Fahrettin TALAY, Zehra YAŞAR, Risk FAKTÖRLERİ

Gebelikte Tromboembolik Hastalıklara Tanısal Yaklaşım

Gebelik ve postpartum dönem venöz tromboemboli VTE için kanıtlanmış risk faktörüdür. Günümüzde pulmoner emboli PE gebelik ile ilişkili ölümlerin önemli nedenlerindendir ve anne ölümlerinin %20’sini oluşturmaktadır. Her 10 derin ven trombozundan DVT birinde PE geliştiği bilinmektedir. VTE tanısı semptomların ve bulguların gebeliğin beklenen fizyolojik değişiklikleriyle benzer olması nedeniyle oldukça zordur. Gebelikte VTE tanısının gecikmeden konması ve uygun tedavinin düzenlenmesi gebenin ve fetusun komplikasyonlardan korunması için hayati önem arzeder.Tanısal işlemler sırasında oluşabilecek radyasyon maruziyeti de doğru görüntüleme yönteminin uygulanmasının önemini göstermektedir. Bu derlemede gebede karşılaşabileceğimiz tromboembolik hastalıklara tanısal yaklaşım basamakları gözden geçirilmiştir.

Anahtar Kelimeler:

Gebelik, Tromboembolik Hastalıklar

The Management Of Tromboembolic Diseases In Pregnancy

Pregnancy and postpartum period are well-established risk factors for venous thromboembolism VTE . Currently pulmonary embolism PE is a leading cause of pregnancy related mortality and responsible for 20 percent of maternal deaths. PE is known to occur in one of every 10 deep vein thrombosis DVT . The clinical diagnosis of VTE is challenging because of the overlap of signs and symptoms between physiologic changes and development of PE or DVT. Accurate and early diagnosis is important in pregnancy to prevent fetus and pregnant from complications. And also accurate imaging is essential because of the anxieties relating to fetal radiation exposure during diagnostic procedures. In this review diagnostic algorithm of VTE discussed for accurate and reliable management in pregnancy.

Keywords:

Pregnancy, Thromboembolic Diseases,

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Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. The New England journal of medicine. 2008;359(19):2025-33.
Stone SE, Morris TA. Pulmonary embolism during and after pregnancy. Critical care medicine. 2005;33(10 Suppl):S294-300.
Pillny M, Sandmann W, Luther B, Muller BT, Tutschek B, Gerhardt A, et al. Deep venous thrombosis during pregnancy and after delivery: indications for and results of thrombectomy. Journal of vascular surgery. 2003;37(3):528-32.
Mac KAP, Berg CJ, Liu X, Duran C, Hoyert DL. Changes in pregnancy mortality ascertainment: United States, 1999-2005. Obstetrics and gynecology. 2011;118(1):104-10.
James AH, Abel DE, Brancazio LR. Anticoagulants in pregnancy. Obstetrical & gynecological survey. 2006;61(1):59-69; quiz 70-2.
Bremme KA. Haemostatic changes in pregnancy. Best practice & research Clinical haematology. 2003;16(2):153-68.
Sultan AA, Tata LJ, West J, Fiaschi L, Fleming KM, Nelson-Piercy C, et al. Risk factors for first venous thromboembolism around pregnancy: a population- based cohort study from the United Kingdom. Blood. 2013;121(19):3953-61.
Zotz RB, Gerhardt A, Scharf RE. Inherited thrombophilia
thromboembolism. Best practice & research Clinical haematology. 2003;16(2):243-59.
Friederich PW, Sanson BJ, Simioni P, Zanardi S, Huisman MV, Kindt I, et al. Frequency of pregnancy- related venous thromboembolism in anticoagulant factor-deficient
prophylaxis. Annals of internal medicine. 1996;125(12):955-60.
Branch DW, Silver RM, Blackwell JL, Reading JC, Scott JR. Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience. Obstetrics and gynecology. 1992;80(4):614-20.
Chan WS, Spencer FA, Ginsberg JS. Anatomic distribution of deep vein thrombosis in pregnancy. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2010;182(7):657-60.
Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, et al. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. American journal of respiratory and critical care medicine. 2011;184(10):1200-8.
Cutts BA, Tran HA, Merriman E, Nandurkar D, Soo G, DasGupta D, et al. The utility of the Wells clinical prediction model and ventilation-perfusion scanning for pulmonary embolism diagnosis in pregnancy. Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis. 2014;25(4):375-8.
Chan WS, Spencer FA, Lee AY, Chunilal S, Douketis JD, Rodger M, et al. Safety of withholding anticoagulation in pregnant women with suspected deep vein thrombosis following negative serial compression ultrasound and iliac vein imaging. CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne. 2013;185(4):E194-200.
Kovac M, Mikovic Z, Rakicevic L, Srzentic S, Mandic V, Djordjevic V, et al. The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. European journal of obstetrics, gynecology, and reproductive biology. 2010;148(1):27-30.
Polak JF, Wilkinson DL. Ultrasonographic diagnosis of symptomatic deep venous thrombosis in pregnancy. American journal of obstetrics and gynecology. 1991;165(3):625-9.
Kearon C, Ginsberg JS, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. 1998;129(12):1044-9.
Lohr JM, Kerr TM, Lutter KS, Cranley RD, Spirtoff K, Cranley JJ. Lower extremity calf thrombosis: to treat or not to treat? Journal of vascular surgery. 1991;14(5):618-23.
Carpenter JP, Holland GA, Baum RA, Owen RS, Carpenter JT, Cope C. Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography. Journal of vascular surgery. 1993;18(5):734-41.
Cahill AG, Stout MJ, Macones GA, Bhalla S. Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation- perfusion. 2009;114(1):124-9.
International Conference on Harmonisation; draft guidance on E2F Development Safety Update Report; availability. Notice. Federal register. 2008;73(151):45462-3.
Hughes JS, Watson SJ, Jones AL, Oatway WB. Review of the radiation exposure of the UK population. Journal of radiological protection : official journal of the Society for Radiological Protection. 2005;25(4):493-6.
Cook JV, Kyriou J. Radiation from CT and perfusion scanning in pregnancy. BMJ (Clinical research ed). 2005;331(7512):350.
Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. 2000;21(16):1301-36.
Bourjeily G, Paidas M, Khalil H, Rosene-Montella K, Rodger M. Pulmonary embolism in pregnancy. Lancet. 2010;375(9713):500-12.
Chen MM, Coakley FV, Kaimal A, Laros RK, Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstetrics and gynecology. 2008;112(2 Pt 1):333-40.
Bourjeily G, Chalhoub M, Phornphutkul C, Alleyne TC, Woodfield CA, Chen KK. Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology. 2010;256(3):744-50.