Advertisement

Thromboembolische Komplikationen in Schwangerschaft und Wochenbett

  • U.H. Winkler

Zusammenfassung

Thromboembolische Erkrankungen gehören zu den häufigsten Ursachen mütterlicher Mortalität Tiefe Venenthrombosen treten in der Schwangerschaft etwa 4- bis 6-mal, im Wochenbett 20- bis 30-mal häufiger auf als bei nichtschwangeren Frauen. Immobilisation, Trauma, insbesondere operative Traumen, Dehydratation und Infektionen stellen auslösende Risikokonstellationen dar.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. American College of Obstetricians and Gynecologists (2000) Thromboembolism in pregnancy. ACOG Practice Bulletin No 19Google Scholar
  2. Arzneimittel-Schnellinformation des BfArM (1996) Dtsch Ärztebl 93: A 987Google Scholar
  3. Aschwanden M, Labs KH, Engel H, Schwob A, Jeanneret C, Mueller-Brandt J, Jaeger KA (2001) Acute deep vein thrombosis: Early mobilisation does not increase the frequency of pulmonary embolism. Thromb Haemost 85: 42–46PubMedGoogle Scholar
  4. Badaracco MAM, Vessey MP (1974) Recurrence of venous thromboembolism diasease and use of oral contraceptives. BMJ 1: 215–217PubMedCrossRefGoogle Scholar
  5. Barbour LA, Kick SD, Steiner JF et al. (1994) A prospective study of heparin-induced osteoporosis in pregnancy using bone densitometry. Am J Obstet Gynecol 170: 862–869PubMedGoogle Scholar
  6. Bauersachs RM, Lindhoff-Last E, Wollf U, Ehrly AM (1999) Aktuelles Management der tiefen Venenthrombose. Med Welt 49: 194–214Google Scholar
  7. Beller FK, Winkler UH (1990) Variköse und thromboembolische Komplikationen. In: Beller FK, Kyank H (Hrsg) Erkrankungen während der Schwangerschaft. VEB Thieme, Leipzig, S 193–201Google Scholar
  8. Boneu B, Bis G, Pelzer H et al. (1991) D-dimers, thrombin-antithrombin III complexes and prothrombin fragments 1+2: diagnostic value in clinically suspected deep vein thrombosis. Thromb Haemost 65: 28–32PubMedGoogle Scholar
  9. Brill-Edwards P, Ginsberg JS, Gent M et al. (2000) Safety of withholding heparin in pregnant women with a history of venous thromboembolism. N Engl J Med 343: 1439–1444PubMedCrossRefGoogle Scholar
  10. Chan WS, Anand S, Ginsberg JS (2000) Anticoagulation of pregnant women with mechanical heart valves: a systemic review of the literature. Arch Intern Med 160: 191–196PubMedCrossRefGoogle Scholar
  11. Dahlman TC (1993) Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin. Am J Obstst Gynecol 168: 1265–1270Google Scholar
  12. Department of Health (1989) Confidential enquiries into maternal deaths in England and Wales 1982–1984. HMSO, LondonGoogle Scholar
  13. De Swiet M, Floyd E, Letsky E (1987) Low risk of recurrent thromboembolism in pregnancy. Br J Hosp Med 38: 264PubMedGoogle Scholar
  14. Evans W, Laifer SA, McNanley TJ, Ruzycky A (1997) Management of throboembolic disease associated with pregnancy. J Matern Fetal Med 6: 21–27PubMedCrossRefGoogle Scholar
  15. Francis CS, Marder VJ (1991) Fibrinolytic therapy for venous thrombosis. Prog Cardiovasc Dis 34: 193–204PubMedCrossRefGoogle Scholar
  16. Ginsberg JS, Hirsh J (1989) Use of anticoagulants during pregnancy. Chest 95: 156–160Google Scholar
  17. Ginsberg JS, Hirsh J, Rainbow AJ, Coates G (1989 a) Risks to the fetus of radiological procedures used in the diagnosis of maternal venous thromboembolic desease. Thromb Haemost 61: 189–196PubMedGoogle Scholar
  18. Ginsberg JS, Hirsh J, Turner DC, Levine MN, Burrows R (1989 b) Risk to the fetus of anticoagulation therapy during pregnancy. Thromb Haemost 61: 197–203PubMedGoogle Scholar
  19. Goldhaber SZ, Buring JE, Lipnick RJ, Hennekens CK (1984) Pooled analysis of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. Am J Med 76: 393PubMedCrossRefGoogle Scholar
  20. Greer IA (1989) Thromboembolic problems in pregnancy. Fetal Med Rev 1: 79–103CrossRefGoogle Scholar
