Venous thromboembolic disease during pregnancy
Diagnostic and therapeutic difficulties
Keywords:
VENOUS THROMBOEMBOLISM, PULMONARY EMBOLISM, PREGNANCY COMPLICATIONS
Abstract
Venous thromboembolism (VTE) is the main cause of maternal morbimortality, followed by hemorrhage. The thromboembolic disease accounts for 19.6 % of obstetric deaths. The study presents the clinical case of a 29 year old patient with a bad obstetric history, who, pregnant with her fourth child evidenced bilateral pulmonary embolism and subsequently lost her pregnancy. The cause of death could not be attributed to any of the thromboembolisms known until today, in spite of the high incidence (50%) of thromboembolic diseases in the pregnant population with venous thromboembolism.
References
(1) Chang J, Elam-Evans L, Berg C, Herndon J, Flowers L, Seed KA et al. Pregnancy-related mortality surveillance-United States, 1991-1999. MMWR Surveill Summ 2003; 52(2): 1-8.
(2) Rosemberg VA, Lockwood CJ. Thromboembolism in pregnancy. Obstet Gynecol Clin N Am 2007; 34(3): 481-500.
(3) Greer I. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999; 353(9160): 1258-65.
(4) Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359(19): 2025-33.
(5) Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999; 353(9159): 1167-73.
(6) Dentali F, Crowther M. Acquired thrombophilia during pregnancy. Obstet Gynecol Clin N Am 2006; 33(3): 375-88.
(7) Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143(10): 697-706.
(8) Galea DP, Formosa M, Brincat MP, Buhagiar L, Samuel A, Kunovski G. Extensive pulmonary embolism in late pregnancy associated with anticardiolipin antibodies. Malta Med J 2004; 16(2): 36-8.
(9) Chunilal SD, Bates SM. Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost 2009; 101(3): 428-38.
(10) Zotz RB, Gerhardt A, Scharf RE. Prediction, prevention and treatment of venous thromboembolic disease in pregnancy. Semin Thromb Hemost 2003; 29(2): 143-54.
(11) Nelson SM, Greer IA. Thrombophilia and the risk for venous thromboembolism during pregnancy, delivery, and puerperium. Obstet Gynecol Clin N Am 2006; 33(3): 413-27.
(12) Hughes GR, Kamashta MA. Seronegative antiphospholipid syndrome. Ann Rheum Dis 2003; 62(12): 1127.
(13) Kline JA, Williams, GW, Hernández-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005; 51(5): 825-9.
(14) Dresang LT, Fontaine P, Leeman L, King VJ. Venous thromboembolism during pregnancy. Am Fam Physician 2008; 77(12): 1709-16.
(15) Wong V, Cheng CH, Chan KC. Fetal and neonatal outcome of exposure to anticoagulants during pregnancy. Am J Med Genet 1993; 45(1): 17-21.
(2) Rosemberg VA, Lockwood CJ. Thromboembolism in pregnancy. Obstet Gynecol Clin N Am 2007; 34(3): 481-500.
(3) Greer I. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999; 353(9160): 1258-65.
(4) Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359(19): 2025-33.
(5) Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999; 353(9159): 1167-73.
(6) Dentali F, Crowther M. Acquired thrombophilia during pregnancy. Obstet Gynecol Clin N Am 2006; 33(3): 375-88.
(7) Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143(10): 697-706.
(8) Galea DP, Formosa M, Brincat MP, Buhagiar L, Samuel A, Kunovski G. Extensive pulmonary embolism in late pregnancy associated with anticardiolipin antibodies. Malta Med J 2004; 16(2): 36-8.
(9) Chunilal SD, Bates SM. Venous thromboembolism in pregnancy: diagnosis, management and prevention. Thromb Haemost 2009; 101(3): 428-38.
(10) Zotz RB, Gerhardt A, Scharf RE. Prediction, prevention and treatment of venous thromboembolic disease in pregnancy. Semin Thromb Hemost 2003; 29(2): 143-54.
(11) Nelson SM, Greer IA. Thrombophilia and the risk for venous thromboembolism during pregnancy, delivery, and puerperium. Obstet Gynecol Clin N Am 2006; 33(3): 413-27.
(12) Hughes GR, Kamashta MA. Seronegative antiphospholipid syndrome. Ann Rheum Dis 2003; 62(12): 1127.
(13) Kline JA, Williams, GW, Hernández-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005; 51(5): 825-9.
(14) Dresang LT, Fontaine P, Leeman L, King VJ. Venous thromboembolism during pregnancy. Am Fam Physician 2008; 77(12): 1709-16.
(15) Wong V, Cheng CH, Chan KC. Fetal and neonatal outcome of exposure to anticoagulants during pregnancy. Am J Med Genet 1993; 45(1): 17-21.
Published
2012-03-31
How to Cite
1.
Pérez G, Chiarella M, Cairoli E, Sosa L, Alonso J. Venous thromboembolic disease during pregnancy. Rev. Méd. Urug. [Internet]. 2012Mar.31 [cited 2024Nov.25];28(1):54-7. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/363
Section
Clinical Cases
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
