| Popis: |
Pregnancy and puerperium are high-risk periods for deep venous thrombosis and pulmonary embolism. The main risk for venous thromboembolism in pregnancy is personal history, and thrombophilia is the second most important risk factor. Thrombophilia is a higher tendency to develop thrombosis, that may be due to acquired and/or inherited factors. The most common cause of acquired thrombophilia is antiphospholipid syndrome, and inherited thrombophilia includes factor V Leiden, G20210A mutation in the prothrombin gene, and deficiency of proteins C, S and antithrombin. During pregnancy, the majority of thrombotic episodes occurs in the deep veins of the lower limbs. Diagnostic imaging involves compression ultrasonography and magnetic resonance. Pulmonary embolism may complicate thrombosis, and for its investigation, computed tomography pulmonary angiography and ventilation/perfusion scintigraphy are options that generates less fetal radiation. Treatment of acute thromboembolism during pregnancy requires full anticoagulation, usually performed with low molecular weight or unfractionated heparin. Thromboembolism prevention during pregnancy can be performed pharmacologically (anticoagulation) or mechanically (intermittent pneumatic compression or graduated compression stockings). Low molecular weight heparin is the anticoagulant of choice in pregnancy, due to its superior safety profile. When indicated, pharmacological thromboprophylaxis should be maintained during the entire pregnancy. After delivery, treatment should be continued for at least six weeks. The delivery route in women undergoing anticoagulation is defined by obstetric conditions. |