  21. Greer IA (1991) The problem and prophylaxis of thromboembolism in pregnancy. Curr Med Lit Thromb 1: 131–138Google Scholar
  22. Greer IA (1999) Thrombosis in pregnancy: maternal and fetal issues. Lancet 353: 1258–1265PubMedCrossRefGoogle Scholar
  23. Greer A, Thomson AJ (2001) Management of venous thromboembolism in pregnancy. Best Pract Res Clin Obstet Gynecol 15: 583–603CrossRefGoogle Scholar
  24. Greer IA, Ginsberg JS, Greer IA, Hirsh J (2001) Use of antithrombotic agents during pregnancy. Chest 119: 122–131CrossRefGoogle Scholar
  25. Greinacher A, Eckhardt T, Mumann J, Müller-Eckhardt C (1993) Pregnancy complicated by heparin associated thrombocytopenioa: Management by a prospectively in vitro selected heparinoid (Org 10172). Thromb Res 71: 123–126PubMedCrossRefGoogle Scholar
  26. Hall JG, Pauli RM, Wilson KM (1989) Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med 68: 122–140CrossRefGoogle Scholar
  27. Harenberg J, Leber G, Zimmermann R, Schmidt W (1987) Thromboembolieprophylaxe mit niedermolekularem Heparin in der Schwangerschaft. Geburtsh Frauenheilk 47: 15–18PubMedCrossRefGoogle Scholar
  28. Heilmann L, Rath W, von Tempelhoff GF, Harenberg J, Breddin HK, Riess H, Schramm W (2002) Niedermolekulare Heparine in der Schwangerschaft. Deutsch. Ärzteblatt 99: B342–B347Google Scholar
  29. Hellgren M, Blomback M (1981) Blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. Gynecol Obstet Invest 12: 141–154PubMedCrossRefGoogle Scholar
  30. Hellgren M, Svensson PJ, Dahlbäck B (1995) Resistance to activated protein C as a basis for venous thromboembolism associated with pregnancy and oral contraceptives. Am J Obstet Gynecol 172: 210–213CrossRefGoogle Scholar
  31. Hirsh J, Fuster V (1994) Guide to anticoagulant therapy. Part 1: Heparin. Circulation 89: 1449–1468PubMedCrossRefGoogle Scholar
  32. Holzgreve W, Carey JC, Hall BD (1976) Warfarin-induced fetal abnormalities. Lancet 2: 914–915PubMedCrossRefGoogle Scholar
  33. Hugo R von, Theiss W, Kuhn WG (1984) Thromboembolische Erkrankungen in der Geburtshilfe. Gynäkologe 17: 115–123Google Scholar
  34. Hull RD, Hirsh J, Sackett DL et al. (1981) Replacement of venography in suspected venous thrombosis by impedance plethysmography and 125J-Fibrinogen leg scanning: a less invasive approach. Ann Intern Med 94: 12–15PubMedGoogle Scholar
  35. Hull RD, Raskob GE, Coates G, Panju AA (1990) Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism. Chest 97: 23–26PubMedCrossRefGoogle Scholar
  36. Iturbe-Alessio I, del Carmen Fonseca M, Mutchinik O, Santos MA, Zajarias A, Salazar E (1986) Risk of anticoagulant therapy in pregnant women with artificial heart valves. N Eng J Med 315: 1390–1393CrossRefGoogle Scholar
  37. Kupfermine MJ, Eldor A, Steinman N et al. (1999) Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med 340: 8–13Google Scholar
  38. Lao TT, de Swiet M, Letsky E, Walters BNJ (1985) Prophylaxis of thromboembolism in pregnancy: an alternative. Br J Obstet Gynaecol 92: 202–206PubMedCrossRefGoogle Scholar
  39. LeCuru F, Desnos M, Taurelle R (1996) Anticoagulant therapy in pregnancy: report of 54 cases. Acta Obstet Gynecol Scand 75: 217–221PubMedCrossRefGoogle Scholar
  40. Lensing AWA, Prandoni P, Brandjes D et al. (1989) Detection of deep vein thrombosis by real-time B-mode ultrasonograpy. N Engl J Med 320: 342–345PubMedCrossRefGoogle Scholar
  41. Letzky EA, Swiet M (1994) Maternal hemostasis: coagulation problems of pregnancy. In: Loscalzo J, Schafer Al (eds) Thrombosis and hemorrhage. Blackwell, Oxford, pp 965–998Google Scholar
  42. Lichey J, Reschofski I, Dissmann T et al. (1991) Fibrin degradation product Ddimer in the diagnosis of pulmonary embolism. Klin Wochenschr 69: 522–526PubMedCrossRefGoogle Scholar
  43. Magnani HN (1993) Heparin-induced thrombocytopenia (HIT) An overview of 230 patients treated with Orgaran (Org 10172). Thromb Haemost 70: 554–561PubMedGoogle Scholar
