Der Gynäkologe

, Volume 41, Issue 6, pp 436–448 | Cite as

Lungenarterienembolie: Herztod in der Geburtsmedizin

  • K.J.G. Schmailzl
  • D. Glüsing
  • R. Grieg
  • R. Parsche
  • J. Schwuchow
Leitthema
  • 83 Downloads

Zusammenfassung

Die häufigste Ursache der Müttersterblichkeit (30–40%) in entwickelten Ländern ist die Lungenarterienembolie, eine „internistische“ und keine eigentlich geburtsmedizinische Erkrankung. Anamnese, D-Dimere, ggf. Echokardiographie und Computertomographie oder Magnetresonanztomographie sind die Schlüssel zu ihrer Diagnostik. Indikationen und Wertung der Befunde sind nicht selten komplex; die Diagnostik und Differenzialdiagnostik einer tiefen Bein- und Beckenvenenthrombose wie der Lungenarterienembolie – ihre wichtigste Komplikation – sollten interdisziplinär organisiert und in einem „clinical pathway“ konsentiert werden.

Schlüsselwörter

Lungenarterienembolie Beinvenenthrombose D-Dimere Echokardiographie Computertomographie 

Pulmonary embolism: cardiac death in pregnancy

Abstract

The most common cause of maternal death (30–40%) in developed countries is pulmonary embolism, an “internal” rather than an obstetric disease. Patient history, D-dimer results, echocardiography (when required), and computed tomography or magnetic resonance imaging provide the clues to its diagnosis. Indications and evaluation of findings are frequently complex. Diagnostics and differential diagnosis of deep vein thrombosis as well as pulmonary embolism – the most important complication – should be pursued using a multidisciplinary approach, and a consensus regarding clinical pathway should be reached.

Keywords

Pulmonary embolism Deep vein thrombosis D-dimer Echocardiography Computed tomography 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Tapson VF (2008) Acute pulmonary embolism. N Engl J Med 358: 1037–1052PubMedCrossRefGoogle Scholar
  2. 2.
    Heit JA, Kobbervig CE, James AH et al. (2005) Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 143: 697–706PubMedGoogle Scholar
  3. 3.
    Rosendaal FR, Helmerhorst FM, Vandenbroucke JP (2002) Female hormones and thrombosis. Arterioscler Thromb Vasc Biol 22: 201–210PubMedCrossRefGoogle Scholar
  4. 4.
    Grady D, Wenger NK, Herrington D et al. (2000) Postmenopausal hormone therapy increases risk for venous thromboembolic disease: the Heart and Estrogen/progestin Replacement Study. Ann Intern Med 132: 689–696PubMedGoogle Scholar
  5. 5.
    Hellgren M (2003) Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 29: 125–130PubMedCrossRefGoogle Scholar
  6. 6.
    Eichinger S, Weltermann A, Philipp K et al. (1999) Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden. Thromb Haemost 82: 1232–1236PubMedGoogle Scholar
  7. 7.
    PIOPED Investigators (1990) Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 263: 2753–2759CrossRefGoogle Scholar
  8. 8.
    Lensing AWA, Prandoni P, Brandjes D (1989) Detection of deep-vein thrombosis by real-time-B-mode-ultrasonography. N Eng J Med 320: 342–345Google Scholar
  9. 9.
    Heijboer H, Büller HR, Lensing AWA et al. (1993) A comparison of real-time compression ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients. N Engl J Med 329: 1365–1369PubMedCrossRefGoogle Scholar
  10. 10.
    Jäger K, Eichlisberger R, Frauchiger B (1993) Stellenwert der bildgebenden Sonographie für die Diagnostik der Venenthrombose. Hämostaseologie 13: 116–124Google Scholar
  11. 11.
    Weinmann EE, Salzmann EW (1994) Deep-vein thrombosis. N Engl J Med 331: 1630–1642PubMedCrossRefGoogle Scholar
  12. 12.
    Krüger S, Graf J, Kunz D et al. (2003) Brain natriuretic peptide zur Diagnose der Rechtsherzbelastung bei akuter Lungenembolie. Poster (P9) auf dem 44. Kongress der Deutschen Gesellschaft für Pneumologie, München 26.–29.3.2003Google Scholar
  13. 13.
    Bar J, Blickstein D, Hod M, Bar-Hava I (2000) Increased D-dimer levels in twin gestation. Thromb Res 98: 485–489PubMedCrossRefGoogle Scholar
  14. 14.
    Epiney M, Boehlen F, Boulvain M et al. (2005) D-dimer levels during delivery and the postpartum. J Thromb Haemost 3: 268–271PubMedCrossRefGoogle Scholar
  15. 15.
    Wells PS, Ginsberg JS, Anderson DR et al. (1998) Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 129: 997–1005PubMedGoogle Scholar
  16. 16.
    Wells PS, Anderson DR, Rodger M et al. (2001) Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med 135: 98–107PubMedGoogle Scholar
  17. 17.
    Brouwers EMJ, Wielopolski P, Beck EJR van et al. (2000) Contrast enhanced MR angiography for the diagnosis of pulmonary embolism – a comparison with conventional pulmonary angiography. Proc Intl Soc Mag Reson Med 8: 73Google Scholar
  18. 18.
    Meaney JFM, Weg JG, Chenevert TL et al. (1997) Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 336: 1422–1427PubMedCrossRefGoogle Scholar
  19. 19.
    Stein PD, Fowler SE, Goodman LR et al. for the PIOPED II Investigators (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354: 2317–2327PubMedCrossRefGoogle Scholar
  20. 20.
    Roy P-M, Colombet I, Durieux P et al. (2005) Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ 331: 259PubMedCrossRefGoogle Scholar
  21. 21.
    Wood KE (2002) Major pulmonary embolism – Review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 121: 877–905PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • K.J.G. Schmailzl
    • 1
  • D. Glüsing
    • 1
  • R. Grieg
    • 2
  • R. Parsche
    • 2
  • J. Schwuchow
    • 3
  1. 1.Medizinische Klinik ARuppiner KlinikenFontanestadt Neuruppin/Mark BrandenburgDeutschland
  2. 2.Medizinische Klinik BRuppiner KlinikenFontanestadt Neuruppin/Mark BrandenburgDeutschland
  3. 3.Zentrum für bildgebende DiagnostikFontanestadt Neuruppin/Mark BrandenburgDeutschland

Personalised recommendations