of cardiac pathology in pregnant women. The advantages of certain methods of examination of pregnant women with pathology of the heart and main vessels, as well as limitations and precautions performing certain instrumental imaging techniques during pregnancy are discussed. The specificity of diagnostics during pregnancy, presented in this paper, is based on current recommendations of the European Society of Cardiology, a few studies by individual authors and the own experience of members of a multidisciplinary team operating on the basis of two academic institutions — M.M. Amosov National Institute of Cardiovascular Surgery (ANICVS) and the Institute of Pediatrics, Obstetrics and Gynecology named by O.M. Lukyanova. The paper presents 7.5 years of experience in such cooperation. An expert screening examination of the cardiovascular system was performed on 2818 patients (4448 visits), 162 of whom required specialized examination and treatment at the ANICVS during the period from December 2013 to April 2021. Due developed and implemented diagnostic program both at the outpatient and inpatient stages of medical care for pregnant and parturient women with severe cardiac pathology, as well as coordinated and professional work of members of the multidisciplinary team, the survival rate in this complex group of patients was 97.3% among pregnant and parturient women and 93.3% among babies. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pregnancy, cardiac pathology, features of diagnostic algorithm, risk stratification.

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Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team

Сіромаха¹,

Davydova²,

Limanskaya³

et al. 2021

UJPP

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Features of disorders and methods of correction of the hemostasis system in women with antenatal fetal death

Benyuk,

Chebotarova,

Hychka

et al. 2023

RHW

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The improvement of the providing medical services quality to pregnant women remains an urgent issue in modern obstetrics. Women with perinatal losses deserve special attention, especially in the second half of pregnancy. Changes in the hemostasis system are an integral part of the development of pregnancy. The tendency to hypercoagulation has significant pathogenetic significance and can be the cause of a number of complications – miscarriage in the I trimester of pregnancy and preeclampsia, premature birth, antenatal fetal death (AFD) – in the II and III trimesters of pregnancy. Also, pregnancy is a background process for the activation of a number of diseases, in particular hereditary thrombophilia.The objective: to evaluate the changes in the hemostasis system in women with antenatal fetal death and the effectiveness of the use of low molecular weight heparins for the correction of disorders in the hemostasis system in this category of patients during childbirth and in the postpartum period.Materials and methods. 72 women were examined, including 42 pregnant women with AFD (main group) and 30 pregnant women with a physiological course of pregnancy, childbirth and the postpartum period (control group). The state of the hemostasis system was studied using a standard coagulogram. D-dimer was determined by immunoturbometric analysis.To assess the state of the hemostasis system, the following biochemical tests were used: procoagulant link – fibrinogen content and indicators: prothrombin index, activated partial thrombin time (APTT), thrombin time (TP), ancistrone time (AT), soluble fibrinogen-monomer complex (SFMC), factor X (FX); to evaluate the antithrombin system, the content of antithrombin-III (AT-III), protein C were determined; to characterize the state of the fibrinolytic system – the amount of plasminogen, α2-antiplasmin, fibrinogen degradation products (FDC).Thrombophilia markers and antiphospholipid antibodies were also determined. The preference was given to vaginal childbirth. During childbirth, mechanical compression of the lower limbs was applied using special compression stockings (compression level 2). In 12 hours after delivery thromboprophylaxis with low molecular weight heparins was started, the drug of choice being enoxaparin sodium. After 48 hours of the postpartum period, a comparative analysis of coagulogram indicators was performed to further determine the timing of thromboprophylaxis.Results. Analysis of family thrombotic anamnesis revealed risk factors in 12 (28.6%) patients of the main group. In close relatives of the first line, the presence of peripheral vein thrombosis was found – 5 (41.7%) cases, myocardial infarction under the age of 45 – 3 (25.0%) cases, pulmonary embolism – 1 (8.3%) case, transient ischemic attack of the brain – 3 (25.0%).In the control group only 2 (6.6%) patients had a family history of venous thromboembolism in first-line relatives. The analysis of the coagulation system shows significantly higher fibrinogen values (the main group – 5.3±0.2 g/l, the control group – 4.3±0.1 g/l; p<0.05), functional FX activity (the main group – 149.3±3.1%, control group – 107.3±2.7%; p<0.05), SFMC (main group – 15.9±1.2 μg/ml, control group – 7.8±0.9 μg/ml; p<0.05) and D-dimer (main group – 4.4±0.25 μg/ml, control group – 0.7±0.2 μg/ml; p< 0.05) in pregnant women of the main group. An increase in these indicators is a predictor of thrombus formation, activation of blood coagulation by the internal pathway with a decrease in the antithrombin reserve due to FX.During the correlation analysis, a strong direct relationship (r=0.8633) was established between the indicators of SFMC and FX in the blood serum of pregnant women of the main group, the combination of which determines the tendency to clot formation. Determination of markers for the most common types of thrombophilia shows the dominance of hereditary forms (prothrombin, Leiden mutation, MTHFR) in 43% of pregnant women of the main group.The implementation of the proposed treatment approach contributed to a significant decrease in the average concentration of fibrinogen 48 hours after delivery in postpartum women of the main group (main group: before delivery – 5.3±0.2 g/l, after 48 hours after delivery – 3.9±0.3 g/l; control group: 48 hours after delivery – 3.2±0.2 g/l; p<0.05) in combination with a synergistic decrease in the average indicators of SFMC (main group: before delivery – 15.9±1.2 μg/ml, 48 hours after delivery – 6.2±0.2 μg/ml; control group: 48 hours after delivery – 5.4±0.3 μg/ml; p<0.05) and FX (main group: before delivery – 149.3±3.1%, after 48 hours after delivery – 103.1±3.6%; control group: after 48 hours after delivery – 117.1±4.1%; p<0.05).Conclusions. Increased coagulation function was confirmed in pregnant women with antenatal fetal death (AFD). Thanks to the proposed method of correcting disorders in the hemostasis system, a decrease in the frequency of postpartum thromboembolism in women with AFD is achieved, as well as an improvement in the main indicators of the hemostasis system. This prevents the emergence of a chronic form of the syndrome of disseminated intravascular blood coagulation which is developed in the cases of AFD.

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Pulmonary embolism in pregnant women and women in childbirth

Cited by 2 publications

References 9 publications

Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team

Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team

Features of disorders and methods of correction of the hemostasis system in women with antenatal fetal death

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