Enfermedad tromboembólica venosa en el embarazo
Dificultades diagnósticas y terapéuticas
Palabras clave:
TROMBOEMBOLIA VENOSA, EMBOLIA PULMONAR, COMPLICACIONES DEL EMBARAZO
Resumen
La enfermedad tromboembólica venosa (ETEV) es la principal causa de morbimortalidad materna, seguida en segundo lugar por las hemorragias. La primera da cuenta de 19,6% de las muertes obstétricas. Presentamos el caso clínico de una paciente de 29 años con mala historia obstétrica, que cursando la cuarta gesta instala una embolia pulmonar bilateral seguida por la pérdida del embarazo. No se logró atribuir a ninguna de las trombofilias conocidas hasta el momento la responsabilidad de la misma, a pesar de la alta incidencia (50%) de trombofilias en la población embarazada con ETEV.
Citas
(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.
Publicado
2012-03-31
Cómo citar
1.
Pérez G, Chiarella M, Cairoli E, Sosa L, Alonso J. Enfermedad tromboembólica venosa en el embarazo. Rev. Méd. Urug. [Internet]. 31 de marzo de 2012 [citado 25 de noviembre de 2024];28(1):54-7. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/363
Sección
Casos Clínicos
