Gebelik ve Venöz Tromboembolizm

Gebelik sırasında ortaya çıkan venöz tromboembolizm VTE maternal mortalite ve morbiditeyi arttıran önemli ve önlenebilir bir durumdur. Gelişmiş ülkelerde gebeliğe bağlı venöz tromboemboli sonucu maternal mortalite oranı 100.000 gebelikte 0.4-1.6’dır. Gebelik sırasında derin ven trombozu DVT ya da pulmoner emboli riski yaklaşık % 0.1’dir ve bu oran aynı yaştaki gebe olmayan kadınlardan 3-4 kat daha yüksektir. Gebelik sırasında venöz tromboembolinin önlenmesi konusunda tek bir görüş birliği bulunmayıp farklı klinik senaryolar için belirtilmiş birçok kılavuz önerileri bulunmaktadır. Genel hatları ile değerlendirildiğinde, tüm hastalar gebelik ve postpartum dönemde her muayenede VTE riski açısından tekrar değerlendirilmeli ve dökümante edilmelidir.

Anahtar Kelimeler:

Gebelik, tromboprofilaksi, VTE

Pregnancy and Venous Thromboembolism

Venous thromboembolism VTE is a condition that can be occurred in the pregnancy period that causes increase in maternal mortality and morbidity. The incidence of mortality in developed countries for pregnancy related VTE is defined as 0,4-1,6 per 100.000 pregnancies. Deep vein thrombosis and pulmonary emboli risk during pregnancy is 0.1%. This ratio is 3-4 times higher than same age women in non pregnant population. There is no consensus about prophylaxis for venous thromboembolism in pregnancy. Several guidelines can be found for different scenarios. In general point of view, all patients at each visit during pregnancy and the postpartum period should be reassessed in terms of risk for VTE and findings should be documented.

Keywords:

Pregnancy, thromboprophylaxis, VTE,

PDF

___

Claire McLintock. Thromboembolism in pregnancy: Challenges and controversies in theprevention of pregnancy-associated venous throm- boembolism and management of anticoagulation in women with mec- hanical prosthetic heart valves. Best Practice & Research Clin Obstet Gynaecol 2014;28:519–536
Shannon M. Bates. Treatment and prophylaxis of venous thromboembo- lism during pregnancy. Thrombosis Research 2003;108:97– 106.
Kafkas S, Kadıköylü G. Gebelikve kalıtsal trombofili. ADÜ Tıp Fakültesi Dergisi 2005; 6:43 – 50.
Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the post- partum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 2008;6:632–637.
Mc Lintock C. Thromboembolism in pregnancy: Challenges and cont- roversies in the prevention of pregnancy-associated venous thrombo- embolism and management of anticoagulation in women with mechani- cal prosthetic heart valves. Best Prac Research Clinic Obstet Gynaecol 2014;28: 519–536.
Friedman AM, Ananth CV, Lu Y-S, D’Alton ME, Wright JD. Cesarean De- livery: Original Research Underuse of Postcesarean Thromboembolism Prophylaxis. Obstet Gynecol 2013;122:1197–204.
Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353:1258-65.
Hellgren M, Blomback M. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium: I, Normal condition. Gynecol Obstet Invest 1981;12:141-54.
Blanco-Molina A, Trujillo-Santos J, Criado J, et al. Venous thromboem- bolism during pregnancy or postpartum: findings from the RIETE Re- gistry. Thromb Haemost 2007;97:186–90.
Morgan ES, Wilson E, Watkins T, Gao F, Hunt BJ. Maternal obesity and venous thromboembolism. Int J Obstet Anesth 2012; 21:253–263.
Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-ba- sed case-control study. Am J Obstet Gynecol 2008;198:233.e1-233.e7.
Chest, Feb 2012;141, ACOG practice Bulletin No 123,2011.
Wu P, Poole TC, Pickett JA, Bhat A, Lees CC. Current obstetric gui- delines on thromboprophylaxis in the United Kingdom: evidence based medicine? Eur J Obstet Gynecol Reprod Biol2013;168:7–11.
Lussana F, Coppens M, Cattaneo M, Middeldorp S. Pregnancy-related venous thromboembolism: Risk and the effect of thromboprophylaxis. Thromb Res 2012;129:673–680.
Rose SAA, Manohar S. Thromboprophylaxis in obstetrics and gynaeco- logy. Apollo Medicine Vol. 3, No.1, March 2006
Amerikan Obstetrik ve Jinekoloji Derneği: Antifosfolipid sendromu. Pratik bülteni No. 68, Kasım 2005.
Lindqvist PG, Hellgren M. Obstetric Thromboprophylaxis: The Swedish Guidelines. Advances in Hematology Volume 2011, Article ID 157483, 6 pages.
Riskli Gebelikler Yönetim Rehberi http://sbu.saglik.gov.tr/Ekutuphane/ kitaplar/risgebyonreh.pdf (htp://sbu.saglik.gov.tr/Ekutuphane/kitaplar/ risgebyonreh.pdf)