Pulmonary thrombo-embolism in pregnancy: diagnosis and management

Abstract

Key pointsVenous thromboembolism (VTE) in pregnancy remains a leading cause of direct maternal mortality in the developed world and identifiable risk factors are increasing in incidence.VTE is approximately 10-times more common in the pregnant population (compared with non-pregnant women) with an incidence of 1 in 1000 and the highest risk in the postnatal period.If pulmonary imaging is required, ventilation perfusion scanning is usually the preferred initial test to detect pulmonary embolism within pregnancy. Treatment should be commenced on clinical suspicion and not be withheld until an objective diagnosis is obtained.The mainstay of treatment for pulmonary thromboembolism in pregnancy is anticoagulation with low molecular weight heparin for a minimum of 3 months in total duration and until at least 6 weeks postnatal. Low molecular weight heparin is safe, effective and has a low associated bleeding risk.Educational aimsTo inform readers about the current guidance for diagnosis and management of pulmonary thromboembolism in pregnancy.To highlight the risks of venous thromboembolism during pregnancy.To introduce the issues surrounding management of pulmonary thromboembolism around labour and delivery

Profilaxia de tromboembolismo venoso na gestação

“…This phenomenon can be attributed to the increased compression of the left common iliac vein by the right common iliac artery against the fifth lumbar vertebra, caused by the pregnant uterus. 6 The prevalence of VTE is 0.5 to 2.2 cases in every 1,000 births, depending on the population studied. 7,[11][12][13][14][15][16] The absolute incidence of VTE during pregnancy and the puerperium was 107 per 100,000 woman-years in the United Kingdom (UK) 17 and 175 per 100,000 woman-years in Denmark and Canada.…”

“…[3][4][5] Pregnant women have three of the etiopathogenic components of Virchow's triad: a) stasis, caused by compression of the vena cava and left common iliac by the pregnant uterus and by reduced venous tone resulting from the myorelaxant action of progesterone; b) hypercoagulability, secondary to induction of hepatic synthesis of coagulation factors VII, VIII, and X by placental estriol, increased levels of fibrinogen and plasminogen activator inhibitor types I and II, and reduced synthesis of protein S; c) endothelial injury, which occurs in implantation, endovascular remodeling of the uterine spiral arteries, and placental delivery. 6 The risk of VTE is five to 10 times greater during pregnancy and can be as much as 20 times greater during the puerperium, when compared with women of the same age who are not pregnant. [6][7][8] After this period, the frequency reduces rapidly, although there is a residual risk that lasts for up to 12 weeks after delivery.…”

“…6 The risk of VTE is five to 10 times greater during pregnancy and can be as much as 20 times greater during the puerperium, when compared with women of the same age who are not pregnant. [6][7][8] After this period, the frequency reduces rapidly, although there is a residual risk that lasts for up to 12 weeks after delivery. 9 Deep venous thrombosis (DVT) in lower limbs is responsible for 75 to 80% of VTE episodes during pregnancy.…”

“…9 Deep venous thrombosis (DVT) in lower limbs is responsible for 75 to 80% of VTE episodes during pregnancy. 6 Approximately two thirds of DVTs occur during the prenatal period and are equally distributed across the three trimesters. However, 43 to 60% of PE events occur during the first 6 weeks of the postpartum period.…”

A case of successful systemic thrombolysis in massive thromboembolia of pulmonary artery against the background of pregnancy

“…С момента зачатия возникает гиперкоагуляция, которая нормализуется спустя 6-8 нед. после родов [5]. На фоне вазодила-тирующего эффекта гормонов беременности, а также компрессии вен малого таза увеличенной беременной маткой происходят снижение скорости кровотока и венозный застой в системе нижней полой вены.…”