[Thromboembolic complications during pregnancy and delivery].

ABSTRACT

INTRODUCTION: Venous thromboembolism is one of the leading cause of maternal mortality worldwide. The incidence of venous thromboembolism is estimated at 0.76 to 1.72 per 100.000 pregnancies which is four times as great as the risk in nonpregnant women. The purpose of this article is to raise awareness of this frequent problem in pregnancy and provide a practical approach for the diagnosis, management, and prevention of venous thromboembolism during pregnancy and delivery. RISK FACTORS A number of risk factors for the development venous thromboembolism have been identified. The two most important risk factors for venous thromboembolism in pregnancy are thrombophilia and previous venous thromboembolism. Deep venous thrombosis in the majority of cases occurs in the lower extremities and pelvis. DIAGNOSIS As the clinical diagnosis of venous thromboembolism is unreliable, the women who are suspected of having deep venous thrombosis or pulmonary embolism should be examined promptly using imaging diagnostics. The first diagnostic method is Doppler ultrasound. Where available, individual authors recommend magnetic resonance venography, pulmonary angiography or computed tomography. THERAPY Unfractionated heparin or low-molecular-weight heparin has a central place in the prevention and treatment of venous thromboembolism in pregnancy because they do not pass through the placenta, thus avoiding the risks likely to be induced by warfarin. The prevention of venous thromboembolism must focus on the patients known to be at high risk bearing in mind that the recommendations for prophylaxis, even in high-risk patients, are based on the limited data.