  44. Mätzsch T, Bergqvist D, Hedner V et al. (1990) Effects of low molecular weight heparin and unfragmented heparin on induction of osteoporosis in rats. Thromb Haemost 63: 505–509PubMedGoogle Scholar
  45. Martinelli I, Taioli E, Cetin I et al. (2000) Mutations in coagulation factors in women with unexplained late fetal loss. N Engl J Med 343: 1015–1018PubMedCrossRefGoogle Scholar
  46. Mogensen K, Skibsted L, Wadt J (1989) Thrombectomy of acute iliofemoral venous thrombosis during pregnancy. Surg Gynecol Obstet 169: 50–54PubMedGoogle Scholar
  47. Oakley CM (1995) Anticoagulation and pregnancy. Eur Heart J 10: 1317–1319Google Scholar
  48. Pabinger I, Kyrle PA, Meistinger M, Eichinger S, Wittmann E, Lechner K (1994) The risk of thromboembolism in asymptomatic patients with protein C and protein S deficiency: a prospective cohort study. Thromb Haemost 71: 441–445PubMedGoogle Scholar
  49. Partsch H, Blättler W (1996) Leitlinien zurThromboembolie-Prophylaxe. Phlebol 25: 261–266Google Scholar
  50. Ruehm SG, Zimmy K, Debatin JF (2001) Direct contrast-enhanced 3D MR venography. Eur Radiol 11: 102–112PubMedCrossRefGoogle Scholar
  51. Sandier DA, Martin JF, Duncan JS et al. (1984) Diagnosis of deep vein thrombosis: comparison of clinical evaluation, ultrasound, plethysmograph and venoscan with X-ray venogram. Lancet 2: 716–719CrossRefGoogle Scholar
  52. Sbarouni E, Oakley CM (1994) Outcome of pregnancy in women with valve prostheses. Br Heart J 71: 196–201PubMedCrossRefGoogle Scholar
  53. Schindler JM, Kaiser M, Gerber A, Vuilliomenet A, Popovic A, Bertel O (1990) Colour coded duplex sonography in suspected deep vein thrombosis of the leg. BMJ 301: 1369–1370PubMedCrossRefGoogle Scholar
  54. Siegert G, Tiebel O, Justus B (1992) Veränderungen von Gerinnungs-und Fibrinolyseparametern während des Verlaufes der normalen Schwangerschaft. Klin Lab 38: 1136–1340Google Scholar
  55. Sipes SL, Weiner CP (1990) Venous thromboembolic disease in pregnancy. Semin Perinatol 14: 103–118PubMedGoogle Scholar
  56. Stein PD, Terrin ML, Hales CA et al. (1991) Clinical, laboratory, roengenographic, and electrocardiographic findings in patients with acute pulmonary em-bolism and no preexisting cardiac or pulmonary disease. Chest 100: 598–603PubMedCrossRefGoogle Scholar
  57. Stevenson RE, Burton M, Ferlauto GJ, Taylor HA (1989) Hazards of oral anticoagulants during pregnancy. JAMA 243: 1549–1551CrossRefGoogle Scholar
  58. Tengborn L, Bergqvist D, Matzsch T, Bergqvist A, Hednar V (1989) Recurrent thromboembolism in pregnancy and puerperium. Is there a need for thrombophrophylaxis?. Am J Obstet Gynecol 160: 90–95PubMedGoogle Scholar
  59. THRIFT: Thromboembolic Risk Factors Consensus Group (1992) Risk of and prophylaxis for venous thromboembolism in hospital patients. BMJ 305: 567–574CrossRefGoogle Scholar
  60. Toglia MR, Nolan TE (1996) Venous thromboembolism during pregnancy: a current review of diagnosis and management. Obstet Gynecol Surv 52: 60–72CrossRefGoogle Scholar
  61. Toglia MR, Weg JG (1996) Venous thromboembolism during pregnancy. N Engl J Med 335: 108–114PubMedCrossRefGoogle Scholar
  62. Warkentin TE, Levine N, Hirsh J et al. (1995) Heparin-induced thrombocytopenia in patients treatet with low molecular-weight heparin or unfractionated heparin. N Engl J Med 332: 1330–1335PubMedCrossRefGoogle Scholar
  63. Wersch JWJ van, Ubachs JMH (1991) Blood coagulation and fibrinolysis during normal pregnancy. Eur J Clin Chem Clin Biochem 29: 45–50PubMedGoogle Scholar
  64. Winkler UH (1997) Thromboembolierisiko, hormonelle Kontrazeption und Östrogensubstitution. Gynäkologe 30: 341–351CrossRefGoogle Scholar
  65. Winkler UH, Schindler AE (1996) Zur Prophylaxe und Behandlung derThrombose in der Schwangerschaft. Geburtsh Frauenheilk 56: 301–312PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • U.H. Winkler

There are no affiliations available

Personalised recommendations